Post on 14-Jan-2016
description
RADIATION MONITORING
STRATEGY IN EUROPE
Guy FRIJATORONTO, May 2013
Professor of Radiology and Consultant in Paris
Hôpital Européen Georges Pompidou Oncologic , Cardiovascular and Trauma center
FACTS
European regulatory background
European heterogeneity
Referral Guidelines : underuse
EUROPEAN REGULATORY BACKGROUND
Euratom Directive, 1997optimisation, DRLjustificationmaintenanceclinical audit
New BSS in preparation
EUROPEAN REGULATORY BACKGROUND
Into National Law
National Regulatory Body
HERCA
EUROPEAN HETEROGENEITY
DOSE DATAMED 2, 2013
Heterogeneity in :
Demographics, Equipments,
Practices
11
11
OECD-2012
COLLECTIVE DOSE
COLLECTIVE DOSE
UNSCEAR, 2008
World 1.9 mSv Australia 2.2 mSv USA 3.3 mSv
Europe, 2013 1.1 mSv
REFERRAL GUIDELINES
European survey by the ESR
Availability of RG (~ 70%)
Production: UK and France
Adopted and adaptated: others
EUROPEAN REFERRAL GUIDELINES
Evidence based
Almost 400 situations
Recommendations, textual format
“ In Belgium we have referral guidelines; in fact, nobody really takes them into account ”…
“ Referral guidelines for diagnostic imaging in general are not in use in Hungary ”…
“ They are not used in the Netherlands ”…
“ Although we have several official referral guidelines published (in Spain), they are not used generally speaking ”…
“ In Italy the referral guidelines were published in 2004 by the Ministry of Health. Unfortunately they are not always
followed in clinical practice ”…
“ There is no official guide line enforcement in the State service in Ireland ”…
“ In Germany, the guidelines are note routinely used ”…
“ In France, there are guidelines, but they are not used ”…
CHANGE IN PARADIGM
Producing Using
CHANGE IN PARADIGM
Using EBMProducing EBM
CDS
European Projects
ESR – CDS Project
ESR – ACR co-operation
ESR – HERCA co-operation
ESR – CDS PROJECT
Principle approved by the EC and by HERCA
RCR, SFR, ESR: common approach
NDSC and ACR experiences
ESR – CDS PROJECT
Initially limited to the top 10-20 clinical situations
Potentially extended to paediatric, cardiovascular and others…
ESR – ACR : Globalisation
MOU in 2013
Cross-relations in the professional field, including R.P. and CDS
Global Summitt
ESR – HERCA
Common understanding of the challenges
Shared strategies
Justification: CDS
Optimisation: CT
Public awareness
New solutions : WHY ?
Regulation only: failed
Fragmented approach
- by topics
- by stakeholders
Theories on behavioural changes
Total Quality Monitoring of RP
GPS Approach
Clinical audit
Public campaign
… and regulation !!!
Total Quality Monitoring
GlobalAll the stepsAll the stakeholders
PersonalisedPatient centricClinical setting
Safe Justification
OptimisationTechnological improvements
GPS
ALL THE STEPS GPS
Protocol
Examination
Report
Dose exposure
Scheduling
Risk factorJustification
Order
IT SUPPORT!!!!!
STAKEHOLDERSGPS
PERSONALISED GPS
Patient centric
Individual risk-benefit No dose threshold
Individual Risk-Benefit
GPS
OncologyOncology
ScreeningScreening
PredictionPrediction
PERSONALISED GPS
Dose recording management
Tailored
Clinically relevant
Tailored Dose recording
Courtesy of QuaelumCourtesy of Quaelum
TOTAL SAFETY MONITORING GPS
Avoid unnecessary tests
Record the Dose (CT)
Optimise the protocols
Track the perls
Optimise the equipments (CT)
DLPmax. = 994 mGy.cm
Wrong arm position
PERFORMANCE QUALITY CONTROL
Correct patient positioning Scout view Isocentre of the Gantry
Over scanning - Overlapping
CLINICAL AUDIT
Developing a model adapted to this global approach
Tool potentially useful
PUBLIC CAMPAIGN
Image Gently: behavioural changes
Paediatric campaign in Europe, with the ESPR
IMPORTANCE OF IT
CDS
Patient dataJustification
TraceabilityFollow-up
Dose recording
ComplianceDRL
AuditProfiling
CDS CPOE IT
STAKEHOLDERS
Medical board
Administrative staff
Radiographers
Radiologists
Medical physicists
IT department
SAFETY
Technological improvements
CT dose reduction
CT Dose Reduction
New softwares : iterative reconstruction Dose decrease up to 70-90 % !!!! Policy of Equipment upgrade Immediate Benefit !!!!!
New softwares : iterative reconstruction Dose decrease up to 70-90 % !!!! Policy of Equipment upgrade Immediate Benefit !!!!!
TAKE HOME
Holistic approach
Patient centric
Appropriate IT tools
Holistic approach
Patient centric
Appropriate IT tools
CONCLUSION
Beyond dose exposure
The best use of imaging
resources for the patients
and the society benefits
THANK YOU!!!!