Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at...
Transcript of Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at...
![Page 1: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/1.jpg)
Patient exposure Tracking: IAEA
Smart Card/SmartRadTrack project
Madan M Rehani, PhD International Atomic Energy Agency, Vienna, Austria
![Page 2: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/2.jpg)
What Was and What is Now
2006
• Why track examinations?
• What for?
• How is it going to be
useful?
• How to do it?
• What dose quantities?
• Is it possible, may be by
2030?
2012
• Who does not want it?
• It is possible
• It is done
• It is promising area
• How to extend coverage?
• How to include nuclear
medicine?
2
![Page 3: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/3.jpg)
3
![Page 4: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/4.jpg)
4
![Page 5: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/5.jpg)
5
Critics
• Not feasible
• Why? What are you going to use it for?
• It may implicate staff for having given
more radiation dose to patient.
![Page 6: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/6.jpg)
6
Situation before 2008
![Page 7: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/7.jpg)
7
![Page 8: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/8.jpg)
8
Looking back
• It was good that I did not pursue it aggressively
about 5 years ago
• Radiation units were not as matured
• PACS not talking to each other
• e-Health was in infancy
• Reports of few tens of or of ≥100 mSv doses to an
individual were not there
![Page 9: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/9.jpg)
NOW in 2011
9
![Page 10: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/10.jpg)
10
IAEA http://rpop.iaea.org
Project in part by Extra budgetary grant from U S Govt.
![Page 11: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/11.jpg)
11
![Page 12: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/12.jpg)
12
IAEA Bulletin May 2009
![Page 13: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/13.jpg)
13
![Page 14: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/14.jpg)
14
![Page 15: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/15.jpg)
15
![Page 16: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/16.jpg)
16
![Page 17: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/17.jpg)
17
![Page 18: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/18.jpg)
18
AAPM 2010
![Page 19: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/19.jpg)
19
![Page 20: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/20.jpg)
20
![Page 21: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/21.jpg)
21
![Page 22: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/22.jpg)
22
• 33%: > 5 CT exams • 5%: 22-132 exams
Number of CT Examinations
31,500 patients 190,712 CT examinations 22 year period
Sodickson et al.
Radiology 251; 175-184,
2009
![Page 23: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/23.jpg)
23
• 15%, ED > 100 mSv • 4%, 250 -1375 mSv •1% >399 mSv
Estimated Cumulative Dose
Sodickson et al.
Radiology 251; 175-184,
2009
![Page 24: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/24.jpg)
24
![Page 25: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/25.jpg)
25
![Page 26: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/26.jpg)
• De Mauri A, Brambilla M, Chiarinotti D,
Matheoud R, Carriero A, De Leo M. Estimated
radiation exposure from medical imaging in
hemodialysis patients. J Am Soc Nephrol. 2011
Mar;22(3):571-8.
• Cook SH, Fielding JR, Phillips JD.Repeat
abdominal computed tomography scans after
pediatric blunt abdominal trauma: missed
injuries, extra costs, and unnecessary radiation
exposure. J Pediatr Surg. 2010 Oct;45(10):2019-
24.
26
![Page 27: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/27.jpg)
• Stiles BM, Mirza F, Towe CW, Ho VP, Port JL,
Lee PC, Paul S, Yankelevitz DF, Altorki NK
Cumulative radiation dose from medical imaging
procedures in patients undergoing resection for
lung cancer. Ann Thorac Surg. 2011
Oct;92(4):1170-8;
27
![Page 28: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/28.jpg)
• Guite KM, Hinshaw JL, Ranallo FN, Lindstrom
MJ, Lee FT Jr.Ionizing radiation in abdominal
CT: unindicated multiphase scans are an
important source of medically unnecessary
exposure. J Am Coll Radiol. 2011
Nov;8(11):756-61.
28
![Page 29: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/29.jpg)
29
Joint position statement with
WHO/FDA/ ESR/ IOMP/ISRRT
![Page 30: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/30.jpg)
Nationwide PACS- Estonia (1.3m)
• CT, interventional, NM, radiography and
mammography (excl. dental) in PACS
• Government
• Teaching medical institutions
• Non-teaching Hospitals
• Private medical institutes:
• Private CT clinics:
30
![Page 31: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/31.jpg)
Courtesy E Gerrshkevitsh
31
![Page 32: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/32.jpg)
Courtesy E Gerrshkevitsh 32
![Page 33: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/33.jpg)
Courtesy E Gerrshkevitsh
33
![Page 34: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/34.jpg)
Similar Situation but at sub-national level
• Finland
• Denmark
• Malta
• ……..about a dozen countries
34
![Page 35: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/35.jpg)
76
█ IAEA Survey for Smart Card/SmartRadTrack Project
76 countries (All of the six most populous countries and 16 of the 20
most populous)
35
![Page 36: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/36.jpg)
36
![Page 37: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/37.jpg)
37
How useful do you think a radiation exposure tracking program
would be (assuming practicalities are attended to)?
Extremely
useful
28.9%
Very useful
60.5%
Moderately
useful
10.5%
Mildly useful
0.0% Not useful
0.0%
90%
Total=76 countries
![Page 38: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/38.jpg)
IAEA Survey in 76 countries
• Eight (11%) countries indicated that such a
program is actively being planned and
• 3 (4%) stated that they have a program for
tracking procedures only, but not for dose.
• 8 respondents from 8 different countries
(Belgium, Bulgaria, Iran, Italy, Lebanon, PR of
China, Slovakia and USA), stated that such a
program is actively being planned.
38
![Page 39: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/39.jpg)
IAEA Survey
• Which types of studies will be tracked?
• What radiation quantities will be tracked?
• Goals of the program: Justification,
Optimization, QA, policy development,
licensure/certification/regulation, decision
support for ordering examinations, risk
assessment, research and for population doses.
39
![Page 40: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/40.jpg)
New BSS Interim version Nov 2011
40
![Page 41: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/41.jpg)
41
![Page 42: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/42.jpg)
Definition-European BSS
Clinical responsibility: responsibility regarding
individual medical exposures attributed to a practitioner,
notably: justification; optimisation; clinical evaluation of
the outcome; cooperation with other specialists and the
staff, as appropriate, regarding practical aspects; obtaining
information, if appropriate, of previous examinations;
providing existing medical radiological information and/or
records to other practitioners and/or referrer, as required;
giving information on the risk of ionising radiation to
patients and other individuals involved, as appropriate.
42
![Page 43: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/43.jpg)
Misconceptions
• Radiation doses on a card with patient
• Card like ATM card or Credit Card
• Acts as digital signature to access information
online
43
![Page 44: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/44.jpg)
44
IAEA http://rpop.iaea.org
Project in part by Extra budgetary grant from U S Govt.
![Page 45: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/45.jpg)
45
Lancet Sept.2010
Rehani & Frush. The Lancet 376 (9743); 754-755
![Page 46: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/46.jpg)
46
![Page 47: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/47.jpg)
47
![Page 48: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/48.jpg)
48
![Page 49: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/49.jpg)
36 Countries who responded to IAEA survey
Algeria, Argentina, Armenia, Bosnia and
Herzegovina, Bulgaria, Colombia, Costa Rica,
Czech Republic, Egypt, Estonia, Finland, Greece,
Honduras, Hong Kong (China), Ireland, Ireland,
Kenya, Lithuania, Malaysia, Macedonia, Malta,
Mexico, Moldova, Montenegro, Portugal,
Nicaragua, Romania, Russian Federation, Serbia,
Singapore, Slovakia, Slovenia, Spain, Sri Lanka,
Sudan, Tajikistan, Tanzania, Uruguay
49
![Page 50: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/50.jpg)
50
Is there a unique permanent identification number for every
person in the country valid for life?
YES 81%
NO 19%
Total=36
![Page 51: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/51.jpg)
51
Is this permanent number used for X ray examinations whenever
a person visits a hospital?
YES 44%
NO 56%
Total=36
![Page 52: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/52.jpg)
52
If this number is NOT used, it is because of :
Lack of technology
92%
Confidentiality issue of
patient 8%
Percentages out of 20 answers!!
![Page 53: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/53.jpg)
53
Most basic: paper card
Like Vaccination card
Merits:
• Helps tracking of individual exposure history
• Can serve a great deal of purpose
• Is very good so long as it is maintained and used
Demerits:
• Record is only with patient, not with health care system
• Is highly dependent upon patient and health care provider
![Page 54: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/54.jpg)
54
IAEA X-ray record card
Actions on Patient ID
Actions on data collection on repeated examination
![Page 55: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/55.jpg)
55
![Page 56: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/56.jpg)
56
Unique Card Number
• World Population 6.7 billion
• Credit Cards have already 16 digits. That can
cover all people in world
• BUT health system unfortunately has not been as
sexy to global service providers as financial
![Page 57: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/57.jpg)
Issues nearly Resolved
• Use of reference dose quantities (e.g. DLP &
CTDI in CT; KAP & CAK in fluoroscopy …)
• CT & fluoroscopy have dose displays &
records
• DICOM- communication of images
• IHE- Structured dose reports, REM
communication of dose
57
![Page 58: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/58.jpg)
Nuclear Medicine
The Need for an Integrated Approach to Tracking
Radiation Exposure: Challenges with Nuclear
Medicine
M Mercuri, M Rehani, A Einstein
Paper under Communication
58
![Page 59: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/59.jpg)
Practicability issues largely unresulved
• Use of patient identifiers
• Off line studies
• Nuclear Medicine
59
![Page 60: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/60.jpg)
60
MoU US & Europe for health care data exchange
![Page 61: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/61.jpg)
61
![Page 62: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/62.jpg)
Recommendations from Meeting of the
IAEA
Smart Card/SmartRadTrack Project 25-27 January, 2010
62
https://rpop.iaea.org/RPOP/RPoP/Content/Documents/Whitepape
rs/recommendations-smartradtrack.pdf
• Action for manufacturers
• Government
• Appropriate groups, professional societies
and organizations, and regulatory bodies
![Page 63: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/63.jpg)
63
![Page 64: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/64.jpg)
64
Referring physicians
Country Resp.
Czech
Republic 175 28.14%
Finland 90 14.47%
India 51 8.20%
Pakistan 43 6.91%
Croatia 37 5.95%
FYR
Macedonia 34 5.47%
Brazil 26 4.18%
Indonesia 24 3.86%
Philippines 21 3.38%
Country Resp.
Iran 16 2.57%
Kazakhstan 15 2.41%
Hungary 14 2.25%
Malaysia 14 2.25%
Lebanon 12 1.93%
USA 12 1.93%
Sri Lanka 11 1.77%
P.R. China 5 0.80%
Republic of
Moldova 4 0.64%
Slovenia 4 0.64%
Country Resp.
Cyprus 3 0.48%
Armenia 2 0.32%
Georgia 2 0.32%
Lithuania 2 0.32%
Australia 1 0.16%
Bulgaria 1 0.16%
Ireland 1 0.16%
Spain 1 0.16%
UK 1 0.16%
622 physicians from 28 countries
![Page 65: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/65.jpg)
65
How often in your clinical practice do you think knowing history of
previous CT scans will help in making a better decision?
Always 23.0%
Mostly 49.0%
Occasionally 21.1%
Rarely 6.9%
![Page 66: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/66.jpg)
66
Do you think having a system by which you have quick information
about patients dose history will be helpful?
Yes 60.6%
Maybe 31.4%
Not really 7.9%
No answer 0.2%
![Page 67: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/67.jpg)
We are in a situation where turning back
is Not possible
67
![Page 68: Patient exposure Tracking: IAEA Smart Card/SmartRadTrack …€¦ · Similar Situation but at sub-national level ... Singapore, Slovakia, Slovenia, Spain, Sri Lanka, Sudan, Tajikistan,](https://reader034.fdocuments.us/reader034/viewer/2022042310/5ed870e97e56c56f112eb6ee/html5/thumbnails/68.jpg)
Recap
• 2006 vs 2012
• Current momentum, series of studies
• IAEA survey: 76 countries-status & interest
• IAEA & EU requirements
• Patient identifier
• Issues nearly resolved & unresolved
• Referring physician’s survey: IAEA
68