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!!!!