FPS PUBLIC
HEALTH,HEALTH,
FOOD CHAIN
FOODSAFETY
CHAIN SAFETY
AND ENVIRONMENT
AND ENVIRONMENT
Medical Imaging
Federal initiative
Dr Aldo Perissino (internal medicine and public health)
FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT
Organisers
 Federal Public Health Service
 National Insurance Institute
 Federal Agency Nuclear Control
FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT
Imaging techniques
Radiology
Conventional radiology
CT scan
Interventional radiology
Nuclear medicine
Mixed Modality (CT + PET,…)
FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT
Position of the problem
 Widespread access
 Appropriateness of chosen examinations
The exposure to ionising radiations grew drastically these
last years.
 Belgium is among the greatest “irradiating
countries”
 1 person in 5 has a CT each year
 Every person in Belgium has one X-ray examination each
year (2008)
Positioning the problem
Mean exposure to medical irradiation in various countries
X 1,5
X4
Source: UNSCEAR rapport 2008
FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT
Target
Framework: a set of initiatives aiming at the
optimisation of the use of medical imaging
Workgroups:
 Accreditation and optimisation
 Guidelines
 Awareness campaign
 Inform
 Raise awareness
FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT
Campaign: target groups
The population
Indirect impact on prescribers and professionals
The prescribers
The performers
FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT
Target group:
Population and patients
 Inform on the opportunity of medical
imaging
 Call upon awareness and stimulate it:
 An examination must have an indication
 When indicated, an examination has to be
performed
FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT
Target group: Prescribers
 Family practitioners and specialists
 Better choice of examinations:
 guidelines and “folia”
 Improve communication with patients:
 indirect effect of the campaign
FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT
Target group: Performers
 Radiologists, Technicians, Nurses:
 accreditation and optimisation
 directives
 Performers = gatekeeper
 Better communication between
performers and prescribers:
 Indirect effect of the campaign and the spreading of
information
FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT
Target group: Performers
Interventional procedures:
awareness of impact and doses
delivered
Dosimetry
FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT
Key points
 Justification: every procedure must be
indicated
Provided that the indication is correct,
irradiation is a secondary matter, on behalf of
what follows:
 Optimisation: limit irradiation strictly to the
need (ALARA)
If a non-irradiating technique of equal value is
available, it should be preferred
FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT
Key points
 Protect frail groups:
 pregnancy
 children
FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT
Campaign themes
 Quality !
 Awareness
 Reduction of unnecessary exposure
 No compulsion
FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT
Radiation protection of patient in fluoroscopy
Radiation protection of
protection
staff
in fluoroscopy
of staff
in fluoroscopy
http://rpop.iaea.org
FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT
Radiation protection of patient in fluoroscopy
1. Maximise distance between patient and tube to the extent possible
2. Minimise distance between patient and image receptor
3. Minimise fluoroscopy time
4. Use pulsed fluoroscopy with the lowest frame rate possible to obtain images
of acceptable quality
5. Avoid exposing the same area of the skin in different
projections
6. Larger patients or thicker body parts trigger an increase in entrance surface
dose (ESD)
7. Oblique projections also increase ESD
8. Avoid the use of magnification
9. Minimize number of frames and cine runs to clinically acceptable level
10. Use collimation
FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT
Radiation protection of staff in fluoroscopy
http://www-ns.iaea.org/tech-areas/communication-networks/norp/isemir-web.htm
FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT
Radiation protection of staff in fluoroscopy
1.
2.
3.
4.
5.
Use protective devices
Make good use of time-distance-shielding (TDS) principle
Use ceiling suspended screens, lateral shields and table curtains
Keep hands outside the primary beam unless totally unavoidable
Only 1% - 5% of radiation falling on the patient’s body exits the
other side
6. Keep X ray tube under the patient table and not over it
7. Use personal dosimetry - Use at least two dosimeters
8. Update your knowledge about radiation protection
9. Address your concerns about radiation protection to radiation
protection specialists
10. REMEMBER! Quality – Equipment - Injectors
FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT
Conclusion
 Reduce (suppress?) useless examinations
 Part of a broader action plan
 Awareness
 Communication
 Patient empowerment
FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT
Thanks for listening !