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ISRQSA Newsletter´s new format

ISRQSA Newsletter has a slightly new format, although the focus and aim are unchanged. Readers can now access the "Table of Contents" in two ways and view an article by clicking its title.
  1. A single page PDF "Table of Contents" as previously used. You can preview, download and save this PDF file to your mobile device from here. This format provides a list of all the topics, connects you to the articles and enables you to return to this list when convenient.
  2. In an ISR web page. An article is either displayed in full text or accessed by the embedded links to external web pages.
We hope you would find this material informative and useful.

Kindly forward the ISRQSA newsletter to colleagues with interest in RQS and direct distribution or contribution queries to LSLAU@bigpond.net.au.

Lawrence Lau, FACR, FAMS, FRANZCR, FRCR
Editor, ISRQSA News



TABLE OF CONTENTS


Quality Practice and Tools

Quality and Safety News

Message from the Editor

THE NEXT FRONTIER

Value-based Radiology (VR) is gathering momentum and support. One way to describe value is quality patient-centred care on the one hand and the cost to deliver this on the other. Quality care includes radiation safety. VR enables prompt diagnosis, early and appropriate intervention; and reduces misdiagnosis and error, hospital admission, and downstream cost, e.g. pharmaceuticals. Quality care in radiology consists of many elements, e.g. access, people-centredness, appropriateness, safety, etc. The WHO recently launched a Framework for Integrated People-Centred Health Services and succinctly explained this concept in a video entitled “What is people-centred care?”

In the last decade, the collaborative efforts to improve radiological quality and safety gathered pace. Leadership and teamwork from professional societies, international organisations, and UN agencies have led to a significant improvement in awareness and advocacy and a strengthening of system-based radiation safety policy and infrastructure. Some examples include the International Action Plans, Basic Safety Standards, Bonn Call-for-Actions, and the formation of interdisciplinary international, regional, and national radiation safety campaigns. These campaigns put radiological quality and safety issues on the main agenda of radiological societies. You will find updates from some of these campaigns in this edition.

Education and training are the most commonly used strategies to improve radiation safety. Prof. Garcia Monaco drew our attention to the increasing use of e-learning and virtual education to extend the reach to professionals in the different regions. The stakeholders are identifying meaningful indicators to assess the outcome of these improvement efforts. Levers are proposed to encourage more appropriate use of procedures. There are links to these topics in the list of contents.

While the steady progress in radiation safety at a system-level is encouraging, more work is desirable in radiology facilities. It is the use of the recommendations and guidance tools in daily practice that will lead to better patient care and outcome. A practitioner cannot do this alone! Facility-based leadership, cultural change, and combined teamwork from management, radiologists, radiographers, medical physicists, etc. are needed. Radiology facilities need guidance to implement these improvement actions. Prof. Husseiny reported on her team’s innovative actions to implement Clinical Referral Guidelines in Egypt and her region. This and other improvement opportunities will be explored in the forthcoming International Conference on Radiation Protection in Medicine: Achieving Change in Practice. The experts will review the progress since the Bonn Conference, examine the developments, and identify the priorities relating to radiation safety. The International Society of Radiology is proud to be a cooperating organisation.

The 2014 Newsletter editorial focused on “Promote awareness, share experience, encourage participation and facilitate improvement.” Organisations could advocate and facilitate knowledge sharing, ultimately the use of guidance tools by the practitioners is essential to deliver more appropriate and safer use of radiology procedures. More collaborations are necessary to integrate the recommendations and guidance tools into the daily workflow.

Improvement in radiological quality and safety is an on-going journey!

Kindly forward the newsletter to colleagues with interest in RQS and direct distribution or contribution queries to LSLAU@bigpond.net.au.

Lawrence Lau, FACR, FAMS, FRANZCR, FRCR
Editor, ISRQSA News
Advisor to the ISR President



Message from the International Society of Radiology (ISR) President

I am pleased to contribute to this new issue of the ISRQSA newsletter nicely edited by Dr. Lawrence Lau, this time presented in the new ISR Newsletter format.

The ISR has formed a Communication Committee chaired by Prof. Jose Del Cura from Spain. Social media such as Facebook, Twitter, etc. will be used in addition to Newsletters and Web pages to strengthen communication with ISR members and other stakeholders. The “ISR Newsletter" will include different sections by incorporating the established bi-annual ISRQSA News, and GO RAD, etc. ISQRSA News will stay as the newsletter focusing on radiological and safety issues.

It is my great pleasure to announce an innovative project on virtual education related to Radiation Protection Training for the General Practitioner that will be released during the third quarter of 2017. This educational initiative joins the efforts of both the ISRQSA and Virtual Education Subcommittees.

The driving force behind this endeavour is lead by Prof. Donald Frush and a selected group of renowned speakers in cooperation with IAEA. I take this opportunity to thank their efforts and dedication to fulfil this project. The program shown below covers different aspects of quality, safety, and communication relating to medical imaging, especially in paediatrics.

The ISR Webmaster and specialists in pedagogy using modern communication and learning tools didactically organised the educational content in a novel format. Multimedia graphics for better comprehension and an interesting role-play method with self-assessment nicely reflects proper or wrong physician-patient communication on radiation risks. An ambitious interactive audiovisual format for self-review and reflection is included to facilitate inclusion of acquired concepts in clinical practice.

Likewise to every Virtual ISR activities free and open access is warranted worldwide, especially interesting for public and professionals in developing countries.

With this novel educational initiative, ISR rejoins its pioneering path started a decade ago with the First Virtual Congress of Radiology, which was followed by several other till 2013. Taking into account that the global e-learning market has grown by 900% in the last 15 years and with the projection that 50% of classes will be provided this way in 2019, a realignment of ISR virtual education is expected.

In this context, this flexible, effective and technologically-based model of education will undoubtedly contribute to better worldwide promotion and diffusion of radiation protection training and communication skills with the resultant benefits for patients and health care.

I am looking forward to all readers to join this educational project devoted to Radiation Protection Training for the General Practitioner that together with many other announcements that are included in this newsletter will contribute to improving patient care.

Professor Ricardo Garcia Monaco
President, International Society of Radiology





WHO Framework for Integrated People-Centred Health Services



People-centred Care

The WHO just launched a Framework for Integrated People-Centred Health Services. Globally, 1 in 20 people still lacks access to essential health services that could be delivered at a primary care clinic instead of a hospital. Where services are accessible, they can be fragmented and of poor quality. WHO is supporting countries to progress towards universal health coverage by designing health services for people instead of diseases and health institutions, so that everyone gets the right care, at the right time, in the right place.

The concept is explained in a video “What is people-centred care?” recently released by the WHO website. The video is a useful advocacy and communication tool and is used to advocate for appropriate use of radiation in health care.

Although the verbal messages do not explicitly mention “radiation” or “radiology,” radiation/radiology feature several times in the images. Radiology is used as an example of the unnecessary use of tests.

You are encouraged to use/share this video as it can help to integrate our messages about the safe and appropriate use of radiation in health care (and in particular the justification of radiological procedures) into the broader concept of integrated people-centred health services.

The video calls for progress towards universal health coverage by designing health services for people instead of diseases and health institutions, so that everyone gets the right care, at the right time, in the right place.

This message is entirely consistent with what we are promoting through the Bonn Call-for-Action and the new BSS requirements for medical exposures.

Contribution from Dr. Maria del Rosario Perez, World Health Organisation.



New IAEA Online Resources for Medical Professionals

The International Atomic Energy Agency (IAEA) has launched new elearning courses and free webinars aimed to provide continuing education to medical professionals.

Two free e-learning courses have been launched in 2016, and since then, more than 2,100 users registered and 351 certificates completed. Each course is organised in modules, with estimated total duration of five hours.

E-learning course on Radiation Dose Management in Computed Tomography is designed to help learning the appropriate use of CT, understand the various CT techniques and scan parameters, understand CT dose metrics and dose tracking methods, address the needs of creating various CT protocols for different body regions and clinical questions, learn how to optimise exposure to children and pregnant patients.

E-learning course on Safety and Quality in Radiotherapy is designed to help radiotherapy professionals to improve their understanding of safety in radiotherapy, learn techniques to reduce and avoid incidents in radiotherapy, understand the value and use of incident learning systems, learn about useful sources of information to enhance safety in radiotherapy, and gain insights into improving safety culture in medical facilities.

Free Webinars on topics from Radiation Protection in Medicine have been launched in early 2016, and since then, eleven online webinars broadcasted and attended by 2425 participants. Five of them have been organised jointly with Image Gently. The recorded past webinars are available in archive through RPOP website.




Contribution from Dr. Jenia Vassileva, Radiation Protection of Patients Unit, International Atomic Energy Agency patient.protection@iaea.org



With Heads, Hands and Hearts



Heads, hands, and hearts are the fundamental attributes of those working with the Image Gently Alliance. Success takes a combination of both thinking and doing (heads and hands) but is most compelling when the element of conviction (really, passion: heart) is included. These attributes or no less evident in the Alliance’s most recent campaign, aptly named “Have-A-Heart”.

This campaign was headed by Kevin Hill, MD, MS From Duke Children's Hospital and Andrew Einstein, MD, PhD from Columbia University Medical Centre. The campaign committee was comprised of paediatric cardiologists, including cardiac interventionalists, adult cardiologists, radiologists with cardiac imaging expertise, technologists, and medical physicists exemplary of the multi-stakeholder value of Alliance efforts, including campaigns.

In addition to the material on the Alliance’s website, a position statement on informed use of modalities that use ionising radiation in the Journal of the American College of Cardiology Cardiovascular Imaging was coincident with the campaign release. This project was the effort of multiple specialties, and represents a consensus agreement by 13 organisations. This article ”Radiation Safety in Children with Congenital and Acquired Heart Disease: A Scientific Position Statement on Multimodality Dose Optimisation from the Image Gently Alliance” is available at no charge, sponsored by the Image Gently Alliance.

The Have-A-Heart Campaign was an important collaboration between specialties that use ionising radiation in the care of children with congenital and acquired cardiovascular disorders and is a testimonial to shared thinking, doing, and passion: heads, hands and heart.

Contribution from Donald Frush, MD; Chair, Image Gently Alliance.

Have-A-Heart Campaign Participants

Image Gently Alliance Member Organisations, including:

American Association of Physicists in Medicine (AAPM)
American College of Radiology (ACR)
American Society of Radiologic Technologists (ASRT)
Society for Paediatric Radiology (SPR)

Additional Participating Societies:
American Academy of Paediatrics (AAP)
American College of Cardiology (ACC)
American Society of Nuclear Cardiology (ASNC)
Heart Rhythm Society (HRS)
North American Society for Cardiovascular Imaging (NASCI)
Paediatric and Congenital Electrophysiology Society (PACES)
Society for Cardiovascular Angiography and Interventions (SCAI)
Society of Cardiovascular Computed Tomography (SCCT)
Society of Nuclear Medicine and Molecular Imaging (SNMMI)

Further reading
Campaign launch Press Release: Medical Groups Join Forces to Improve Cardiac Imaging Use in Children “Have-A-Heart Campaign” to Empower More Informed Patient-Provider Imaging Communications



Using Social Media to Image Wisely®

Social media has become one of the most effective ways to communicate the importance of radiation safety.

During 2017, members of the Image Wisely Executive Committee have started delivering regular news and related resources to radiologists, medical physicists, radiologic technologists, other imaging practitioners and patients on Facebook and Twitter accounts.

Promote Key Messages

Our leaders are encouraging colleagues to like, share and retweet essential messages about the importance of radiation safety and pledging annually to Image Wisely. These messages link our followers to comprehensive information on the initiative’s website.

Committee members recently crafted new material to address concerns about exposure to ionising radiation from medical imaging and treatment, by focusing on



Extend Reach

Image Wisely’s reach continues to grow, with nearly 2,500 Facebook and 1,800 Twitter followers.

On Twitter, Image Wisely’s messages get amplified through retweeting to the American College of Radiology (ACR) 27,000 and Radiological Society of North America (RSNA) 30,000 followers.

We hope that our sister organisations will spread the word. You’ll find cases, pledge announcements, electronic educational exhibits, important dates and other related news to share.

Follow Image Wisely on Facebook, Twitter

With your help, we can extend Image Wisely’s reach. Please consider following our Facebook and/or Twitter accounts. Together, we can increase awareness, increase the number of pledges, share content, foster engagement and drive individuals to our website.

Don’t know how to use Facebook or Twitter? Social media is a tool. See how others use it first — and then find out what feels right for you. There are no hard rules. Experiment with it: Use it a little or a lot. Use the Facebook and/or Twitter app on your smartphone while you’re waiting in a line or at other downtimes or during a professional conference. You can find “how-tos” on the ACR and RSNA websites. If you’re interested in contributing content to the Image Wisely website, please contact Elliot Fishman at efishman@jhmi.edu.

Thank You

Specific thanks go to members of the Image Wisely Executive Committee who are helping to grow out ongoing social media efforts.

The Image Wisely® initiative is a collaborative effort of the American College of Radiology (ACR), the Radiological Society of North America (RSNA), the American Association of Physicists in Medicine (AAPM) and the American Society of Radiologic Technologists (ASRT). Image Wisely’s primary goals are raising awareness and providing information and educational material about the use of ionising radiation in medical imaging. The chief mechanism for distributing this information is a dedicated website, which provides resources and information for imaging professionals. In addition, related information may also be found on its Facebook and Twitter accounts.

Contribution from Elliot K. Fishman, MD, FACR, Image Wisely Executive Committee Vice Co-Chair, and William W. Mayo-Smith, MD, FACR, Image Wisely Executive Committee Co-Chair



17th French-Tunisian (AFTR) Congress of Radiology & 4th Congress of the African Society of Radiology (ASR): Report on “AFROSAFE Session”

The 17th French-Tunisian (AFTR) Congress of Radiology and the 4th Congress of The African Society of Radiology (ASR) was held in Royal Hotel Hammmet from March 31st to April 2nd. A large part of the program was dedicated to safety in radiology and radiation protection in order to adopt the establishment of Francophone arm of AFROSAFE which was launched in October 2016 at the French Radiological Congress in Paris.

The organisers of this session include member s from the AFROSAFE (Francophone) steering committee, representatives of Francophone African national and regional Societies of radiology (SRANF), Maghreb, Algeria, Tunisia, Morocco, Senegal, Cameroon, Cote d’Ivoire, Burkina Faso, Congo), as well as industr y representatives who had attended the Paris meeting.

Key personalities were invited to this session in Tunisia. These include:

The Session took place on Saturday 1st April 2017 and the afternoon was divided into three sessions followed by discussion and conclusions. It was chaired by Prof. Azza Hammou and Prof. Sudhir Vinayak. We had round table discussions about radiation protection campaigns presented by regional organisations, challenges and identified opportunities, IAEA and WHO points of view, continuation of policy decisions and strategic implementation.

This was then followed by a plenary session where all registered persons were invited. The plenary speech was given by Prof. Guy Frija and the topic was “European perspectives in Radiation Protection”.

It had been suggested by our experts from IAEA and WHO to integrate radiation protection talks within the rest of the general radiology program. This was incorporated and there was an excellent response since many registrants attended and showed interest.

The AFROSAFE session was very successful as it allowed participants to share and discuss national, regional and global experiences in identifying common problems and propose relevant solutions. Many objectives were identified and discussed; amongst them were these important issues: In summary, we can conclude that the Francophone arm of AFROSAFE, namely “AFROSAFE F” is an important and promising project. It will enrich radiation protection within imaging practice of Africa. Establishment of a strategic action plan and its implementation tools are still to be finalised. Heterogeneity and gaps have to be identified and objectives updated according to new concepts of justification and optimisation tools, but the steering committee is determined to succeed.

Contribution from Profs. Azza Hammou and Sudhir Vinayak.



ArabSafe - An Initiative to Adhere to the Bonn Call-for-Action in the Arab World

ArabSafe was launched during the Arab Health Congress in Dubai, United Arab Emirates (UAE) early 2017 with the support of local authorities, international societies, and professionals in the field of radiation protection to adhere to the Bonn Call-for-Action in the Arab World. Soon after that, several meetings took place in Saudi Arabia, UAE, Qatar, and Morocco with international societies and organisations to establish campaign action plan and identify the ArabSafe Steering Committee.

Background

Across the world, a rallying appeal for health professionals to implement the principles of radiation protection and radiation safety is still enduring. There is an apparent effect from campaigns like Image Gently, Image Wisely, EuroSafe Imaging, Canada Safe Imaging, and many more throughout the world that highlight the importance of the joint statement of position of the IAEA and WHO known as Bonn Call-for-Action, the result of an International Conference on Radiation Protection in Medicine in December 2012.

Almost five years later, ArabSafe was initiated to adhere to the Bonn Callfor-Action by implementing the ten actions to promote and encourage compliance with standards, policies, strategies and activities that create a radiation safety culture in the Arab World.

Official Formation

During the 9th Pan Arab Radiology Conference held in Marrakesh, ArabSafe was officially inaugurated on 5th May, 2017 with the support of the Pan Arab Association of Radiological Societies (PAARS), EuroSafe Imaging, International Society of Radiology (ISR) and Image Gently Alliance.

This initiative aims to impact the current diagnostic imaging practice, support self-regulation, increase awareness of radiation safety of patients, workers, and the general public, and promote a radiation safe culture.

Each Arabic country will foresee the implementation of the campaign, depending on its capabilities and situation, by promoting the Bonn Call-for-Action to their local authorities, governing bodies, scientific societies, and professionals.

A logo has been considered for the campaign. In addition, an official website has been designed and is currently in use and will be available in Arabic, English and French once it's fully developed.

ArabSafe’s Aims

Current Activities

The ArabSafe Steering Committee Contribution from Associate Professor Sarah K. Hagi, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.



Radiological Quality and Safety Activities from China

The Quality and Safety Subcommittee of Chinese Society of Radiology held its 2017 Annual Meeting in Nanjing, Jiangsu from June 2 to 4, 2017. Amongst others, the following is an outline of the four hot topics discussed.

1. Radiological Technique Optimisation

Radiological quality and safety experts in China have published consensus recommendations for digital radiography and CT scanning to guide best practice in image quality and diagnostic data optimisation, and patient safety. Studies have shown that normalisation and regular quality control actions in digital mammography significantly improve procedure quality and diagnostic accuracy.

2. Radiation Protection of Patients

The Chinese experts have conducted studies and published reports on radiation protection in paediatric radiology.

3. Radiology Infrastructure Modernisation

At present, the vast majority of hospitals in China use a combined manual and electronic system for the storage of medical records. It will take some time before system-wide implementation of a paperless, fullyintegrated, and user-friendly electronic medical record (EMR) system.
Before the introduction of EMR, it is worth considering the: (1) adoption of a staged implementation; (2) provision of secure and controlled data access; and (3) identification of an appropriate EMR system for a particular setting.

With the modernisation of radiology infrastructure underway, many departments in large and medium-sized hospitals in China consider the transition to a digital environment as one of their missions and priorities. Many of these hospitals have already implemented digital information systems. An integration of a Picture Archiving and Communication System (PACS), Radiology Information System (RIS) and Hospital Information System (HIS) provides a common platform towards seamless workflow, patient data storage, and retrieval. China has become the world's largest Internet-using nation since 2002. This infrastructure and IT experience offer opportunities and facilitate improvements in radiological quality and safety.

4. Quality Radiology Practice

Many factors influence the quality of data interpretation, radiology reporting, and radiological diagnosis, e.g. workload (i.e. volume and complexity), workforce (i.e. capacity, capability, competency, expertise, experience, attitude, and moral, etc.), image quality, network status, etc. It is important to strike a balance between the demand for timely reporting and the quality and accuracy of interpretation. Examples of opportunities to improve turn-around-time and accuracy of interpretation include team collaboration, knowledge sharing, human-machine interface enhancement and continuing education and training, etc.

Contribution from

Liang Wang (王良), Department of Radiology, Tongji Hospital,Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China wang6@tjh.tjmu.edu.cn
Wenzhen Zhu (朱⽂珍), Department of Radiology, Tongji Hospital,Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
Guangming Lu (卢光明), Department of Radiology, Nanjing Jinling Hospital, Medical College of Nanjing University, Nanjing, China
Shiyuan Liu (刘⼠远), Department of Radiology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
Zhengyu Jing (⾦征宇), Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China



Proactive Leading Steps to Implement Clinical Imaging Guidelines in Egypt



The medicine of the ancient Egyptians is considered the oldest documented evidence in Edwin Smith papyri. It was highly advanced for that time and included simple non-invasive surgery, emergency and injury treatment, setting of bones, dentistry, and a comprehensive set of pharmacopoeia. The earliest recorded physician in the world was the Egyptian Pharos Hesy-Ra, who practiced medicine in ancient Egypt and was the "Chief of Dentists and Physicians" to King Djoser, who ruled in the 27th century BC.

Meanwhile, Egypt is now taking the lead in the implementation of Clinical Imaging Guidelines (CIG) in the African and Arab regions, to justify radiological examinations and improve radiology practice through the appropriate use of CIG.

This process is run by a volunteer team of Egyptian expert radiologists from several Egyptian universities led by Dr. Dina Husseiny via two approaches.

1st Approach: Education

A novel approach has been established in Egypt to ensure concrete CIG implementation, which is different from other countries who focused only on training. Education carves knowledge in the mind of health professionals. "Education proved successful with medical classifications, like TNM and other clinical guidelines,” Dr. Dina Husseiny added.

Accordingly, CIG has been integrated, for the first time, in undergraduate and postgraduate medical and radiographer’s education curriculum. Ten Egyptian medical universities adopted our curriculum design. "We did not find an available curriculum to adopt, so we decided to design one of our own that would be suitable for our educational system.”

2nd Approach: Spreading CIG via successive national, regional and international events

a) An “IAEA Experts and Champions Meeting on CIG” was held in Cairo in February 2017; with the participation of IAEA, WHO, Royal College of Radiologists, Deans of Egyptian Universities, Presidents of Medical Societies, and African Experts to discuss the implementation of CIG in Africa.

b) Three workshops on CIG were held in March and April 2017, at Ain Shams University (ASU), Armed Forces College of Medicine (AFCM) and Misr University for Science and Technology (MUST) for health practitioners and medical students.

c) The Egyptian Society of Radiology and Nuclear Medicine and the Egyptian Atomic Energy Authority in their joint activities and conferences decided to make CIG a fixed session in all their future events to ensure sustainability. There is current cooperation with EuroSafe Imaging (Prof. Guy Frija, Chairman) and RCR experts (Dr. Joanna Brown and Dr. Denis Remedios) in this regard.

d) Being the country with the highest IAEA regional performance indicators in radiation protection in Medicine, Egypt supported the African Society of Radiology meeting in Tunisia April 2017 and the Pan Arab Association of Radiological Societies PAARS meeting in Marrakesh in May 2017, to introduce models and value of CIG to the region as an IAEA expert. This is in cooperation with the African Society of Radiology, EuroSafe Imaging, WHO, and AFROSAFE. Egypt is also a founding member of the newly launched ArabSafe campaign that will support radiation safety in the Arab regions. Egypt will host the next Pan Arab Association of Radiological Societies PAARS conference in 2018, and being the moderator of the radiation protection sessions in this meeting, Dr. Dina Husseiny confirms that CIG will largely and effectively take place in the coming PAARS.

e) Egypt is currently cooperating with six countries in Africa to implement CIG in the region in an IAEA project.

Contribution from Prof. Dina Husseiny Salama, Head of the Radiology Department, Egyptian Atomic Energy Authority, Chairman of the Radiation Protection Committee, Director of Radiation Protection Division at Egyptian Society of Radiology and Nuclear Medicine, National Counterpart and International Expert for IAEA and WHO.



Challenges and Possible Solutions Concerning Interventional Radiology Procedure Justification, Optimisation, and Adverse Event Minimisation in Nigeria

Life without challenge is not worth living; our ability to resolve the challenges is what makes the world interesting and exciting. It’s all about Interventional Radiology (IR) and radiation protection in Nigeria.

Interventional radiology is a subspecialty of radiology that employs the use of minimally invasive and targeted disease treatment options under imaging guidance. It is less invasive than surgery, often done on an outpatient basis, does not usually require general anaesthesia, has reduced morbidity and mortality and shorter hospitalisation.

Available IR procedures in Nigeria include balloon angioplasty and stenting, renal angioplasty, carotid and mesenteric angioplasty, venous stents like IVC filters, thrombolysis under imaging guidance, embolisation, treatment of infertility via fallopian tube recanalisation and varicocele embolisation, ablations, and image-guided biopsy and drainage.

The application of IR continues to expand as new techniques are continuously evolving. These techniques have replaced or are fast replacing more expensive and traumatic surgical procedures. Patients understand the benefits of these techniques and demand greater access.

Procedure Justification in Interventional radiology

The concept of procedure justification in IR has been poorly addressed. Interventional radiology poses an entirely new set of questions when considering justification. Specifically, risks to both patients and staff have to be considered on the one hand. On the other hand, there are risks from radiation, contrast medium complications, etc. Benefits which patients accrue relate to reduced morbidity. There are few scientific studies comparing clinical outcomes of IR with alternative surgical approaches which are very important for the development of referral guidelines which is an important tool in procedure justification and informed choice about alternative techniques.

The Nigerian Nuclear Regulatory Authority (NNRA) has produced a guidance document on IR procedures. The Nuclear Safety and Radiation Protection Act (1999, no.19) stipulates that medical exposures shall be justified by weighing the diagnostic benefits they produce against the radiation detriment they might cause, taking into account the benefits and risks of available alternative techniques that do not involve medical exposure. Also, the medical practitioner shall consider the efficacy, benefits, and risks of alternative diagnostic modalities, e.g. ultrasound or magnetic resonance imaging. In justifying each type of examination by radiography or fluoroscopy, relevant guidelines will be taken into account, such as those established by the World Health Organisation. The issue is that of implementation and enforcement.
Development of referral guidelines is essential and incorporation with emphasis on its importance during training of physicians and radiation workers is essential in procedure justification.

Optimisation

The concept of optimisation was introduced in the 1940s by the International Commission on Radiological Protection (ICRP) as a direct consequence of the recognition of stochastic effects. According to the Nuclear Safety and Radiation Protection Act (1999, no.19), any medical practitioner who prescribes or conducts radiological diagnostic/ interventional examinations shall ensure that appropriate equipment is used and that the exposure of patients are kept minimum as necessary to achieve the required objective.

A medical practitioner, technologist or other imaging staff should select the technical parameters, as relevant, such that their combination produces the minimum patient exposure consistent with acceptable image quality and the clinical purpose of the examination.

Adverse Event Minimisation

In IR an adverse event is an unexpected harm that results from an interventional procedure and is unrelated to the patient’s underlying medical condition. The harm may vary from mild and reversible to death. All such events must be reported to the Joint Commission on Accreditation of Healthcare Organisations (JCAHO) as well as to local regulatory authorities. This is not an issue in Nigeria.

The major challenges in Nigeria are the professional rivalry between the radiologists and radiographers on professional boundaries that gave room to quackery. Secondly, an uncontrolled importation of used/ refurbished radiology equipment and the non-involvement of the radiologists in setting policies that pertain their profession. The Nigerian Society of Interventional Radiology is working hard to resolve existing challenges. However, despite all the challenges interventional radiology continues to grow in Nigeria.

Contribution from Professor Ahmed Ahidjo and Dr. Mohammed Lawan, Department of Radiology, College of Medical Sciences, University of Maiduguri, Nigeria



ISRRT Council Adopted Three Position/Policy Statements on Radiation Protection in Medicine at the 19th ISRRT World Congress

ISRRT has focused on strategic priorities that show our commitment in pursuit of universal standards in radiation protection in medicine. These priorities included development of position/policy statements regarding radiation protection requirements consistent with the international Basic Safety Standards for inclusion in radiographer’s scopes of practice. One of the goals of the ISRRT is to ensure that infrastructure is in place to support radiation protection in medicine and mechanisms for regulatory support to minimise medical radiation exposure.

The Bonn Call-for-Action asked all global stakeholders to help enhance the implementation of the principle of optimisation of radiation protection and safety in all countries. The ISRRT recognises that the radiographer/ radiological technologist bears the responsibility for delivering exposure of ionising radiation during diagnostic and therapeutic procedures and is the last person with the patient before the exposure is made. In response to the Bonn Call-for-Action, ISRRT has made this part of their strategic priorities.

During the 2016 World Congress, held in Seoul Korea, the ISRRT Council approved three position/policy statements that support justification and optimisation for applying a team approach to minimising radiation exposure from medical radiation procedures and treatment. In addition, these position statements promote the safer use of radiation in medicine and promote protecting patients from unnecessary radiation exposure. The ISRRT expects all qualified radiographers and radiologic technologists to be competent in the principles of justification and the practice of ionising radiation dose optimisation relevant to their clinical work.

The three position/policy statements are now available for member countries to assist with implementing radiation protection processes in their countries.

Below are the titles of the position/policy statements that were adopted this past fall. If you are interested in reading the entire position statement along with its supporting documentation and reference for the following please log into the ISRRT Website to read the documents in their entirety.

Contribution from Donna Newman, Director of Professional Practice, International Society of Radiographers and Radiological Technologists.













An Update from the International Organisation for Medical Physics










The history of the International Organisation for Medical Physics (IOMP) spans over more than 50 years. In this period of time, we saw dramatic changes in healthcare and in particular, the progress of medical technology. While in mid-1960 there were about 6,000 medical physicists globally (mainly in the USA and the Western world), now these are about 25,000 globally, with many medical physicists in low-and-medium-income countries.

IOMP has made special contributions to medical physics education and training. In the past two decades, IOMP co-organised nearly 100 workshops, seminars and courses with attendees from about 85 countries. The most significant professional development was in Asia, where in the past decade the growth of medical physics specialists is over 120%. Due to this reason, the International Conference on Medical Physics in 2016 was held in Bangkok, organised by the Thai colleagues and the South-East Asian Federation of Organisations for Medical Physics (SEAFOMP). At this large professional event, IOMP organised a special School with 42 educational symposia, which attracted hundreds of students and young colleagues.

Quality and safety is the hallmark of medical physicists’ day-to-day activities, be it in imaging or in therapy. While every medical physicist plays this role in day-to-day work, the IOMP deals with international organisations. IOMP is a recognised NGO with IAEA and WHO and collaborates with ISR and IRPA. IOMP participated in the Third Global Forum on Medical Devices held at Centre International de Conférences Genève (CICG) on 10-12 May 2017.

During the last 6 months, IOMP jointly with IRPA, WHO and Middle East Federation of Organisation of Medical Physics (MEFOMP) organised its 4th Regional Workshop on Radiation Safety Culture in Healthcare at Doha, Qatar on 6-7 February 2017. The Hamad Medical Corporation was the local organiser. There were 153 participants from 5 countries of the region (Saudi Arabia, Lebanon, Egypt, UAE besides Qatar).

Back in 2013, IOMP established the 7th November as the International Day of Medical Physics (IDMP) and this day is celebrated every year with different themes. The IDMP website provides information about the IDMPs. The theme for 2017 IDMP is Providing a Holistic Approach to Women Patients and Women Staff Safety in Radiation Medicine. This is in recognition of the fact that 2017 marks the 150th Anniversary of the birth of Marie Sklodowska Curie whose birthday was chosen by IOMP to be IDMP. Due to this reason, the latest issue (March 2017) of the IOMP e-Newsletter Medical Physics World is dedicated to women in the profession.

Contribution from Prof. Madan Rehani, Vice President and Prof. Slavik Tabakov, President, International Organisation for Medical Physics.













An Update from the World Health Organisation

3rd WHO Global Forum on Medical Devices

The 3rd Global Forum on Medical Devices was held from 10th to 12th May 2017, in the Geneva Conference Centre. It included plenary, panels, parallel sessions, workshops, exhibition and poster sessions. WHO is preparing the report and will upload the abstracts and presentations to the website, to be ready by the end of June.

Forming part of the WHO Medical Devices Technical Series, the WHO recently launched four books:

World Health Assembly WHA70 WHO Hospitals website

WHO will update the “Hospitals” website and stakeholders’ information is important, e.g. WHO Survey on technical resources for hospitals for XXI century

4th Global Forum on Human Resources for Health

The Health Workforce Department is organising the 4th Global Forum on Human Resources for Health to be held from 13th to 17th November 2017 in Dublin, Ireland.

The Forum will be an excellent opportunity to share the experience with other professionals and technicians managing or using health technologies.

Contribution from Drs. Adriana Velazquez Berumen and Maria del Rosario Perez, World Health Organisation.



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