Unintended and accidental medical radiation exposures in radiology: guidelines on investigation and prevention

This paper sets out guidelines for managing radiation exposure incidents involving patients in diagnostic and interventional radiology. The work is based on collation of experiences from representatives of international and national organizations for radiologists, medical physicists, radiographers, regulators, and equipment manufacturers, derived from an International Atomic Energy Agency Technical Meeting. More serious overexposures can result in skin doses high enough to produce tissue reactions, in interventional procedures and computed tomography, most notably from perfusion studies. A major factor involved has been deficiencies in training of staff in operation of equipment and optimization techniques. The use of checklists and time outs before procedures commence, and dose alerts when critical levels are reached during procedures can provide safeguards to reduce risks of these effects occurring. However, unintended and accidental overexposures resulting in relatively small additional doses can take place in any diagnostic or interventional X-ray procedure and it is important to learn from errors that occur, as these may lead to increased risks of stochastic effects. Such events may involve the wrong examinations, procedural errors, or equipment faults. Guidance is given on prevention, investigation and dose calculation for radiology exposure incidents within healthcare facilities. Responsibilities should be clearly set out in formal policies, and procedures should be in place to ensure that root causes are identified and deficiencies addressed. When an overexposure of a patient or an unintended exposure of a foetus occurs, the foetal, organ, skin and/or effective dose may be estimated from exposure data. When doses are very low, generic values for the examination may be sufficient, but a full assessment of doses to all exposed organs and tissues may sometimes be required. The use of general terminology to describe risks from stochastic effects is recommended rather than calculation of numerical values, as these are misleading when applied to individuals

The European Federation of Organisations for Medical Physics (EFOMP) White Paper : Big data and deep learning in medical imaging and in relation to medical physics profession

Big data and deep learning will profoundly change various areas of professions and research in the future. This will also happen in medicine and medical imaging in particular. As medical physicists, we should pursue beyond the concept of technical quality to extend our methodology and competence towards measuring and optimising the diagnostic value in terms of how it is connected to care outcome. Functional implementation of such methodology requires data processing utilities starting from data collection and management and culminating in the data analysis methods. Data quality control and validation are prerequisites for the deep learning application in order to provide reliable further analysis, classification, interpretation, probabilistic and predictive modelling from the vast heterogeneous big data. Challenges in practical data analytics relate to both horizontal and longitudinal analysis aspects. Quantitative aspects of data validation, quality control, physically meaningful measures, parameter connections and system modelling for the future artificial intelligence (AI) methods are positioned firmly in the field of Medical Physics profession. It is our interest to ensure that our professional education, continuous training and competence will follow this significant global development.Peer reviewe

Medical applications of ionizing radiation and radiation protection for European patients, population and environment

Medical applications of ionising radiation (IR) represent a key component of the diagnosis and treatment of many diseases, guaranteeing efficient health care. The use of IR in medicine, the largest source of general population radiation exposure, is potentially associated with increased risk of cancer and non-cancer diseases, which needs to be evaluated to provide evidence-based input for risk-benefit considerations. Efforts are also needed to improve the safety and efficacy of medical applications through optimisation. The EC Euratom programme enhances research in medical radiation protection. The four complementary multidisciplinary projects presented here contribute to (1) improving knowledge on exposure and effects of diagnostic and therapeutic applications and (2) transferring results into clinical practice. The common aim is to optimise use for individual patients, enhance education and training, ensuring adherence to ethical standards, particularly related to technologies based on artificial intelligence. MEDIRAD, SINFONIA and HARMONIC focus on improving exposure estimation and studying the detrimental effects of diagnostic and therapeutic medical exposures in patients and staff using different endpoints. EURAMED rocc-n-roll brings together the results of the projects and the recommendations generated by them to build, in collaboration with the EU Radiation Protection research platforms, a strategic research agenda and a roadmap for research priorities

Education and training in radiation protection in Europe: an analysis from the EURAMED rocc-n-roll project

Background: A Strengths, weaknesses, opportunities and threats analysis was performed to understand the status quo of education and training in radiation protection (RP) and to develop a coordinated European approach to RP training needs based on stakeholder consensus and existing activities in the field. Fourteen team members represented six European professional societies, one European voluntary organisation, two international healthcare organisations and five professions, namely: Medical Physicists; Nuclear Medicine Physicians; Radiologists; Radiation Oncologists and Radiographers. Four subgroups analysed the “Strengths”, “Weaknesses”, “Opportunities” and “Threats” related to E&T in RP developed under previous European Union (EU) programmes and on the Guidelines on Radiation Protection Education and Training of Medical Professionals in the EU. Results: Consensus agreement identified four themes for strengths and opportunities, namely: (1) existing structures and training recommendations; (2) RP training needs assessment and education & training (E&T) model(s) development; (3) E&T dissemination, harmonisation, and accreditation; (4) financial supports. Weaknesses and Threats analysis identified two themes: (1) awareness and prioritisation at a national/global level and (2) awareness and prioritisation by healthcare professional groups and researchers. Conclusions: A lack of effective implementation of RP principles in daily practice was identified. EuRnR strategic planning needs to consider processes at European, national and local levels. Success is dependent upon efficient governance structures and expert leadership. Financial support is required to allow the stakeholder professional agencies to have sufficient resources to achieve a pan European radiation protection training network which is sustainable and accredited across multiple national domains.info:eu-repo/semantics/publishedVersio

Core curriculum for medical physicists in radiology. Recommendations from an EFOMP/ESR working group

Some years ago it was decided that a European curriculum should be developed for medical physicists professionally engaged in the support of clinical diagnostic imaging departments. With this in mind, EFOMP (European Federation of Organisations for Medical Physics) in association with ESR (European Society of Radiology) nominated an expert working group. This curriculum is now to hand. The curriculum is intended to promote best patient care in radiology departments through the harmonization of education and training of medical physicists to a high standard in diagnostic radiology. It is recommended that a medical physicist working in a radiology department should have an advanced level of professional expertise in X-ray imaging, and additionally, depending on local availability, should acquire knowledge and competencies in overseeing ultrasound imaging, nuclear medicine, and MRI technology. By demonstrating training to a standardized curriculum, medical physicists throughout Europe will enhance their mobility, while maintaining local high standards of medical physics expertise. This document also provides the basis for improved implementation of articles in the European medical exposure directives related to the medical physics expert. The curriculum is divided into three main sections: The first deals with general competencies in the principles of medical physics. The second section describes specific knowledge and skills required for a medical physicist (medical physics expert) to operate clinically in a department of diagnostic radiology. The final section outlines research skills that are also considered to be necessary and appropriate competencies in a career as medical physicist

Radiation exposure in X-ray-based imaging techniques used in osteoporosis

Recent advances in medical X-ray imaging have enabled the development of new techniques capable of assessing not only bone quantity but also structure. This article provides (a) a brief review of the current X-ray methods used for quantitative assessment of the skeleton, (b) data on the levels of radiation exposure associated with these methods and (c) information about radiation safety issues. Radiation doses associated with dual-energy X-ray absorptiometry are very low. However, as with any X-ray imaging technique, each particular examination must always be clinically justified. When an examination is justified, the emphasis must be on dose optimisation of imaging protocols. Dose optimisation is more important for paediatric examinations because children are more vulnerable to radiation than adults. Methods based on multi-detector CT (MDCT) are associated with higher radiation doses. New 3D volumetric hip and spine quantitative computed tomography (QCT) techniques and high-resolution MDCT for evaluation of bone structure deliver doses to patients from 1 to 3 mSv. Low-dose protocols are needed to reduce radiation exposure from these methods and minimise associated health risks

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