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Report Regional Workshop on Strengthening Member States National Systems for Safety in Medical Exposure in Line With the Revised International BSS, 9-12 December 2014, Prague, Czech Republic
Annex III
PROJECT TASKS AND IMPLEMENTATION ACTIONS
Task
Work Component
(sub-tasks)
Action by Member State to carry out the
work component
IAEA Input
Task 1.
Development
of diagnostic
references
doses at
clinically
acceptable
image quality
1. At hospital level:
 In each X-ray room (CT,
Radiography, Fluoroscopy)
collect patient doses from predefined examinations and
establish typical (average) dose
for clinically accepted images,
separately for each weight group
 For each X-ray examination,
collect typical doses in different
rooms in your hospital and
analyse results
 Establish local hospital DRLs if
relevant.
2. Specific subtask: Apply and test
the concept of Acceptable
Quality Dose (AQD), based on
Sub-task 1 data collection
forms, modified to include
image quality scoring
3. At country (region) level: Utilise
this approach to perform
national/ regional surveys and
to establish DRLs
 Appoint coordinator - preferably with
medical physics background and good
knowledge of patient dosimetry, working
in close collaboration with experienced
radiologist
 Identify examinations to start with
 Identify X-ray facilities
 Distribute data collection forms, if
necessary, translate them in the local
language
 Coordinate data collection and analysis
 Elaborate typical doses in the facility
 Collect data from different facilities and
analyse their distribution
 Coordinate with TO & Expert to do work
and arrive at conclusions
 Provide feedback to facilities and suggest
optimization actions (see also tasks 2 and
3 for CT and interventional radiology)
 Assign expert
1
 Provide data collection
forms and instructions
 Provide training
 Monitoring results,
feedback and advice
Participants with
expertise to provide
support to others
Radiography – Leos,
Olivera, Adnan
Interventional cardiology –
Leos, Olivera
CT – Adnan, Vesna,
Olivera
Mammography – Simona,
Vesna, Olivera, Dario,
Adnan
NM – Terez, Goran,
Simona
Report Regional Workshop on Strengthening Member States National Systems for Safety in Medical Exposure in Line With the Revised International BSS, 9-12 December 2014, Prague, Czech Republic
Task 2. Patient
dose
management in
CT (adults and
children)
In a particular CT facility:
1. Survey the practice (see task 1)
2. Adopt low dose protocols
adapted to the body size
3. Perform new patient dose data
collection and document
improvement in patient doses
 Appoint coordinator
 Select facilities to start dose estimates and
protocol optimisation
 Use data collection forms from Task 1
 Analyse results and compare with DRLs
and published data; find optimisation
needed
 Adopt low dose protocols adapted to the
body size
 Coordinate with TO & Expert to do work
and arrive at results (see next column)
 Assign expert
 Provide data collection
forms and instructions
 Annalise results and
provide feedback
 Provide guidance material
 Provide training
 Monitor results
Adnan, Vesna, Olivera
Task 3. Patient
and staff dose
management in
image guided
interventional
procedures
In a particular hospital:
1. Survey the use of fluoroscopy to
guide diagnostic/therapeutic
procedures performed by
different medical professionals
(cardiologists, vascular
surgeons, urologists,
gastroenterologists, orthopaedic
surgeons, etc.) and decide which
examinations to start with
In a particular fluoroscopy room:
2. Assess patient and staff doses,
incl. eye dose to operators (if a
dosemeter is available)
3. Adopt low dose protocols,
implement dose reduction tools
4. Document improvement in
patient and staff doses
5. Apply a system for patient dose
registration and set trigger levels
for follow-up of patient at risk
for skin injuries
6. Use SAFRAD for voluntary
reporting of events





 Assign expert
 Provide data collection
forms and instructions
 Annalise results and
provide feedback
 Provide guidance material
 Provide training
 Monitor results
 Access to SAFRAD and
education on use
 Develop informational
materials (poster, leaflet) to
be distributed in
interventional radiology
departments with trigger
levels for patients followup
Leos, Dario, Olivera
Appoint coordinator
Select facilities to start dose estimates
Select procedures to be surveyed
Use data collection forms from Task 1
Analyse results and compare with DRLs
(if available) and published data; find
optimisation needed
 Coordinate with TO & Expert to do work
and arrive at results (see next column)
 Apply procedure for patient dose
registration and patients follow-up;
prepare and distribute informational
materials for patients and staff
 Participate in SAFRAD
2
Report Regional Workshop on Strengthening Member States National Systems for Safety in Medical Exposure in Line With the Revised International BSS, 9-12 December 2014, Prague, Czech Republic
Task 4. Patient
dose
management in
SPECT-CT,
PET-CT and
nuclear cardiac
imaging
Task 5.
Prevention of
unintended and
accidental
exposure in
radiotherapy
In a particular CT facility:
1. Survey the practice (for PET,
start with Tumour imaging
FDG; for SPECT/CT, identify
the most important)
2. Estimate contribution of each
imaging modality to patient dose
3. Compare results with DRLs and
published data
4. Adopt low dose protocols and
document improvement in
patient doses
1. At hospital level:
Perform review of available
safety barriers in radiotherapy
department, perform prospective
risk assessment and plan actions
to improve safety. Establish a
system for tracking of events
and procedure to analyse and
learn. Register and use the
IAEA voluntary reporting
system SAFRON
2. At national level:
Disseminate the contents of the
IAEA training courses to
national professionals. Promote
use of SAFRON
 Appoint coordinator
 Select few facilities to start dose
estimates
 Coordinate with TO & Expert to do work
and arrive at results (see second column)
 Assign Expert
 Develop data collection
forms
 Training
 Guidance material
 Monitor results
At a country level:
 Leading national radiation oncologist and
medical physicists organize the
dissemination
 Organizing meetings at national level,
and in the cases where the number of
professional is large enough, organize
national workshops
 Follow up on the application of the
lessons
At a hospital/department level:
 Establish a safety team to perform review
of available safety barriers and to perform
prospective risk assessment and plan
actions to improve safety
 Establish a system for tracking of events
in radiotherapy departments and
procedure to analyse them and to learn
from them
 Use the IAEA voluntary reporting system
SAFRON
 External expert in case of
national workshop, or subregional workshops when
the number of national
professionals is too small
 Training materials and
publications
 Access to SAFRON and
education on use
3
Terez, Simona
Dario, Nely
Report Regional Workshop on Strengthening Member States National Systems for Safety in Medical Exposure in Line With the Revised International BSS, 9-12 December 2014, Prague, Czech Republic
Task 6.
Supporting
justification of
medical
exposure
through
awareness
actions
1. Evaluate the current practice of:
- use of imaging for particular
clinical questions, to identify
roles of different professionals
and obstacles in
appropriateness (self-referral,
self-presentation,
reimbursement, etc.)
- health screening program and
imaging of asymptomatic
persons
- medical exposure incurred by
a carer or comforter
2. Increase awareness and
knowledge of referring medical
practitioners and radiological
medical practitioners on
appropriateness related to
different procedures
3. Develop or adapt national
imaging referral guidelines or
translate/adopt available
international guidelines
Task 7.
1. Survey the practice of use of
Rationalising
different imaging modalities,
patient exposure
with a special emphasis on the
in dental
use of dental CBCT, dental
imaging
imaging for children; use of xray equipment by dentists and
their training
2. Participate in dose survey for
dental CBCT
3. Develop and disseminate
national guidelines on imaging
in dentistry or translate/adopt
international ones
 Appoint coordinator from a professional
radiological society/ health authority;
involve professional societies of referring
physicians (GPs, other specialities)
 If needed, translate questionnaire
developed by the IAEA in local language
 Perform survey among referring and
radiological medical practitioners and
provide feedback in order to create
awareness
 Organize a meeting to discuss national
approaches to implement AwarenessAppropriateness-Audit
 Support development of implementation
tools, e.g. national imaging referral
guidelines, decision support systems, etc.
 Translate available informational
materials in local language and distribute
them in the country
 Organize national training/ awareness
activities
 Appoint coordinator - preferably from
dental university centre
 Coordinate with dental radiologists/
professional dental society in the country
 Perform dose survey
 Coordinate with TO & Expert to do work
and arrive at conclusions
 Develop/implement guidelines
 Organise training activities
4
 Develop questionnaire to
survey practice on use of
different imaging methods
for particular important
clinical indications
 Analyse results and
provide feedback to create
awareness
 Develop training materials
and provide information/
resources
 Organise workshops/
trainings with participation
of referring practitioners
and radiologists to share
experience and discuss
tools
 Expert support to national
actions to develop
implementation tools, like
national imaging referral
guidelines, decision
support systems, etc.
 Assign Expert
 Develop forms for dose
data collection
 Provide guidance material
 Training
 Monitor results
Leos - CBCT
Report Regional Workshop on Strengthening Member States National Systems for Safety in Medical Exposure in Line With the Revised International BSS, 9-12 December 2014, Prague, Czech Republic
Task 8.
Radiation
protection in
radioiodine
therapy
1. Survey the practice of release of
patients after radionuclide
therapy
2. Develop and apply guidelines
for release of patients
3. Develop and apply instructions
for patients and family members
 Select most of the hospitals engaged in
radionuclide therapy
 Create a working group involving
professionals & professional body
 Interact with Expert & TO to develop
national guidelines
 Adopt guidelines
 Assign Expert
 Guidance material
 Assist in preparing
guidelines
Neli, Terez
Task 9.
Radiation
protection in
pregnancy
1. Survey the practice of use of
medical exposure in pregnancy
2. Develop and implement
guidelines for management of
situations of medical exposure
in pregnancy
3. Increase knowledge on
estimation of dose to uterus
 Appoint coordinator
 Participate in survey
 Coordinate with TO & Expert to do work
and arrive at results (see second column)
Olivera
Task 10.
Applying
efficient
inspection
program to
control
justification and
optimisation of
medical
exposure
1. Evaluate current situation and
collect feedback from
radiological practitioners
2. Organise training activities for
inspectors to increase
knowledge and awareness on
patient dose reduction
approaches
3. Develop and implement efficient
inspection program covering
different aspects of justification
and optimisation
 Appoint coordinator from the regulatory
authority responsible to control radiation
protection in medical exposure
 Organise meeting with end-users to
collect feedback on potential
improvements
 Review current inspection program and
checklist
 Coordinate with TO & Expert to improve
inspection program/checklists
 Assign expert
 Develop survey forms
 Annalise results and
provide feedback
 Guidance material
 Training
 Informational posters on
pregnancy for patients and
doctors
 Assign Expert
 Provide guidance material
 Develop checklist template
for inspectors
 Organise practical trainings
for inspectors responsible
for medical applications
 Organise scientific visit for
inspectors with experience
to exchange good practice
5

Report Regional Workshop on Strengthening Member States National Systems for Safety in Medical Exposure in Line With the Revised International BSS, 9-12 December 2014, Prague, Czech Republic
Task 11.
1. Focused on cardiac cath
Database
procedures in children below
creation for risk
age 10:
assessment in
-Collect data on number of
children
procedures performed in last
undergoing high
few years
dose procedures
-Data on repeat procedures on
same patient
-Data on doses to individual
patient
 Select hospitals performing cardiac cath
procedures in children below age 10
 Appoint coordinator
 Coordinate with TO & Expert to collect
and provide data
6
 Assign Expert
 Provide guidance material
 Create database and collect
data
Report Regional Workshop on Strengthening Member States National Systems for Safety in Medical Exposure in Line With the Revised International BSS, 9-12 December 2014, Prague, Czech Republic
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