Optimisation of Radiological Protection in Digital Radiology Techniques for Medical Imaging
26-27 October 2022 | Virtual Event
Over the next decade, ICRP will be hosting several Digital Events each year as we look to review and revise the System of Radiological Protection for the next generation. This Digital Workshop took place over two days, with one, two-hour session taking place on both 26 October 2022 and 27 October 2022.
Use of medical imaging continues to increase, making the major contribution to population exposure from artificial sources of radiation world-wide. Optimisation for medical imaging requires keeping patient exposure to the minimum necessary to achieve the required medical objective. In other words, the number and quality of images must be adequate to obtain the information needed for diagnosis or intervention. The move to digital imaging has provided versatile acquisition, post-processing, and presentation options, but because images are adjusted for optimal viewing, the appearance may not give any indication of whether the dose might be higher than necessary. Nevertheless, digital images provide opportunities for further optimisation and offer the possibility of applying artificial intelligence methods in the future.
This ICRP report, which was available for public consultationuntil 28 October 2022, separates out different components within an organisation that are required to enable radiological protection of imaging to be achieved. Optimisation of radiological protection for digital radiology of patients (radiography, fluoroscopy, and computed tomography) involves selection and installation of equipment, design and construction of facilities, choice of optimal equipment settings, day-to-day methods of operation, quality control programmes, and ensuring that all personnel receive proper initial and career-long training. As new imaging equipment incorporates more options to improve performance, it becomes more complex and less easily understood, so operators have to be given more extensive training. Ongoing monitoring, review, and analysis of performance is required that feeds back into the improvement and development of imaging protocols. Different aspects relating to optimisation of protection will be discussed during the Workshop.
The Task Group has prepared two reports, these set out broad levels for aspects of optimisation that different facilities might achieve, and through which they can progress incrementally. This Workshop sets out the areas that are dealt with in the first report. This recommends practices for developing optimisation through the different stages and includes sections on methods for approaching patient dose and image quality assessment. It stresses the importance of training in achieving progress. The second report, which it is hoped will be available for public consultation in 2023, deals with practical aspects of optimisation of radiological protection for the different x-ray imaging modalities, radiography, fluoroscopy, and interventional and computed tomography. Together they should provide radiology departments with the techniques and tools needed to develop optimisation into a continual process in which all imaging professionals are involved.
26 OCTOBER 2022 Session 1: Structure and Components for Optimisation
Overview of TG108 Report: Components to Establish a Successful Optimisation Programme Colin Martin (ICRP/University of Glasgow)
This report is the first of two prepared by ICRP Task Group 108. It sets out an approach to aid in developing optimisation of radiological protection for radiological imaging programmes. There are several different aspects relating to optimisation of protection. The first is collaboration between radiologists/clinicians, radiographer/imaging technologists, and medical physicists, each of whom have key skills that can only contribute to the process effectively when individuals work together as a core team. The second is appropriate methodology and technology, with the knowledge and expertise required to use each effectively. The third relates to organisational processes that ensure required tasks, such as equipment performance tests, patient dose surveys, and review of protocols are carried out. There is a wide range in equipment, funding, and expertise around the world, and the majority of facilities do not have all the tools, professional teams and expertise to fully embrace all the possibilities for optimisation. The reports set out broad levels for aspects of optimisation that different facilities might achieve, and through which they can progress incrementally; D: Preliminary, C: Basic, B: Intermediate, and A: Advanced. It is hoped that through this approach, radiology teams will be able to plan strategies for introducing optimisation techniques that are appropriate for their own facilities and equipment.
X-ray Equipment Life Cycle and Patient Dosimetry David Sutton (ICRP/NHS Tayside/University of Dundee)
Optimisation is hard to pin down but is the key to protection. The process of image interpretation is both task and reader dependent, so the choice of factors that influence both patient dose and image quality depend on the patient, the clinical question, the examination, the operator performing the procedure, the equipment used to image the patient, and the person interpreting the eventual image.
Two of the key areas discussed in the report are the equipment life cycle and the analysis of patient doses. This presentation briefly describes the treatment afforded to both.
The equipment life cycle is a well understood concept, and describes medical equipment, including imaging equipment, from ‘cradle to grave’. Optimisation is a continual process and is inextricably bound up with the minutiae of the imaging equipment life cycle. Professional skills, methodology and process all play a vital role in the management of the equipment life cycle; understanding and managing it appropriately is essential if optimisation is to be achieved.
Knowledge of the doses delivered to patients is one of the first steps in the clinical optimisation process and personnel involved in performing the exams should have ownership or involvement in the process of dose audit. Patient dose surveys are essential in the development and implementation of an organisation’s dose management strategy. A multi-disciplinary team approach helps to ensure that results of dose surveys are fed back to operators who make changes that are needed.
The Importance of Education and Training Kimberly Applegate (ICRP/University of Kentucky COM)
The use of radiation in medicine may result in unnecessary radiation exposure where equipment is in the hands of untrained or undertrained operators. But this could be largely avoided if the operators were adequately trained in techniques for the optimisation of protection. Although the delay in manifestation of long-term health effects resulting from exposure to ionising radiation makes the associated risks difficult to comprehend or monitor, the overarching requirement ‘to do more good than harm’ makes radiological protection of patients an important ethical duty. Education and training in radiological protection can enhance personnel understanding, foster the development of a culture of safety, of teamwork, and of professionalism, and improve workers’ satisfaction and commitment to radiological protection principles. Investment in an adequate staffing level, with trained healthcare staff and a commitment to their continuous professional development (CPD) are essential when considering investment in new imaging equipment and software.
ICRP Publication 113 sets out a comprehensive discussion of the basic education and ongoing training of all stakeholders in radiological protection in medicine, including suggested content, objectives, management approaches, and the approximate minimum time needed for this training. The recommended knowledge content about radiological protection and dosimetry is important, but effective optimisation also requires other critical skills, namely building a strong team and safety culture based on mutual respect and effective interaction and collaboration between the professional groups. This becomes ever more important due to the complexity of the work environment and with the increasing complexity of modern x-ray equipment. Radiologists and radiographers need to work closely with medical physicists to ensure the operation of dose reduction features are understood and facilities are used properly. Professional links and mutual understanding should be developed from the start through collaborative training and continuing dialogue, with regular reviews and update training focused on maintaining and developing competencies in optimisation through a team approach.
View from WHO (World Health Organization) Emilie van Deventer (WHO)
The World Health Organization contributed to the development of this ICRP publication as it is expected to support the implementation of the International Basic Safety Standards in our Member States. This document on digital radiology is presented with a clinical perspective, linking the concept and practice of optimization of medical imaging with quality of health care. It will be a useful tool towards the Global Action Plan on Patient Safety, and towards the enactment of Universal Health Coverage.
Question & Answer
Views From Around the World
Kwan Ng AsiaSafe
Boris Brkljačić EuroSafe
Mónica Bernardo LatinSafe
Michael Kawooya AfroSafe
Panel Discussion: Application in Different Parts of the World