The meeting was attended by 45 participants from 20 countries from the region Europe of the Technical cooperation program of the IAEA,
including: Armenia,
Azerbaijan,
Bosnia and Herzegovina,
Bulgaria,
Croatia,
Estonia,
Georgia,
Kazakhstan,
Latvia,
Lithuania,
Montenegro,
Poland,
Republic of Moldova,
Romania,
Russian Federation,
The former Yugoslav Republic of Macedonia,
Turkey,
Ukraine,
Portugal,
and experts from United Kingdom,
as well as representatives of IAEA,
ESR and WHO.
The participants represented national radiological professional societies,
health authorities and radiation protection regulatory bodies (fig.
1).
The programme combined presentations from experts and representatives of IAEA,
WHO and ESR,
country presentations by participants,
and discussions in small groups and plenary sessions,
aimed to identify issues and good practices for better justification.
The meeting demonstrated that there were common themes within the region.
Table 1 and 2 summarise identified issues,
suggested solutions and main stakeholders,
for two different group of individuals undergoing medical imaging: for individuals with sympthoms (patients) in Table 1,
and for individuals not referred by a doctor (screening for disease,
individual health assessment in asymptomatic individuals,
research volunteers,
carers & comforters,
immigrants,
athletes) in Table 2.
Table 1.
Difficulties for justification of imaging for individuals with sympthoms (patients),
suggested solutions and main stakeholders
Issue
|
Suggested solution
|
Stakeholders/facilitators
|
Ethics,
informed consent
|
Nil nocere; Guidelines/Standard protocols/Regulations
Medical devices controlled by medical staff; Use alternative non-ionizing methods
|
Public sector,
Governmental institutions,
Hospital radiology departments,
Hospital boards
|
Unnecessary imaging performed by radiologist,
who is financially interested
|
Using reference guidelines,
providing clinical audit
|
Ministry of Health,
Health insurance companies,
Professional societies
|
Pressure from patient,
self-presentation
|
Awareness of public regarding risks related to use of ionising radiation; Guidelines
|
Professional societies,
Mass-media
|
Lack of common understanding of population screening and organisational issues and monitoring
|
Dedicated strategy and action plan: Database; Funding,
QA guidelines; Appropriate training for specialists (radiologists,
radiographers,
administrators); Coordination and monitoring institution
|
Ministry of Health; Ministry of Finance
|
Screening procedures without scientific evidence (e.g.
TB)
|
Scientific evidence based on recent publications,
regulation updated
|
Professional societies,
Research institution,
Ministries
|
Unjustified use of CT for sportsmen (e.g.
professional boxer)
|
Use of MRI or other modalities not using ionising radiation
|
Professional societies,
Regulatory body
|
Commercial pressure: Opportunistic campaigns,
not justified
|
Guidelines for use of imaging for non-asymptomatic individuals
|
Ministry of Health,
Professional societies; Regulatory body
|
Immigrants examination for TB
|
Examination based only on scientific evidence
|
Government,
Ministry of Health
|
Screening of operators,
e.g.
pilots,
professional drivers
|
Examination based only on scientific evidence
|
Ministry of Industry
|
Screening using DEXA
|
Examination based only on scientific evidence
|
Research institutions,
Ministry of Health
|
Discrepancy between internal institutional guidelines and the guidelines adopted by government
|
Harmonization of guidelines
|
Regulatory body,
Medical institutions
|
Promotion of imaging examination for profit
|
Awareness of public regarding hazards related to use of ionising radiation,
discouraging and warnings
|
Government,
Professional societies,
Mass media
|
Researchers and volunteers are not fully aware about radiation risk
|
Involvement of medical physics experts in research group,
optimization of procedures; Ethical committee
|
Research institution,
Scientific foundation; Hospitals
|
Table 2.
Difficulties for justification of imaging of non-asympthomatic individuals,
suggested solutions and main stakeholders
Issue
|
Suggested solution
|
Stakeholders/facilitators
|
Ethics,
informed consent
|
Nil nocere; Guidelines/Standard protocols/Regulations
Medical devices controlled by medical staff; Use alternative non-ionizing methods
|
Public sector,
Governmental institutions,
Hospital radiology departments,
Hospital boards
|
Unnecessary imaging performed by radiologist,
who is financially interested
|
Using reference guidelines,
providing clinical audit
|
Ministry of Health,
Health insurance companies,
Professional societies
|
Pressure from patient,
self-presentation
|
Awareness of public regarding risks related to use of ionising radiation; Guidelines
|
Professional societies,
Mass-media
|
Lack of common understanding of population screening and organisational issues and monitoring
|
Dedicated strategy and action plan: Database; Funding,
QA guidelines; Appropriate training for specialists (radiologists,
radiographers,
administrators); Coordination and monitoring institution
|
Ministry of Health; Ministry of Finance
|
Screening procedures without scientific evidence (e.g.
TB)
|
Scientific evidence based on recent publications,
regulation updated
|
Professional societies,
Research institution,
Ministries
|
Unjustified use of CT for sportsmen (e.g.
professional boxer)
|
Use of MRI or other modalities not using ionising radiation
|
Professional societies,
Regulatory body
|
Commercial pressure: Opportunistic campaigns,
not justified
|
Guidelines for use of imaging for non-asymptomatic individuals
|
Ministry of Health,
Professional societies; Regulatory body
|
Immigrants examination for TB
|
Examination based only on scientific evidence
|
Government,
Ministry of Health
|
Screening of operators,
e.g.
pilots,
professional drivers
|
Examination based only on scientific evidence
|
Ministry of Industry
|
Screening using DEXA
|
Examination based only on scientific evidence
|
Research institutions,
Ministry of Health
|
Discrepancy between internal institutional guidelines and the guidelines adopted by government
|
Harmonization of guidelines
|
Regulatory body,
Medical institutions
|
Promotion of imaging examination for profit
|
Awareness of public regarding hazards related to use of ionising radiation,
discouraging and warnings
|
Government,
Professional societies,
Mass media
|
Researchers and volunteers are not fully aware about radiation risk
|
Involvement of medical physics experts in research group,
optimization of procedures; Ethical committee
|
Research institution,
Scientific foundation; Hospitals
|
To address gaps in the availability of imaging referral guidelines and the lack of guideline use in Europe,
the ESR has developed ESR iGuide,
a clinical decision support (CDS) system for European imaging referral guidelines,
in cooperation with the American College of Radiology (ACR) and National Decision Support Company (NDSC).
Embedding European referral guidelines in a CDS system providing actionable recommendations at the point of care is the most effective way to ensure imaging is used appropriately,
and studies have shown that the implementation of CDS and guidelines leads to a reduction in unnecessary radiation exposure.