Congress:
EuroSafe Imaging 2019
Keywords:
Radiation safety, Fluoroscopy, CT, Radioprotection / Radiation dose, Action 2 - Clinical diagnostic reference levels (DRLs), Action 6 - Clinical audit tool for imaging, Quality assurance
Authors:
J. Damilakis, G. Frija, ESR Office
DOI:
10.26044/esi2019/ESI-0115
Description of activity and work performed
Description of activity and work performed:
The main objectives of EUCLID are to conduct a European survey to collect data needed for the establishment of DRLs for the most important x-ray imaging tasks in Europe (from the radiation protection perspective) on the basis of the clinical indication,
and to specify up-to-date DRLs for these examinations.
A workshop will be organised by the end of 2019 to disseminate and discuss the results of this project.
An External Advisory Panel has been set-up to be consulted on the main project activities and outcomes.
During the first months of EUCLID,
a comprehensive review was carried out to identify the status of existing clinical DRLs for CT,
interventional radiology (IR) and radiography in Europe and beyond.
This was done by analysing recent studies,
standards and publications.
Information about existing clinical DRLs was collected from national competent authorities and other organisations involved in the project.
The findings were taken into consideration during the finalisation of the list of clinical indications for which EUCLID is going to establish DRLs (Tables 1 and 2).
EUCLID has developed and implemented an EU-wide survey to collect data from 20 participating hospitals from 13 different European countries (Figure 3),
chosen among the EuroSafe Imaging Stars network.
The data is collected using a secure online web application for building and managing online surveys and databases.
All data shall be continuously reviewed until the end of the data collection period (Q1 of 2019) in an attempt to avoid inaccurate records.
Data will be prepared for the analysis to be sure that they are in the correct format and truthful.
Moreover,
a Scientific Board has been set up for the verification of data collected for the establishment of clinical DRLs.
Board members are representatives of national regulatory authorities and national scientific/professional societies from the countries in which data is being collected.
Twenty-fifth percentiles,
medians,
and 75th percentiles for dose quantities and dose indices will be calculated for each of the clinical indications and procedures.
CT DRLs will be defined in terms of CTDIvol and DLP (Dose length Product).
IR DRLs will be defined in terms of KAP (Kerma Area Product),
cumulative air kerma at the patient entrance reference point,
fluoroscopy time,
and total number of images.
EUCLID will also investigate the possibility of defining IR DRLs in terms of complexity.
The final data analysis methodology is currently being discussed and will be finalised in consultation with the External Advisory Panel and the Scientific Board.
Table 1: List of CT clinical indications
Clinical task
|
Anatomical location
|
Procedure
|
Stroke
Detection or exclusion of a haemorrhage
|
Head
|
All Phases
|
Chronic sinusitis
Detection or exclusion of polyps
|
Neck
|
All Phases
|
Cervical spine trauma
Detection or exclusion of a lesion
|
Spine
|
All Phases
|
Pulmonary embolism
Detection or exclusion
|
Thorax
|
All Phases
|
Coronary calcium scoring
Risk stratification
|
Coronary Arteries
|
All Phases
|
Coronary angiography
Vessels assessment
|
Coronary Arteries
|
All Phases
|
Lung cancer
Oncological staging
First and F-up
|
Brain
Thorax
Liver
|
All Phases
|
Hepatocellular carcinoma
Oncological staging
|
Liver
|
All Phases
|
Colic /abdominal pain
Exclusion or detection of a stone
|
Abdomen
|
All Phases
|
Appendicitis
Detection or exclusion
|
Abdomen
|
All Phases
|
Table 2: List of Interventional radiology procedures
Clinical task
|
Anatomical location
|
Procedure
|
Arterial occlusive disease of iliac arteries
Angiographic diagnosis and endovascular treatment of arterial stenosis or occlusion causing intermittent claudication or ischemia
|
Pelvis
|
Recanalisation & Stenting
|
Localization and treatment of hepatocellular carcinoma
TACE: transarterial chemoembolisation
|
Liver
|
Transarterial (chemo)embolisation of tumor vasculature and feeding hepatic arteries
|
Arterial occlusive disease of femoropopliteal arteries
Angiographic diagnosis and endovascular treatment of arterial stenosis or occlusion causing intermittent claudication or ischemia
|
Lower extremity
|
Recanalization and angioplasty +-stenting
|
Biliary drainage
Localisation of biliary obstruction and percutaneous treatment of biliary obstruction
|
Abdomen
|
Percutaneous transhepatic cholangiography and biliary drainage
|
Fig. 3: Data collection from 13 European countries.