The Initial step was the selection of the main topics to fulfil the objectives of the WG involving the 11 European experts of the Eurosafe WG (radiologists, medical physicists, radiographers and industry engineers).
The eight topics initially considered as the most relevant to collect the opinions and suggestions were:
1. Information on medical exposure for patients (Art. 58.b of the European directive 2013/59/EURATOM: Member States shall ensure that information relating to patient exposure forms part of the report of the medical radiological procedure).
2. Individual optimisation (Art. 5.b of the European directive: The optimisation of the protection of individuals subject to medical exposure shall apply to the magnitude of individual doses and be consistent with the medical purpose of the exposure).
3. Accidental and unintended exposures (Art. 63.c of the European directive: Member States shall ensure that for all medical exposures the undertaking implements an appropriate system for the record keeping and analysis of events involving or potentially involving accidental or unintended medical exposures, commensurate with the radiological risk posed by the practice).
4. Dosimetric trigger levels (for individual procedures).
5. Comparison with Diagnostic Reference Levels (DRLs).
6. Role of the automatic dose registry and management systems.
7. Dosimetric information for the practitioner.
8. Dosimetric information for the referrer.
One aspect included in the survey was the advantages of automatic dose registries introduced in many European hospitals. Most of these registries are for patient doses but in some cases (e.g. interventional practices) also staff doses may be included.
The survey also included the topic on the advantages of simultaneously monitoring and managing patient and occupational exposures for interventional radiology. The correlation of occupational and patient exposures is recommended by the ICRP [9]. Information in real time inside the catheterisation rooms, not only on patient exposure, but also on occupational exposure during the procedures [10] is helpful for a global optimisation approach.
This is the summary of the survey among the experts of the WG:
· Information on patient exposure for patients.
- The preferred option for the majority of experts was to inform on “the dose values and units, reported by the X-ray system”.
· Individual optimisation.
- The majority of experts highlighted the following aspect “Consider patient and staff doses for interventional procedures”.
· Accidental and unintended exposures.
- All the experts agreed with the following priority “If suspected an accidental or unintended exposure, record and analyse the dose parameters (based on physical quantities) and produce a report for the quality assurance committee”.
· Dosimetric trigger levels (for individual procedures).
- All the experts agreed with the following priority “Trigger levels should be established for interventional procedures to alert on the risk of potential skin injuries”.
· Comparison with Diagnostic Reference Levels (DRLs).
- All the experts agreed with the following priority “The comparison with DRLs should be made at least, once per year and after changes in the X-ray unit or in the imaging protocols”.
· Role of the dose registry and management systems.
- All the experts agreed with the following priority “These systems should allow fulfilling the regulatory requirements (directive 2013/59/EURATOM) on patient dose registration”.
· Dosimetric information for the practitioner
- All the experts agreed that the practitioner should have information on the physical quantities offered by the X-ray system for the different imaging modalities.
· Dosimetric information for the referrer
- For this question, there was no agreement between the experts for the options offered (physical dosimetric quantities, effective doses, or diagnostic reference levels). This aspect would need further discussion.