Congress:
EuroSafe Imaging 2020
Keywords:
Not applicable, Quality assurance, Education and training, Dosimetric comparison, Dosimetry, Fluoroscopy, Catheter arteriography, Radioprotection / Radiation dose, Paediatric, Interventional non-vascular, Action 7 - Radiation protection of children
Authors:
E. Vano, M. D. R. del Rosario Perez, P. Jimenez, A. Nader, R. Ramirez Garcia, P. Miranda, C. Ubeda, Y. Gonzalez
DOI:
10.26044/esi2020/ESI-03445
Background/introduction
Interventional radiology (IR) and cardiology (IC) are increasingly used in children as minimally invasive procedures that can replace more complex paediatric surgery options. The new technology and post-processing in imaging for interventional practices allow a reduction of patient and staff doses maintaining or even improving the image quality.
The International Basic Safety Standards (BSS) establish requirements for the protection from harmful effects of ionizing radiation (BSS 2014). The BSS requirements for the medical exposures of patients include the establishment of diagnostic reference levels (DRLs), and pay special attention to paediatric patients. The Bonn Call for Action (IAEA-WHO 2012) and the Eurosafe Imaging Call for Action (Eurosafe 2018) highlight main actions, and related sub-actions, that were identified as being essential for the strengthening of radiation protection in medicine. The ICRP has issued new recommendations on DRLs (ICRP 2017) including advice for paediatric interventions. However, only a few countries in the world have implemented the use of DRLs in paediatric IR and IC (EC 2018, Kottou 2018, Strauss 2015, Ubeda 2015).
In 2009, the International Atomic Energy Agency (IAEA) launched a pilot program on radiation protection (RP) in paediatric interventional cardiology to propose a methodology to collect data on patient and staff radiation doses. It was estimated that the number of paediatric IC procedures per million inhabitants In Latin America and the Caribbean ranged from 40 to 80 (Vano 2011). One of the main problems identified during the “Ibero-American Conference on Radiation Protection in Medicine” (Conferencia Iberoamericana sobre Protección Radiológica en Medicina, CIPRaM) held in Madrid, in October 2016, to follow the progress of the Bonn Call for Action, was as the “insufficient optimization actions and lack of DRLs” (Vano 2016).
The World Health Organization (WHO), the Pan American Health Organization (PAHO) and the IAEA agreed in 2018, to propose a project for enhancing optimisation in paediatric interventional radiology based on the use of DRLs in Latin American and Caribbean countries (i.e. OPRIPALC from Optimización de la Protección en Radiología Intervencionista Pediátrica en América Latina y el Caribe) Fig. 1 presents a summary of the countries and hospitals that initially accepted to be involved in the OPRIPALC project.
The four main objectives of the OPRIPALC project have been formulated as follows:
1) To promote radiation safety culture in paediatric interventional radiology (including RP training actions). 2) To improve radiation safety and quality of care in the participant centres (including auditing actions). 3) To define optimization strategies based on a collection of patient doses from a sample of representative hospitals in different countries and settings, and using DRLs. 4) To produce a regional consensus document offering guidance to improve optimization of protection and safety for paediatric interventional practices.