ISRQSA Newsletter´s new format
ISRQSA Newsletter has a slightly new format, although the focus and aim are unchanged. Readers can now access the
"Table of Contents" in two ways and view an article by clicking its title.
- A single page PDF "Table of Contents" as previously used. You can preview, download and save
this PDF file to your mobile device from here. This format provides a list of all the topics, connects you
to the articles and enables you to return to this list when convenient.
- In an ISR web page. An article is either displayed in full text or accessed by the embedded links to
external web pages.
We hope you would find this material informative and useful.
Kindly forward the ISRQSA newsletter to colleagues with interest in RQS and direct distribution or contribution
queries to [email protected]
Lawrence Lau, FACR, FAMS, FRANZCR, FRCR
Editor, ISRQSA News
Quality Practice and Tools
Quality and Safety News
Message from the Editor
THE NEXT FRONTIER
Value-based Radiology (VR) is gathering momentum and support. One way to
describe value is quality patient-centred care on the one hand and the cost to
deliver this on the other. Quality care includes radiation safety. VR enables prompt
diagnosis, early and appropriate intervention; and reduces misdiagnosis and error,
hospital admission, and downstream cost, e.g. pharmaceuticals. Quality care in
radiology consists of many elements, e.g. access, people-centredness,
appropriateness, safety, etc. The WHO recently launched a Framework for
Integrated People-Centred Health Services and succinctly explained this
concept in a video entitled “What is people-centred care?”
In the last decade, the collaborative efforts to improve radiological quality and
safety gathered pace. Leadership and teamwork from professional societies, international organisations,
and UN agencies have led to a significant improvement in awareness and advocacy and a strengthening of
safety policy and infrastructure. Some examples include the International Action Plans, Basic Safety Standards,
Bonn Call-for-Actions, and the
formation of interdisciplinary international, regional, and national radiation safety campaigns. These campaigns
put radiological quality and
safety issues on the main agenda of radiological societies. You will find updates from some of these campaigns
in this edition.
Education and training are the most commonly used strategies to improve radiation safety. Prof. Garcia Monaco
drew our attention to the
increasing use of e-learning and virtual education to extend the reach to professionals in the different
regions. The stakeholders are
identifying meaningful indicators to assess the outcome of these improvement efforts. Levers are proposed to
encourage more appropriate
use of procedures. There are links to these topics in the list of contents.
While the steady progress in radiation safety at a system-level is encouraging, more work is desirable in
radiology facilities. It is the use of the
recommendations and guidance tools in daily practice that will lead to better patient care and outcome. A
practitioner cannot do this alone!
Facility-based leadership, cultural change, and combined teamwork from management, radiologists, radiographers,
medical physicists, etc. are
needed. Radiology facilities need guidance to implement these improvement actions. Prof. Husseiny reported on
her team’s innovative
actions to implement Clinical Referral Guidelines in Egypt and her region. This and other improvement
opportunities will be explored in the
forthcoming International Conference on Radiation Protection in Medicine: Achieving Change in
Practice. The experts will review the progress
since the Bonn Conference, examine the developments, and identify the priorities relating to radiation safety.
The International Society of
Radiology is proud to be a cooperating organisation.
The 2014 Newsletter editorial focused on “Promote awareness, share experience, encourage participation and
Organisations could advocate and facilitate knowledge sharing, ultimately the use of guidance tools by the
practitioners is essential to deliver
more appropriate and safer use of radiology procedures. More collaborations are necessary to integrate the
recommendations and guidance
tools into the daily workflow.
Improvement in radiological quality and safety is an on-going journey!
Kindly forward the newsletter to colleagues with interest in RQS and direct distribution or contribution queries
to [email protected].
Lawrence Lau, FACR, FAMS, FRANZCR, FRCR
Editor, ISRQSA News
Advisor to the ISR President
Message from the International Society of
Radiology (ISR) President
I am pleased to contribute to this new issue of the ISRQSA newsletter nicely edited by Dr. Lawrence Lau, this
time presented in the new
ISR Newsletter format.
The ISR has formed a Communication Committee chaired by Prof. Jose Del Cura from Spain. Social media such as
Facebook, Twitter, etc.
will be used in addition to Newsletters and Web pages to strengthen communication with ISR members and other
“ISR Newsletter" will include different sections by incorporating the established bi-annual ISRQSA News, and GO
RAD, etc. ISQRSA News
will stay as the newsletter focusing on radiological and safety issues.
It is my great pleasure to announce an innovative project on virtual education related to Radiation
Protection Training for the General
Practitioner that will be released during the third quarter of 2017. This educational
initiative joins the efforts of both the ISRQSA and
Virtual Education Subcommittees.
The driving force behind this endeavour is lead by Prof. Donald Frush and a selected group of renowned speakers
in cooperation with
IAEA. I take this opportunity to thank their efforts and dedication to fulfil this project. The program shown
below covers different aspects
of quality, safety, and communication relating to medical imaging, especially in paediatrics.
The ISR Webmaster and specialists in pedagogy using modern communication and learning tools didactically
organised the educational
content in a novel format. Multimedia graphics for better comprehension and an interesting role-play method with
reflects proper or wrong physician-patient communication on radiation risks. An ambitious interactive
audiovisual format for self-review
and reflection is included to facilitate inclusion of acquired concepts in clinical practice.
Likewise to every Virtual ISR activities free and open access is warranted worldwide, especially interesting for
public and professionals in
With this novel educational initiative, ISR rejoins its pioneering path started a decade ago with the First
Virtual Congress of Radiology,
which was followed by several other till 2013. Taking into account that the global e-learning market has grown
by 900% in the last 15
years and with the projection that 50% of classes will be provided this way in 2019, a realignment of ISR
virtual education is expected.
In this context, this flexible, effective and technologically-based model of education will undoubtedly
contribute to better worldwide
promotion and diffusion of radiation protection training and communication skills with the resultant benefits
for patients and health care.
I am looking forward to all readers to join this educational project devoted to Radiation Protection Training
for the General Practitioner
that together with many other announcements that are included in this newsletter will contribute to improving
Professor Ricardo Garcia Monaco
President, International Society of Radiology
WHO Framework for Integrated People-Centred
The WHO just launched a Framework for Integrated People-Centred
Health Services. Globally, 1 in 20 people still lacks access to essential
health services that could be delivered at a primary care clinic instead of a
hospital. Where services are accessible, they can be fragmented and of
poor quality. WHO is supporting countries to progress towards universal
health coverage by designing health services for people instead of diseases
and health institutions, so that everyone gets the right care, at the right time,
in the right place.
The concept is explained in a video “What is people-centred care?” recently
released by the WHO website. The video is a useful advocacy and
communication tool and is used to advocate for appropriate use of
radiation in health care.
Although the verbal messages do not explicitly mention “radiation” or
“radiology,” radiation/radiology feature several times in the images.
Radiology is used as an example of the unnecessary use of tests.
You are encouraged to use/share this video as it can help to integrate our
messages about the safe and appropriate use of radiation in health care
(and in particular the justification of radiological procedures) into
the broader concept of integrated people-centred health services.
The video calls for progress towards universal health coverage by designing
health services for people instead of diseases and health institutions, so that
everyone gets the right care, at the right time, in the right place.
This message is entirely consistent with what we are promoting through the
Bonn Call-for-Action and the new BSS requirements for medical exposures.
Contribution from Dr. Maria del Rosario Perez, World Health Organisation.
New IAEA Online Resources for Medical
The International Atomic Energy Agency
(IAEA) has launched new elearning
courses and free webinars aimed to provide continuing
education to medical professionals.
Two free e-learning courses have been launched in 2016, and since
then, more than 2,100 users registered and 351 certificates
completed. Each course is organised in modules, with estimated total
duration of five hours.
E-learning course on Radiation Dose Management in
Computed Tomography is designed to help learning the
appropriate use of CT, understand the various CT techniques and
scan parameters, understand CT dose metrics and dose tracking
methods, address the needs of creating various CT protocols for
different body regions and clinical questions, learn how to optimise
exposure to children and pregnant patients.
E-learning course on Safety
and Quality in Radiotherapy is
designed to help radiotherapy professionals to improve their
understanding of safety in radiotherapy, learn techniques to reduce
and avoid incidents in radiotherapy, understand the value and use of
incident learning systems, learn about useful sources of information to
enhance safety in radiotherapy, and gain insights into improving safety
culture in medical facilities.
Free Webinars on topics from Radiation Protection in Medicine have been launched in
early 2016, and since then, eleven online
webinars broadcasted and attended by 2425 participants. Five of
them have been organised jointly with Image Gently. The recorded
past webinars are available in archive through RPOP website.
Contribution from Dr. Jenia Vassileva, Radiation Protection of Patients Unit,
International Atomic Energy Agency [email protected]
With Heads, Hands and Hearts
Heads, hands, and hearts are the fundamental attributes of those
working with the Image Gently Alliance. Success takes
combination of both thinking and doing (heads and hands) but is
most compelling when the element of conviction (really, passion:
heart) is included. These attributes or no less evident in the
Alliance’s most recent campaign, aptly named “Have-A-Heart”.
This campaign was headed by Kevin Hill, MD, MS From Duke
Children's Hospital and Andrew Einstein, MD, PhD from Columbia
University Medical Centre. The campaign committee was
comprised of paediatric cardiologists, including cardiac
interventionalists, adult cardiologists, radiologists with cardiac
imaging expertise, technologists, and medical physicists exemplary
of the multi-stakeholder value of Alliance efforts, including
In addition to the material on the Alliance’s website,
statement on informed use of modalities that use ionising radiation
in the Journal of the American College of Cardiology Cardiovascular
Imaging was coincident with the campaign release. This project was
the effort of multiple specialties, and represents a consensus
agreement by 13 organisations. This article ”Radiation Safety in
Children with Congenital and Acquired Heart Disease: A Scientific
Position Statement on Multimodality Dose Optimisation from the
Image Gently Alliance” is available at no charge, sponsored by the
Image Gently Alliance.
The Have-A-Heart Campaign was an important collaboration
between specialties that use ionising radiation in the care of
children with congenital and acquired cardiovascular disorders and
is a testimonial to shared thinking, doing, and passion: heads, hands
Contribution from Donald Frush, MD; Chair, Image Gently Alliance.
Have-A-Heart Campaign Participants
Image Gently Alliance Member Organisations, including:
American Association of Physicists in Medicine (AAPM)
American College of Radiology (ACR)
American Society of Radiologic Technologists (ASRT)
Society for Paediatric Radiology (SPR)
Additional Participating Societies:
American Academy of Paediatrics (AAP)
American College of Cardiology (ACC)
American Society of Nuclear Cardiology (ASNC)
Heart Rhythm Society (HRS)
North American Society for Cardiovascular Imaging (NASCI)
Paediatric and Congenital Electrophysiology Society (PACES)
Society for Cardiovascular Angiography and Interventions (SCAI)
Society of Cardiovascular Computed Tomography (SCCT)
Society of Nuclear Medicine and Molecular Imaging (SNMMI)
Campaign launch Press Release: Medical Groups Join Forces to
Improve Cardiac Imaging Use in Children “Have-A-Heart
Campaign” to Empower More Informed Patient-Provider Imaging
Using Social Media to Image Wisely®
Social media has become one of the most
effective ways to communicate the
importance of radiation safety.
During 2017, members of the Image Wisely Executive
Committee have started delivering
regular news and related resources to
radiologists, medical physicists, radiologic
technologists, other imaging practitioners and
patients on Facebook and Twitter accounts.
Promote Key Messages
Our leaders are encouraging colleagues to like,
share and retweet essential messages about
the importance of radiation safety and
pledging annually to Image Wisely. These
messages link our followers to comprehensive
information on the initiative’s website.
Committee members recently crafted new
material to address concerns about exposure
to ionising radiation from medical imaging
and treatment, by focusing on
- Must-read articles
- Electronic education exhibits from RSNA
- Radiation safety cases
- Regulations and standards updates
Image Wisely’s reach continues to grow, with
nearly 2,500 Facebook and 1,800 Twitter
On Twitter, Image Wisely’s messages get
amplified through retweeting to the American
College of Radiology (ACR) 27,000 and
Radiological Society of North America (RSNA)
We hope that our sister organisations will
spread the word. You’ll find cases, pledge
announcements, electronic educational
exhibits, important dates and other related
news to share.
Follow Image Wisely on Facebook, Twitter
With your help, we can extend Image Wisely’s
reach. Please consider following our Facebook
and/or Twitter accounts. Together, we can
increase awareness, increase the number of
pledges, share content, foster engagement
and drive individuals to our website.
Don’t know how to use Facebook or Twitter?
Social media is a tool. See how others use it
first — and then find out what feels right for
you. There are no hard rules. Experiment with
it: Use it a little or a lot. Use the Facebook
and/or Twitter app on your smartphone while
you’re waiting in a line or at other downtimes
or during a professional conference. You can
find “how-tos” on the ACR and RSNA
websites. If you’re interested in contributing
content to the Image Wisely website, please
contact Elliot Fishman at [email protected]
Specific thanks go to members of the Image
Wisely Executive Committee who are helping
to grow out ongoing social media efforts.
- Richard L. Morin, PhD, FACR, FAAPM, Co-Chair,
- Kimberly Applegate, MD, MS, FACR, ACR
- Laura Bancroft, MD, ACR Private Practice
- Rober t G. Dixon, MD, RSNA
- Donald P. Frush, MD, FACR, Image Gently
- Eric L. Gingold, PhD, AAPM, Representative
- Amy K. Hara, MD, ACR Representative
- Mary Mahoney, MD, FACR, RSNA Board
- Greg Morrison, MA, RT (R), ASRT
- Jay K. Pahade, MD, Young Physician
- Pari V. Pandharipande, MD, RSNA
- Don C. Yoo, MD, RSNA Representative
The Image Wisely® initiative is a collaborative
effort of the American College of Radiology
(ACR), the Radiological Society of North
America (RSNA), the American Association of
Physicists in Medicine (AAPM) and the
American Society of Radiologic Technologists
(ASRT). Image Wisely’s primary goals are
raising awareness and providing information
and educational material about the use of
ionising radiation in medical imaging. The chief
mechanism for distributing this information is
a dedicated website
, which provides resources
and information for imaging professionals. In
addition, related information may also be
found on its Facebook
Contribution from Elliot K. Fishman, MD, FACR, Image Wisely Executive Committee Vice Co-Chair, and William W.
Mayo-Smith, MD, FACR, Image Wisely Executive Committee Co-Chair
17th French-Tunisian (AFTR) Congress of
Radiology & 4th Congress of
the African Society of Radiology (ASR): Report on “AFROSAFE
The 17th French-Tunisian (AFTR) Congress of
Radiology and the 4th Congress of The African
Society of Radiology (ASR) was held in Royal
Hotel Hammmet from March 31st to April
2nd. A large part of the program was
dedicated to safety in radiology and radiation
protection in order to adopt the establishment
of Francophone arm of AFROSAFE which
was launched in October 2016 at the French
Radiological Congress in Paris.
The organisers of this session include
member s from the AFROSAFE
(Francophone) steering committee,
representatives of Francophone African
national and regional Societies of radiology
(SRANF), Maghreb, Algeria, Tunisia, Morocco,
Senegal, Cameroon, Cote d’Ivoire, Burkina
Faso, Congo), as well as industr y
representatives who had attended the Paris
Key personalities were invited to this session
in Tunisia. These include:
- The head of EuroSafe within ESR: Prof.
Guy Frija (France);
- 2 international experts of the IAEA
(thanks to TC Project Manager Ms.
Debby Gillet): Prof. Mansouri Boudjema
(Algeria) and Dr. Dina El Husseini
- WHO Representative: Dr. Maria del
Rosario Perez (Geneva);
- The President of African Society of
Radiology (ASR): Prof. Sudhir Vinayak
- The President of Kenya Association of
Radiologists: Dr. Gladys Mwango (Kenya);
- Director of the CNRP: Prof. Asma Zidi
The Session took place on Saturday 1st April
2017 and the afternoon was divided into
three sessions followed by discussion and
conclusions. It was chaired by Prof. Azza
Hammou and Prof. Sudhir Vinayak. We had
round table discussions about radiation
protection campaigns presented by regional
organisations, challenges and identified
opportunities, IAEA and WHO points of view,
continuation of policy decisions and strategic
This was then followed by a plenary session
where all registered persons were invited. The
plenary speech was given by Prof. Guy Frija
and the topic was “European perspectives in
It had been suggested by our experts from
IAEA and WHO to integrate radiation
protection talks within the rest of the general
radiology program. This was incorporated and
there was an excellent response since many
registrants attended and showed interest.
The AFROSAFE session was very successful as
it allowed participants to share and discuss
national, regional and global experiences in identifying common problems and propose
relevant solutions. Many objectives were
identified and discussed; amongst them were
these important issues:
- The shortage of medical physicists;
- Quality systems implementation;
- Patient dose evaluation and
- National and local DRLS establishment
with new concept basis;
- Establishment and implementation of
Clinical Referral Guidelines using modern
- Tools and challenges of dissemination and
- Patient information systems; and
- A new concept was developed for DRLS
based on clinical indications and
In summary, we can conclude that the
Francophone arm of AFROSAFE
namely “AFROSAFE F”
is an important
and promising project. It will enrich radiation
protection within imaging practice of Africa.
Establishment of a strategic action plan and
its implementation tools are still to be
finalised. Heterogeneity and gaps have to be
identified and objectives updated according to
new concepts of justification and optimisation
tools, but the steering committee is
determined to succeed.
Contribution from Profs. Azza Hammou and
ArabSafe - An Initiative to Adhere to the Bonn
Call-for-Action in the
ArabSafe was launched during the Arab Health Congress in Dubai, United
Arab Emirates (UAE) early 2017 with the support of local authorities,
international societies, and professionals in the field of radiation protection to
adhere to the Bonn Call-for-Action in the Arab World. Soon after that,
several meetings took place in Saudi Arabia, UAE, Qatar, and Morocco with
international societies and organisations to establish campaign action plan
and identify the ArabSafe Steering Committee.
Across the world, a rallying appeal for health professionals to implement the
principles of radiation protection and radiation safety is still enduring. There
is an apparent effect from campaigns like Image Gently, Image Wisely,
EuroSafe Imaging, Canada Safe Imaging, and many more throughout the
world that highlight the importance of the joint statement of position of the
IAEA and WHO known as Bonn Call-for-Action, the result of an
International Conference on Radiation Protection in Medicine in December
Almost five years later, ArabSafe was initiated to
adhere to the Bonn Callfor-Action
by implementing the ten actions to promote and encourage
compliance with standards, policies, strategies and activities that create a
radiation safety culture in the Arab World.
During the 9th Pan Arab Radiology Conference held in Marrakesh, ArabSafe
was officially inaugurated on 5th May, 2017 with the support of the Pan
Arab Association of Radiological Societies (PAARS), EuroSafe Imaging,
International Society of Radiology (ISR) and Image Gently Alliance.
This initiative aims to impact the current diagnostic imaging practice,
support self-regulation, increase awareness of radiation safety of patients,
workers, and the general public, and promote a radiation safe culture.
Each Arabic country will foresee the implementation of the campaign,
depending on its capabilities and situation, by promoting the Bonn Call-for-Action
to their local authorities, governing bodies, scientific societies, and
A logo has been considered for the campaign. In addition, an official
website has been designed and is currently in use and will be available in
Arabic, English and French once it's fully developed.
- Involve radiation health professionals in Arab countries;
- Educate about the benefits and risks of radiological procedures;
- Start regular radiation dose monitoring, recording and reporting of all
diagnostic imaging procedures;
- Promote use of guidelines and appropriateness criteria for referrals;
- Promote regular professional development and training;
- Create public awareness on radiation safety;
- Develop international relationships; and
- Each country will foresee the implementation of the campaign,
depending on its capabilities and situation, by promoting the Bonn Call
for action to their local authorities, scientific societies, and professionals.
The ArabSafe Steering Committee
- ArabSafe - UAE Chapter has been working on several activities within
healthcare organisations in UAE including a Radiation Safety Program
and Campaign at a national level;
- ArabSafe - Saudi Arabia Chapter signed an agreement with the Saudi
Patient Safety Centre under the Ministry of Health to establish a
National Radiation Safety Program that includes courses, awareness
material, diagnostic reference level (DRL) pilot study, and the
implementation of tools for appropriateness and referrals; and
- Close collaboration with AFROSAFE campaign since several countries
share similar cultural barriers and challenges.
- Secretary General: Prof. Mansouri Boudjema , Algeria
- Deputy Secretary General: Dr. Eng. Sarah Hagi, Saudi Arabia
- Members: Dr. Jamila Salem Al Suwaidi , UAE and Dr. Dina Husseiny,
Egypt in addition to members assigned by chairmen of radiological
societies in Arab countries who signed the ArabSafe agreement on
May 5th, 2017.
Contribution from Associate Professor Sarah K. Hagi, Faculty of Medicine,
King Abdulaziz University, Jeddah, Saudi Arabia.
Radiological Quality and Safety Activities from China
The Quality and Safety Subcommittee of Chinese Society of Radiology
held its 2017 Annual Meeting in Nanjing, Jiangsu from June 2 to 4, 2017.
Amongst others, the following is an outline of the four hot topics
1. Radiological Technique Optimisation
Radiological quality and safety experts in China have published
consensus recommendations for digital radiography and CT scanning to
guide best practice in image quality and diagnostic data optimisation,
and patient safety. Studies have shown that normalisation and regular
quality control actions in digital mammography significantly improve
procedure quality and diagnostic accuracy.
2. Radiation Protection of Patients
The Chinese experts have conducted studies and published reports on
radiation protection in paediatric radiology.
3. Radiology Infrastructure Modernisation
At present, the vast majority of hospitals in China use a combined
manual and electronic system for the storage of medical records. It will
take some time before system-wide implementation of a paperless, fullyintegrated,
and user-friendly electronic medical record (EMR) system.
Before the introduction of EMR, it is worth considering the: (1) adoption
of a staged implementation; (2) provision of secure and controlled data
access; and (3) identification of an appropriate EMR system for a
With the modernisation of radiology infrastructure underway, many
departments in large and medium-sized hospitals in China consider the
transition to a digital environment as one of their missions and priorities.
Many of these hospitals have already implemented digital information
systems. An integration of a Picture Archiving and Communication System (PACS), Radiology Information System
(RIS) and Hospital
Information System (HIS) provides a common platform towards
seamless workflow, patient data storage, and retrieval. China has
become the world's largest Internet-using nation since 2002. This
infrastructure and IT experience offer opportunities and facilitate
improvements in radiological quality and safety.
4. Quality Radiology Practice
Many factors influence the quality of data interpretation, radiology
reporting, and radiological diagnosis, e.g. workload (i.e. volume and
complexity), workforce (i.e. capacity, capability, competency, expertise,
experience, attitude, and moral, etc.), image quality, network status, etc. It
is important to strike a balance between the demand for timely
reporting and the quality and accuracy of interpretation. Examples of
opportunities to improve turn-around-time and accuracy of interpretation
include team collaboration, knowledge sharing, human-machine interface
enhancement and continuing education and training, etc.
Liang Wang (王良), Department of Radiology, Tongji Hospital,Tongji
Medical College, Huazhong University of Science & Technology, Wuhan,
China [email protected]
Wenzhen Zhu (朱⽂珍), Department of Radiology, Tongji Hospital,Tongji
Medical College, Huazhong University of Science & Technology, Wuhan,
Guangming Lu (卢光明), Department of Radiology, Nanjing Jinling
Hospital, Medical College of Nanjing University, Nanjing, China
Shiyuan Liu (刘⼠远), Department of Radiology, Shanghai Changzheng
Hospital, Second Military Medical University, Shanghai, China
Zhengyu Jing (⾦征宇), Department of Radiology, Peking Union Medical
College Hospital, Chinese Academy of Medical Sciences, Beijing, China
Proactive Leading Steps to Implement Clinical
Imaging Guidelines in
The medicine of the ancient Egyptians is considered the oldest documented
evidence in Edwin Smith papyri. It was highly advanced for that time and
included simple non-invasive surgery, emergency and injury treatment,
setting of bones, dentistry, and a comprehensive set of pharmacopoeia. The
earliest recorded physician in
the world was the Egyptian Pharos Hesy-Ra,
who practiced medicine in ancient Egypt and was the "Chief of Dentists
and Physicians" to King Djoser, who ruled in the 27th century BC.
Meanwhile, Egypt is now taking the lead in the implementation of Clinical
Imaging Guidelines (CIG) in the African and Arab regions, to justify
radiological examinations and improve radiology practice through the
appropriate use of CIG.
This process is run by a volunteer team of Egyptian expert radiologists from
several Egyptian universities led by Dr. Dina Husseiny via two approaches.
1st Approach: Education
A novel approach has been established in Egypt to ensure concrete CIG
implementation, which is different from other countries who focused only on
training. Education carves knowledge in the mind of health professionals.
"Education proved successful with medical classifications, like TNM and
other clinical guidelines,” Dr. Dina Husseiny added.
Accordingly, CIG has been integrated, for the first time, in undergraduate and
postgraduate medical and radiographer’s education curriculum. Ten
Egyptian medical universities adopted our curriculum design. "We did not
find an available curriculum to adopt, so we decided to design one of our
own that would be suitable for our educational system.”
2nd Approach: Spreading CIG via successive national,
regional and international events
a) An “IAEA Experts and Champions Meeting on CIG” was held in Cairo in
February 2017; with the participation of IAEA, WHO, Royal College of
Radiologists, Deans of Egyptian Universities, Presidents of Medical Societies,
and African Experts to discuss the implementation of CIG in Africa.
b) Three workshops on CIG were held in March and April 2017, at Ain
Shams University (ASU), Armed Forces College of Medicine (AFCM) and
Misr University for Science and Technology (MUST) for health practitioners
and medical students.
c) The Egyptian Society of Radiology and Nuclear Medicine and the
Egyptian Atomic Energy Authority in their joint activities and conferences
decided to make CIG a fixed session in all their future events to ensure
sustainability. There is current cooperation with EuroSafe Imaging (Prof. Guy
Frija, Chairman) and RCR experts (Dr. Joanna Brown and Dr. Denis
Remedios) in this regard.
d) Being the country with the highest IAEA regional performance indicators
in radiation protection in Medicine, Egypt supported the African Society of
Radiology meeting in Tunisia April 2017 and the Pan Arab Association of
Radiological Societies PAARS meeting in Marrakesh in May 2017, to
introduce models and value of CIG to the region as an IAEA expert. This is
in cooperation with the African Society of Radiology, EuroSafe Imaging,
WHO, and AFROSAFE. Egypt is also a founding member of the newly
launched ArabSafe campaign that will support radiation safety in the Arab
regions. Egypt will host the next Pan Arab Association of Radiological
Societies PAARS conference in 2018, and being the moderator of the
radiation protection sessions in this meeting, Dr. Dina Husseiny confirms that
CIG will largely and effectively take place in the coming PAARS.
e) Egypt is currently cooperating with six countries in Africa to implement
CIG in the region in an IAEA project.
Contribution from Prof. Dina Husseiny Salama, Head of the Radiology
Department, Egyptian Atomic Energy Authority, Chairman of the
Radiation Protection Committee, Director of Radiation Protection Division
at Egyptian Society of Radiology and Nuclear Medicine, National
Counterpart and International Expert for IAEA and WHO.
Challenges and Possible Solutions Concerning
Procedure Justification, Optimisation, and Adverse Event Minimisation in
Life without challenge is not worth living; our ability to resolve the
challenges is what makes the world interesting and exciting. It’s all
about Interventional Radiology (IR) and radiation protection in Nigeria.
Interventional radiology is a subspecialty of radiology that employs the
use of minimally invasive and targeted disease treatment options under
imaging guidance. It is less invasive than surgery, often done on an
outpatient basis, does not usually require general anaesthesia, has
reduced morbidity and mortality and shorter hospitalisation.
Available IR procedures in Nigeria include balloon angioplasty and
stenting, renal angioplasty, carotid and mesenteric angioplasty, venous
stents like IVC filters, thrombolysis under imaging guidance, embolisation,
treatment of infertility via fallopian tube recanalisation and varicocele
embolisation, ablations, and image-guided biopsy and drainage.
The application of IR continues to expand as new techniques are
continuously evolving. These techniques have replaced or are fast
replacing more expensive and traumatic surgical procedures. Patients
understand the benefits of these techniques and demand greater access.
Procedure Justification in Interventional radiology
The concept of procedure justification in IR has been poorly addressed.
Interventional radiology poses an entirely new set of questions when
considering justification. Specifically, risks to both patients and staff have
to be considered on the one hand. On the other hand, there are risks
from radiation, contrast medium complications, etc. Benefits which
patients accrue relate to reduced morbidity. There are few scientific
studies comparing clinical outcomes of IR with alternative surgical
approaches which are very important for the development of referral
guidelines which is an important tool in procedure justification and
informed choice about alternative techniques.
The Nigerian Nuclear Regulatory Authority (NNRA) has produced a
guidance document on IR procedures. The Nuclear Safety and Radiation
Protection Act (1999, no.19) stipulates that medical exposures shall be
justified by weighing the diagnostic benefits they produce against the
radiation detriment they might cause, taking into account the benefits
and risks of available alternative techniques that do not involve medical
exposure. Also, the medical practitioner shall consider the efficacy,
benefits, and risks of alternative diagnostic modalities, e.g. ultrasound or
magnetic resonance imaging. In justifying each type of examination by
radiography or fluoroscopy, relevant guidelines will be taken into account,
such as those established by the World Health Organisation. The
issue is that of implementation and enforcement.
Development of referral guidelines is essential and incorporation with
emphasis on its importance during training of physicians and radiation
workers is essential in procedure justification.
The concept of optimisation was introduced in the 1940s by the
International Commission on Radiological Protection (ICRP) as a direct consequence of the recognition of
stochastic effects. According to the
Nuclear Safety and Radiation Protection Act (1999, no.19), any medical
practitioner who prescribes or conducts radiological diagnostic/
interventional examinations shall ensure that appropriate equipment is
used and that the exposure of patients are kept minimum as necessary
to achieve the required objective.
A medical practitioner, technologist or other imaging staff should select
the technical parameters, as relevant, such that their combination
produces the minimum patient exposure consistent with acceptable
image quality and the clinical purpose of the examination.
Adverse Event Minimisation
In IR an adverse event is an unexpected harm that results from an
interventional procedure and is unrelated to the patient’s underlying
medical condition. The harm may vary from mild and reversible to death.
All such events must be reported to the Joint Commission on
Accreditation of Healthcare Organisations (JCAHO) as well as to local
regulatory authorities. This is not an issue in Nigeria.
The major challenges in Nigeria are the professional rivalry between the
radiologists and radiographers on professional boundaries that gave
room to quackery. Secondly, an uncontrolled importation of used/
refurbished radiology equipment and the non-involvement of the
radiologists in setting policies that pertain their profession. The
Nigerian Society of Interventional Radiology is working
hard to resolve existing challenges. However, despite all the challenges
interventional radiology continues to grow in Nigeria.
Contribution from Professor Ahmed Ahidjo and Dr. Mohammed Lawan,
Department of Radiology, College of Medical Sciences, University of
An Update from the International Organisation
for Medical Physics
The history of the International Organisation
for Medical Physics (IOMP) spans over more
than 50 years. In this period of time, we saw
dramatic changes in healthcare and in
particular, the progress of medical technology.
While in mid-1960 there were about 6,000
medical physicists globally (mainly in the USA
and the Western world), now these are about
25,000 globally, with many medical physicists
in low-and-medium-income countries.
IOMP has made special contributions to
medical physics education and training. In the
past two decades, IOMP co-organised nearly
100 workshops, seminars and courses with
attendees from about 85 countries. The most
significant professional development was in
Asia, where in the past decade the growth of
medical physics specialists is over 120%. Due
to this reason, the International Conference on
Medical Physics in 2016 was held in Bangkok,
organised by the Thai colleagues and the
South-East Asian Federation of Organisations
for Medical Physics (SEAFOMP). At this large professional event, IOMP organised a special
School with 42 educational symposia, which
attracted hundreds of students and young
Quality and safety is the hallmark of medical
physicists’ day-to-day activities, be it in imaging
or in therapy. While every medical physicist
plays this role in day-to-day work, the IOMP
deals with international organisations. IOMP
is a recognised NGO with IAEA and WHO
and collaborates with ISR and IRPA. IOMP
participated in the Third
Global Forum on
Medical Devices held at Centre International
de Conférences Genève (CICG) on 10-12
During the last 6 months, IOMP jointly with
IRPA, WHO and Middle East Federation of
Organisation of Medical Physics (MEFOMP)
organised its 4th Regional Workshop on
Radiation Safety Culture in Healthcare at
Doha, Qatar on 6-7 February 2017. The
Hamad Medical Corporation was the local organiser. There were 153 participants from
5 countries of the region (Saudi Arabia,
Lebanon, Egypt, UAE besides Qatar).
Back in 2013, IOMP established the 7th
November as the International Day of
Medical Physics (IDMP) and this day is
celebrated every year with different themes.
The IDMP website provides information about
the IDMPs. The theme for 2017 IDMP is
Providing a Holistic Approach to Women
Patients and Women Staff Safety in Radiation
Medicine. This is in recognition of the fact that
2017 marks the 150th Anniversary of the
birth of Marie Sklodowska Curie whose
birthday was chosen by IOMP to be IDMP.
Due to this reason, the latest issue (March
2017) of the IOMP
Physics World is dedicated to women in the
Contribution from Prof. Madan Rehani, Vice
President and Prof. Slavik Tabakov, President,
International Organisation for Medical Physics.
An Update from the World Health Organisation
3rd WHO Global Forum on Medical
World Health Assembly WHA70
The 3rd Global Forum on
Medical Devices was held from 10th to 12th May 2017, in the
Geneva Conference Centre. It included
plenary, panels, parallel sessions, workshops,
exhibition and poster sessions. WHO is
preparing the report and will upload the
abstracts and presentations to the website, to
be ready by the end of June.
Forming part of the WHO Medical Devices
Technical Series, the WHO recently launched
WHO Hospitals website
- From 1st July 2017 Dr. Tedros, from
Ethiopia will become the Director General
of the WHO;
- The Cancer Resolution that calls for a
strengthening of infrastructure and
technologies was approved; and
- Many other interesting discussions took
place during the WHA covering sepsis,
antimicrobial resistance, emergencies
response, health workforce, etc.
WHO will update the “Hospitals” website
and stakeholders’ information is important, e.g.
WHO Survey on technical resources for
hospitals for XXI century
4th Global Forum on Human
Resources for Health
The Health Workforce Department is
organising the 4th Global Forum on Human
Resources for Health
to be held from 13th to
17th November 2017 in Dublin, Ireland.
The Forum will be an excellent opportunity to
share the experience with other professionals
and technicians managing or using health
Contribution from Drs. Adriana Velazquez
Berumen and Maria del Rosario Perez, World