Patient Radiation Exposure Tracking Spanish Perspective and initial experience

E. Vano. J.I. Ten and J.M. Fernandez San arlos !niversit" #ospital. Radiolog" $epart%ent. o%plutense !niversit". Madrid& Spain
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European Me%'er States Scenario

We have in Europe:
Common regulations. Recommended Guidelines (advisory). European research programmes.

We expect a new Directive on Basic Safety Standards (by the end of 2013 with so!e chan"es in the area of #edica$ Exposures% Wi$$ have & years for the #S i!p$e!entation%
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'urrent !ain European re"u$ation app$ied to !edica$ exposures

COUNCIL IREC!I"E #$%&'%EUR(!O) o* '+ ,une -##$ on health protection o* individuals against the dangers o* ioni.ing radiation in relation to medical e/posure.

'urrent European re"u$ation +-.&3.Eurato!

(rt% &%2: #e!ber States sha$$ pro!ote the esta'lish%ent and the use o( diagnostic re(erence levels for radiodia"nostic exa!inations %% (rts% &%3) * and +: (ppropriate )ualit" assurance progra%%es inc$udin" ,ua$ity contro$ !easures and patient dose .. assess!ents are i!p$e!ented %% (rt% 12: %% #e!ber States sha$$ ensure that the distribution o( individual dose esti%ates (ro% %edical exposure %%% is deter!ined %%

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!he aim o* the guidelines is to provide practical advice to )em0er 1tates on the implementation o* Council irective #$%&'%EUR(!O)

The experience o( several European Research Progra%%es is that recording patient doses is not enough

0he effort to record patient doses shou$d be aco!!panied by:

( : va$idation. ca$ibration of the too$s used )ualit" control o( the (ull processby 12ray syste!s to "ive dose va$ues3 proper transfer of data3 prob$e!s with wron" patient identity3 confidentia$ity3 etc% Individual and collective exploitation o( the dose data to correct as soon as possib$e the innapropriate or excesive use of radiation (!ore than si!p$y D45s 66 %
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-$ (utonomous Communities2
Comunidad Autnoma de Andaluca Comunidad Autnoma de Aragn Principado de Asturias Comunidad Autnoma de Illes Balears Comunidad Autnoma de Canarias Comunidad Autnoma de Cantabria Comunidad Autnoma de Castilla-La Mancha Comunidad Autnoma de Castilla y Len Comunidad Autnoma de Catalua Comunidad Autnoma de E tremadura Comunidad Autnoma de !alicia Comunidad de Madrid "egin de Murcia Comunidad #oral de $a%arra Comunidad Autnoma de Pas &asco Comunidad Autnoma de La "io'a Comunidad &alenciana Ciudad Autnoma de Ceuta Ciudad Autnoma de Melilla
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1pain2 &$.' millions inha0itants (3+-3) -$ (utonomous Communities

1pain has di**erent health cards *or the di**erent (utonomous Communities. !he European 4ealth card is also availa0le. 1panish Government approved a uni5ue 1panish card on 3+ 1eptem0er 3+-'

1aturday 3- 1eptem0er 3+-'

6riday 3+ 1eptem0er 3+-'

So%e *ational experiences to (ul(il *ational Regulations in Spain +IR doses shall 'e recorded individuall", D8594 ($ose -n .ine for Interventiona$ Radio$o"y is an auto!atic syste! to transfer3 process and archive patient dose reports fro! interventiona$ radio$o"y and cardio$o"y 12ray units !ade at the San arlos !niversit" #ospital in Madrid. D8594 a$$ows to 'e alerted when patient hi"h dose va$ues are produced in so!e of the catheteri:ation $aboratories to proceed with correction actions or clinical (ollo/0up if appropriate% Spanish Societ" o( ardiolog" and Spanish Societ" o( Interventional Radiolog"1 involved.
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$-.IR versi2n 3.4

D9'8# #;;S D9'8# 4DS4 in process 9!p$e!entation
;atient dose correction factors inte"rated and certified by the #edica$ ;hysics Service of the different hospita$s% 8pti!i:ation strate"ies and investi"ation and fo$$ow2up of hi"h doses responsibi$ity of the different c$inica$ and !edica$ physics services%
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OLIR 3.- 7 Interventional la0oratories lin8ed to the OLIR system 6ive University 4ospitals and -& interventional la0s

4ospital U. :rincipe de (sturias

4ospital U. :uerta de 4ierro 4ospital Cl9nico 1an Carlos

4ospital U. La :rincesa

4ospital U. 1evero Ochoa

Inter%entional Cardiology labs Inter%entional radiology labs

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Su!!ary (#adrid (ut% 'o!!unity

<u!ber of =ospita$s connected: / <u!ber of 9'.94 roo!s: 1& <u!ber of patients: +//<u!ber of studies: 12727 Sept 2012 > Sept 2013

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entral dose registr" in the 5as)ue 6utono%ous o%%unit". 7-sakidetza8 +Spain,

In(or%ation (ro% J.I. Ten0Mor2n +Sept. 394:,. Eus?adi: (utono!ous 'o!!unity with 2%2 !i$$ions inhabitants (2012 % &%-@ of the Spanish popu$ation% &%2 !i$$ions of i!a"in" procedures.year% 1& hospita$s (& reference hospita$s with A1000 beds and B12 $oca$ % C$oba$ hea$th !ana"e!ent and fu$$ inte"ration of the patient c$inica$ record (8sabideC$oba$ % 'entra$ ;('S (9#;(1 (CD( %
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Initial o';ective< =lo'al %anage%ent o( all T studies

($$ the '0 syste!s inte"rated (31 syste!s Sie!ens3 0oshiba3 ;hi$ips y CE % ;atient dose data co$$ected for a$$ the '0 procedures% Eva$uation of the proper use of the '0 procedure (Eustification % (udit of the exa!ination protoco$s used (opti!i:ation %
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6ccess to the patient dose in(or%ation

ICO) header 1C (1econdary Capture) ICO) 1R )::1 :ersonali.ed inter*aces L: reported; e**ective and organ doses estimated
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Integrated s"ste% derived (ro% the $ose-n.ine o( the S !# and 6=F6 P6 S

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Patient dose values as part o( the clinical patient record

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Main results +Januar" 39430 Sept 394:,

30 de 31 '0s fu$$y inte"rated% 2*/3000 '0 procedures re"istered in the syste!% +/ @ of the procedures with the fu$$ infor!ation% Du$$ inte"ration in the e$ectronic patient c$inica$ report Data base under eva$uation of the $oca$ !edica$ physicists (derivin" $oca$ D45 and opti!i:ation strate"ies %

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'ha$$en"es
;rofessiona$s3 so!e patients and hea$th authorities3 interested on so%e individual patient dose values (D45 are not enou"h : chi$dren3 patients with !any procedures3 patients with hi"h dose procedures3 etc% (ny syste! of radiation exposure trac?in"3 should also allo/ to i%prove the use o( %edical i%aging.

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