Attention. Therefore, all the data and statements made in this presentation are preliminary and might change in the future.

Transcription

1 Attention The aim of the Dose Datamed II workshop in Athens was to present preliminary data, collect feedback from the audience and to work towards final results and conclusions. Therefore, all the data and statements made in this presentation are preliminary and might change in the future. Please use the data with care and indicate its preliminary character! We would appreciate any feedback made based on the data presented with an at:

2 INTRODUCTION TO POPULATIN DOSE ESTIMATIONS IN DDM2 Workshop on European Population Doses from Medical Exposure April 2012 Ritva Bly Project Coordinator STUK, Finland

3 BACKGROUND 1/2 The guidance developed under the DOSE DATAMED1 project, together with best available survey data from these ten countries around the year 2002, is published by the European Commission as Radiation Protection 154. European Guidance on Estimating Population Dose from Medical X-ray Procedures (RP154). Dose Datamed 1 started in the end of RP 154 was published 2008.

4 BACKGROUND 2/2 Rapid technological development during the last decade and the need for updated comparable data about the doses from medical exposure procedures, in X-ray diagnostics, interventional radiology and nuclear medicine (NM), in the European Union Member States. The availability of population dose data will facilitate the implementation of radiation protection requirements in the EU Member States as well as the future decision-making on these matters on national and EU level.

5 Collective effective dose from TOP20 examinations of 12 European countries in S, TOP20, msv/1000 population INTERVENTION RADIOGRAPHY/FLUOROSCOPY PLAIN FILM RADIOGRAPHY COMPUTED TOMOGRAPHY 0 DE BE CH IS FR NO SE NL LI DK FI UK Aroua A. et.al. Collective doses from medical exposures: an intercomparison of the TOP20 radiological examinations based on EC guidelines RP 154; European IRPA 2010, Helsinki

6 DURATION OF THE DDM2 Project started 28 th December 2010 Final report until 27 th December 2012 Project will end 27 th March 2013

7 OBJECTIVES The objective of the project is to collect available data on the doses from radiodiagnostic procedures in the European Union and to facilitate the further implementation of Radiation Protection 154. To achieve the above objectives, the study aims at 1. Providing advice and collecting feedback from the application of the guidance RP 154; 2. Providing estimates of population doses in EU Member States and the population dose in European Union as a whole; 3. Providing a database for population dose information which will enable continuous collection and follow-up of European population doses.

8 ORGANIZATION Provide link to worldwide surveys Observer WHO/ UNSCEAR Give support Coordinator STUK (WP1) Ritva Bly Panel of Scientific Experts Give support GAEC (WP6) Stavroula Vogiatzi STUK (WP5) Hannu Järvinen NCRRP (WP4) Jenia Vassileva NRPA (WP3) Hilde Olerud Public Res. Centre Henri Tudor (WP2) Andreas Jahnen Provide data Give support National contact persons

9 OBSERVERS Observer World Health Organization (WHO) and United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) Ferid Shannoun (WHO) Malcolm Crick (UNSCEAR)

10 No Name Country and Institute 1 Abbas Aroua, Switzerland Chairman IRA PANEL OF SCIENTIFIC EXPERTS Brief description Participant to DDM1. Member of HERCA WG6. Involved since mid-1990s in conducting nationwide surveys on the exposure of the Swiss population to medical X-rays. 2 Virginia Tsapaki Greece Expert in interventional radiology and CT. Participation in the European Medical ALARA network (EMAN) project as the EFOMP representative. 3 Renato Padovani Italy EFOMP 4 Anders Frank Sweden SSM 5 Bernard Aubert 6 Paul Shrimpton 7 Elke Nekolla France IRSN UK HPA Germany BfS 8 Paul Stoop Netherlands RIVM 9 Donald Mc IAEA Lean Coordinated the national study of diagnostic reference levels for diagnostic radiology ( ), assessed frequencies and collective doses at the region level (2003, 2008). Secretary General of EFOMP. Medical physicist with experiences in clinical nuclear medicine. Experienced in performing population surveys on a national and European level due to the work of HERCA WG6. Involved in the EMAN project. Participant to DDM1. Member of HERCA WG MA. Involved in national surveys (2002 and 2007) of population exposure. Medical physicist with more than 30 years experience in the development and promotion of patient dosimetry and protection in diagnostic radiology. Instrumental in the periodic performance of national patient dose surveys and the formulation of reference doses for x-ray and CT examinations. Participant to DDM1. Member of HERCA WG 6. Responsible for the assessment of medical exposures of the German population, the estimation of radiation risks due to medical exposures, and benefit risk evaluations (screening mammography, CT). Participant to DDM1 and member of HERCA. Strong expertise in Nuclear medicine.

11 Work items METHODOLOGY: SIX WORK PACKAGES WP 1: Management and coordination WP 2: General questionnaire and database WP 3: Population dose for countries with national surveys WP 4: Population dose for countries without surveys Responsible Partner STUK, Ritva Bly Public Research Centre Henri Tudor (CRP-HT), Andreas Jahnen Norwegian Radiation Protection Authority (NRPA), Hilde Olerud National Centre of Radiobiology and Radiation Protection (NCRRP), Jenia Vassileva Intensive co-operation WP 5: Population dose in EU as a whole WP 6: European Workshop STUK, Hannu Järvinen Greek Atomic Energy Commission (GAEC), Stavroula Vogiatzi

12 WP1: MANAGEMENT AND COORDINATION The project management is carried out by a lead contractor with the support of partners with relevant knowledge and experience in the field. The contractor has ensured the organization and resources needed to fulfil the objectives of the contract and has co-ordinated and supervised the work of the involved partners and the Panel of Scientific Experts, the latter one with the help of the Chair of the Panel. The contractor has regularly reported on progress to the Commission. The contractor has ensured the consultation of the relevant cooperation organizations and kept these abreast of the results of the work. This includes Working Party on Medical Exposures of the Article 31 Group of Experts and HERCA.

13 WP2: GENERAL QUESTIONNAIRE AND DATABASE 1/2 The data was collected surveying following topics: National legal and regulatory frameworks for determination, recording and collection of medical dose data. Background data on healthcare systems related to radiodiagnostic procedures, e.g. numbers of staff and equipment, referral and payment arrangements, etc. Availability of national DRLs, their respective values and national guidelines for their implementation. Information on any completed national dose surveys and estimations of population doses. Frequency and dose data of radiodiagnostic prodedures.

14 WP2: GENERAL QUESTIONNAIRE AND DATABASE 2/2 The questionnaires were based on the experiences and information collected within DOSE DATAMED 1 and it was largely consulted. The practical implementation of the questionnaires and data collection was carried out using internet based questionnaires and Excel-sheets. National contact points were identified to provide data. For the purpose of systematic evaluation of the results and to enable a continuous follow-up and update of population dose in Europe and the trends in their development, a database for population doses was established.

15 WP3: POPULATION DOSE FOR COUNTRIES WITH NATIONAL SURVEYS 1/2 The following information was collected: List of 'top 20' exams in the country, as defined in RP 154 publication. List of the five nuclear medicine examinations ('NM top 5') or more with the biggest contribution to the patient doses from nuclear medicine procedures. Frequency and effective dose data for the 'top 20 exams', 'NM top 5' and for all radiodiagnostic procedures. Gender and age distribution for the 'top 20' and 'NM top 5' exams.

16 WP3: POPULATION DOSE FOR COUNTRIES WITH NATIONAL SURVEYS 1/2 The following information was collected: List of 'top 20' exams in the country, as defined in RP 154 publication; 74, 225 or more examinations. List of the five nuclear medicine examinations ('NM top 5') or more with the biggest contribution to the patient doses from nuclear medicine procedures. Frequency and effective dose data for the 'top 20 exams', 'NM top 5' and for all radiodiagnostic procedures. Gender and age distribution for the 'top 20' and 'NM top 5' exams.

17 WP3: POPULATION DOSE FOR COUNTRIES WITH NATIONAL SURVEYS 2/2 Annual collective dose and the per caput (and, if available, per exposed patient) effective dose for: o each of the 'top 20' and 'NM top 5' exams, o the main groups of procedures, including computed tomography, plain radiography and fluoroscopy, interventional fluoroscopy and nuclear medicine, o the medical exposure from radiodiagnostic procedures as a whole. Possible national modifications for top 20 and NM top 5 lists Other information regarding the data sources, time of collection of primary data, methodologies used for data collection and processing, estimated uncertainties, etc.

18 WP4: POPULATION DOSE FOR COUNTRIES WITHOUT NATIONAL SURVEYS A limited collection of original data on national or regional level for 5 selected test countries. The aim is to test the guidelines (RP 154) and identify any deficiencies and needs for amendment or further development. A training course was organized including lectures and practical demonstrations or exercises given or conducted by the partners of the consortium. Nominating 1-2 experts or advisors for each of the test countries, in order to give practical support and advice on organizing the national survey for population dose estimation and on the analysis and reporting of the results.

19 SUPPORT TO THE 5 TEST COUNTRIES: Croatia, Italy, Poland, Slovenia and Spain Practical support and advice o on organizing the national survey for population dose estimation and o on the analysis and reporting of the results. A draft of a work plan was collaborated. The practical support and advice was given mainly by correspondence and phone conversations.

20 WP5: POPULATION DOSE IN EUROPEAN UNION AS A WHOLE On the basis of the results of WP3 and WP4, the doses to patients from radiodiagnostic procedures for the European Union as a whole will be estimated. Due considerations will be given to the lack of data for specific countries or examinations and the uncertainties in the available data. Any identified trends in the doses from radiodiagnostic procedures in the EU and in the individual Member States will be reported. Proposals for the follow-up of population doses in Europe based on the use of the established database will be presented.

21 WP6: EUROPEAN WORKSHOP The purpose of the workshop is to inform on the results and to achieve wide feedback on the European Guidance and follow-up schemes, in order to finalize the proposals before reporting to the EC. The purpose is also to encourage all countries to establish and maintain continuous population dose estimations in accordance with EC directive requirements.

22 PROJECT MEETINGS No Month Date Place Participants Objectives Luxembourg Kick-off meeting Partners EC officials To start the project To plan the survey (WP2). To decide on the first announcement for the Workshop. Extra meeting in Vienna 4th March Sofia Partners EC officials Panel members (1.PM) Discussion and conclusions on the general survey (WP2) Planning of the detailed surveys (WP3 and WP4). Connected with a training course Video conference Partners EC officials Interim discussion and analysis of the progress in WP3 and WP4. Planning the second announcement and Call for papers for the Workshop Helsinki Partners EC officials Panel members (2.PM) Extra meeting in Vienna 2nd March Athens European Workshop Partners EC officials Panel members (3.PM) Extra meeting in autumn Luxembourg Partners EC officials Analysis of the results of WP3, WP4 and WP5. Preparations of conclusions and recommendations. Detailed planning of the Workshop. Presentation of the results. Collection of feedback. Final discussion on the results of the project and the feedback from the Workshop. Preparation of final Report to the Commission and the modifications of RP154.

23 REPORTING OF THE PROJECT An interim report, showing progress of the work, will was submitted to the Commission at twelve months after the date of signature of the contract. This includes information on the work done, preliminary results regarding the doses from medical exposure in the EU and planning for the remaining period of the contract. A draft final report at 24 months will include all relevant information obtained during the execution of the contract. Results of the project. Recommendations to improve the RP 154.

24 FEEDBACK AND MODIFICATIONS