Bulgaria: Patient Radiation Exposure Tracking

Jenia Vassileva

National Centre of Radiobiology and Radiation Protection

at the Ministry of Health

Bulgaria

O Population - 7,4 millions 2490 x-ray systems:

• 1429 conventional;

• 183 mammography;

• 206 СТ

• 43 interventional

O 21 NM departments:

• 12 SPECT and и 7 planar

• 4 SPECT-CT

• 2 PET-CT

Do

seDatam

ed 2

0

500

1000

1500

2000

2500IS

HU

CH

PT

ES

DE

BE

SK

IE

AT

LV

UA

IT

FI

PL

FR

LU

LT

CZ

EE

SI

NO

CY

ME

HR

RS

SE

MT

UK

EL

NL

MD

MK

DK

BG

RO

Overall total frequency per 1000 of

population

Plain radiographyFluoroscopy

Computed tom

ographyInterventional radiology

Positive

O Ordinance № Ordinance № Ordinance № Ordinance № 30 30 30 30 of of of of 2005 2005 2005 2005 of the Ministry of of the Ministry of of the Ministry of of the Ministry of

Health on the Conditions and Terms for Health on the Conditions and Terms for Health on the Conditions and Terms for Health on the Conditions and Terms for

Providing Protection of Individuals in Providing Protection of Individuals in Providing Protection of Individuals in Providing Protection of Individuals in

Relation to Medical ExposureRelation to Medical ExposureRelation to Medical ExposureRelation to Medical Exposure

O Requires all fluoroscopy and stationary

radiography system to have DAP-meter

integrated

O All new CT systems to have dose display

and dose report to be archived with images

Challanges in implementation

O Manual recording > electronic records

O Dose tracking software in one (private) hospital

O Use of these data – for typical dose,

comparison with national DRLs

- Medical physicists insufficient (number and

qualification)

- Radiologists and radiographers motivation?!

O need of education

O role of regulators/ inspectors

What to record?RadiographyRadiographyRadiographyRadiography ProjectionProjectionProjectionProjection(s)(s)(s)(s)

DAPDAPDAPDAP

Fluoroscopy and interventional

radiology

DAP

Cumulative dose (if available)

Fluoroscopy time

Number of images

Mammography Projection(s)

MGD (if available)

CT Phases

Total DLP

CTDI (if possible)

Nuclear medicine Type of exam

Radionuclide/radiopharmaceutical

Administered activity

Dose recording/tracking

For For For For optimisationoptimisationoptimisationoptimisation

• Typical doses

• Regional/National

DRL

• Available to medical

physicists/radiology

staff/management

O Do not need patient ID

O Do not need ALL

doses

O Need details of exam

protocols

For justificationFor justificationFor justificationFor justification

• Individual dose tracking

• Available to referring

doctor and radiologists

• Perfectly together with

images (PACS)

O Need patient ID

O Do not need details of

exam protocol

Individual patient recordsO Art. 6 (2) Data from all x-ray and nuclear medicine

examinations shall be recorded in an individual diagnostic radiation passport from Annex № 1.

O Art. 8. Referring practitioner shall:1. issue written request for examination or procedure after consulting in diagnostic radiation passport and other medical documentation for previous diagnostic examinations in order to avoid unnecessary exposure;2. enter into the request the medical indications for examinations with ionizing radiation;3. refer patient for medical examination with complete supporting medical documentation.

Radiation passport

Not to record dose quantity, only exam!

Educate patients

O To ask questions

O To keep their own records (in paper form)

Electronic health recordO What we have now?

O Unique ID of any citizen

O all GPs are connected electronically to the

National Health insurance fund

O patients may have access to their health records

(info what kind of exams/procedures have been

paid by the insurance)

O Current projects/discussions:

O electronic e-health card

O National PACS – still discussions

O Dose register (national) at NCRRP

State of the art session: Patient dose tracking

and analysis

To increase the awarness of radiologists and

radiographers

INTERNATIONAL PARTNERS

SCIENTIFIC PROGRAM COMMITTEESCIENTIFIC PROGRAM COMMITTEESCIENTIFIC PROGRAM COMMITTEESCIENTIFIC PROGRAM COMMITTEEMadan Rehani (Chair) Austria

Marilyn Goske (Co-Chair) USA

Peter Jarritt UK

Tsuneo Ishiguchi Japain

Rajiv Gupta USA

Renato Padovani Italy

Virginia Tsapaki Greece

Ibrahim Duhaini Qatar

Olivera Ciraj Serbia

Simona Avramova-Cholakova (Secretary)

INTERNATIONAL ADVISORY INTERNATIONAL ADVISORY INTERNATIONAL ADVISORY INTERNATIONAL ADVISORY James Brink (Chair) ACR, RSNA,

AAPM, ASRT

Eliseo Vano (Co-Chair) ICRP

Guy Frija (Co-Chair) ESR

Ola Holmberg IAEA

María del Rosario Perez WHO

Ferid Shannoun UNSCEAR

Kin-Yin Cheung IOMP

Lawrence Lau ISR

Richard Vetter IRPA

COMMITTEECOMMITTEECOMMITTEECOMMITTEEGeorgi Simeonov EC

Ritva Bly HERCA

Graciano Paulo EFRS

Alberto Torresin EFOMP

Boudjema Mansouri Algeria

Valentin Sinitsyn Russia

Larysa Stadnyk Ukraine