Sutton Leiden Presentation Dec 2008 Ds4

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2 j'aime•597 vues

drn

Santé & Médecine Business

Development of DRLs in the UK David Sutton Ninewells Hospital & Medical School Dundee, UK

Why have Diagnostic Reference Levels ? ,[object Object],[object Object],[object Object]

Perceived image quality is task and reader dependent.

[object Object],[object Object],[object Object],Why have Diagnostic Reference Levels ?

[object Object],Why have Diagnostic Reference Levels ?

What is a Diagnostic Reference Level ? ,[object Object],[object Object]

Historical Perspective – What is diagnostic? UK Survey of Patient Dose 1983-5 20 Hospitals 5 37 Pelvis AP 8 88 Abdomen AP 11 71 L Spine AP 4 43 T Spine AP 11 48 Chest PA 5 19 Skull AP Room Ratio Patient Ratio Examination

RCR “Patient Dose Reduction in Diagnostic Radiology 1990” ,[object Object]

1992 – UK National Protocol ,[object Object],[object Object],[object Object]

Doses to patients from medical x-ray examinations in the UK – 1995 review ,[object Object],[object Object],[object Object]

Revised EU Medical Exposures Directive (97/43/Euratom) : MED ,[object Object],[object Object]

MED in UK Law (1) ,[object Object],[object Object]

MED in UK Law (2) ,[object Object],[object Object],[object Object],[object Object]

MED in UK Law (3) ,[object Object],[object Object],[object Object]

Diagnostic Reference Levels ,[object Object],[object Object]

[object Object],[object Object],National Diagnostic Reference Levels

Skull Chest T Spine L spine Abdomen Pelvis Bitewing L Ob Breast UK National Diagnostic Reference Levels 2007 Ba Swallow Ba Meal Ba Enema IVU MCU Pyelography Coronary Angio Venography etc CT Head CT Chest CT Abdomen CT CA ChestAbdoPelvis (Paediatric CT and complete exams)

Variation of National DRL with time - Ba Enema : 75 th percentile threshold 1984 -2005 1984 2005

DoH Guidance April 2007 ,[object Object],[object Object]

Local Diagnostic Reference Levels DoH Guidance April 2007 ,[object Object]

DRLs The first step ,[object Object],[object Object],[object Object]

Setting Local DRLs -or- Choosing DRLs to set locally ,[object Object],[object Object],[object Object],[object Object]

How do you set Local DRLs ,[object Object],[object Object]

NDRL/ : LDRL A guide to the rather indistinct borderline between ‘good and normal practice’ and ‘bad and abnormal practice’ Local DRL NDRL

Or use your own data to set Local DRLs ,[object Object],[object Object]

Criteria for inclusion (1) ,[object Object],[object Object]

Criteria for inclusion (2) ,[object Object]

Criteria for inclusion (3) ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],Setting DRLs in your hospital ,[object Object]

How do you audit against DRLs ,[object Object],[object Object]

What do we mean by “greater than” ,[object Object]

What if your doses exceed the drl? ? ,[object Object],[object Object]

What are the most likely factors to consider if a DRL is consistently exceeded? ,[object Object],[object Object],[object Object],[object Object]

Outcome of investigation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What does a DRL do? ,[object Object],[object Object]

Balancing patient dose and image quality ,[object Object],[object Object]

And Finally ,[object Object],[object Object],[object Object]

THANK YOU FOR YOUR ATTENTION Ninewells Hospital & Medical School

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