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Improving methods to assess medical x-ray exposure of the Swiss population

English title Improving methods to assess medical x-ray exposure of the Swiss population
Applicant Aroua Abbas
Number 127461
Funding scheme Project funding (Div. I-III)
Research institution Institut de Radiophysique Département de Radiologie Université de Lausanne/CHUV
Institution of higher education University of Lausanne - LA
Main discipline Medical Statistics
Start/End 01.08.2010 - 31.07.2012
Approved amount 135'763.00
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All Disciplines (2)

Discipline
Medical Statistics
Cancer

Keywords (6)

Frequency of x-ray examinations; Tarmed codes; Radiological risk; Radiation dose; Patient exposure; Medical dose to the population

Lay Summary (English)

Lead
Lay summary
The radiological risk associated with x-rays in medicine became recently a burning issue for some specific cases: e.g. CT modality and exposure of children. It is dealt with by means of two principles of radiation protection: justification and optimisation, which are able to guarantee the best use of x-ray: to obtain the required diagnostic information with the lowest dose cost. The aim of this work is to develop a new methodology for assessing the exposure of the Swiss population by medical x-rays, using an automated method for surveying the frequency of diagnostic and interventional examinations and more appropriate radiological risk quantifiers. The objectives of the project are: a) to explore the appropriateness of the Tarmed coding system; b) to review the frequency and dosimetric data for the year 2008 and update the collective detriment to the Swiss population due to medical x-ray exposure; c) to develop new quantifiers of radiological risk more adapted to medical irradiation; and d) to compare the medical irradiation of the Swiss population in 2008 with other countries. The appropriateness of the Tarmed coding system will be assessed based on the SantéSuisse database. The Tarmed data will be used in conjunction with the annual statistics collected mainly from hospitals, a sample of medical practices and other healthcare providers such as dentists and chiropractors. The dose data collected over the past five years will be adapted and used and ad hoc investigations will be conducted for the modalities and types of examinations for which the doses must be updated. The use of basic dose quantities such as the dose equivalent in the exposed organs and tissues and the peak skin dose will be considered. Comparisons with European and international data will be performed using the methodologies of the European group Dose Datamed and the UNSCEAR. The main results of this work will be a validation of the method of using the Tarmed system for automatic collection of x-ray frequency data in Switzerland. New radiological risk quantifiers accounting for both stochastic and deterministic effects and better suited to medical irradiation will be tested and introduced. The level of exposure of the Swiss population by medical x-rays in the year 2008 will be determined and compared to the situation in other countries. The scientific information obtained from this study is of great interest for the scientific community dealing with the exposure of the population by diagnostic and interventional radiology, and is also of practical use for many national and international bodies dealing with public health in general, and radiation protection in particular.
Direct link to Lay Summary Last update: 21.02.2013

Responsible applicant and co-applicants

Publications

Publication
Exploring the use of the Swiss medical tariffication codes (TARMED) in the establishment of the frequency of radiodiagnostic examinations
Le Coultre Régis, Aroua Abbas, Samara Eleni-Theano, Rochat Maxime, Coendoz Stéphane, Verdun Robert Verdun (2012), Exploring the use of the Swiss medical tariffication codes (TARMED) in the establishment of the frequency of radiodiagnostic examinations, in Swiss Medical Weekly, 142(w13677), 1-7.
Swiss population exposure to radiation by interventional radiology in 2008
Samara Eleni Theano, Aroua Abbas, Bochud François O., Bize Pierre, Verdun Francis R. (2012), Swiss population exposure to radiation by interventional radiology in 2008, in Health Physics, 103(3), 317-321.
Patient Radiation Risk in Interventional Cardiology
Samara Eleni-Theano, Aroua Abbas, Bochud François Oswald, Delabays Alain, Laedermann Jean-Pascal, Verdun Francis Robert (2012), Patient Radiation Risk in Interventional Cardiology, in OMICS Journal of Radiology, 1(2), 1-9.
Exposure of the Swiss Population By Medical X-Rays: 2008 Review
Samara Eleni Theano, Aroua Abbas, Bochud François O., Ott Barbara, Theiler Thomas, Treier Reto, Trueb Philipp R., Vader John-Paul, Verdun Francis R. (2012), Exposure of the Swiss Population By Medical X-Rays: 2008 Review, in Health Physics, 102(3), 263-270.
Protection of the Patient and the Staff from Radiation Exposure During Fluoroscopy-Guided Procedures in Cardiology
Verdun Robert Verdun, Aroua Abbas, Samara Eleni-Theano, Bochud François Oswald, Stauffer Jean-François (2011), Protection of the Patient and the Staff from Radiation Exposure During Fluoroscopy-Guided Procedures in Cardiology, in Suna Kirac (ed.), InTech, Rijeka, 367-378.
An audit of diagnostic reference levels in interventional cardiology and radiology: are there differences between academic and non-academic centres?
Samara Eleni-Theano, Aroua Abbas, De Palma R, Stauffer JC, Schmidt S, Trueb PR, Stuessi A, Treier Reto, Bochud François Oswald, Verdun Robert Verdun (2011), An audit of diagnostic reference levels in interventional cardiology and radiology: are there differences between academic and non-academic centres?, in Radiation Protection Dosimetry, 148(1), 74-82.
Patient doses in CT examinations in Switzerland: implementation of national diagnostic reference levels
Treier Reto, Aroua Abbas, Verdun Robert Verdun, Samara Eleni-Theano, Stuessi A, Trueb PR (2010), Patient doses in CT examinations in Switzerland: implementation of national diagnostic reference levels, in Radiation Protection Dosimetry, 142(2-4), 244-254.

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Annual Meeting of the Swiss Society of Radiobiology and Medical Physics 14.11.2012 Bienne, Suisse
Dose Data Med 2 Workshop 24.04.2012 Athens, Greece
Journées scientifiques de la Société Suisse de Radiologie 09.06.2011 Interlaken, Suisse
13th EAN Workshop. “ALARA and the medical sector” 07.06.2011 Oscarsborg Fortress, Norway
Workshop on Population doses for countries without national surveys 19.05.2011 Sofia, Bulgaria
European Congress of Radiology 03.03.2011 Vienna, Austria
Journées scientifiques de la Société Suisse de Radiobiologie et de Physique Médicale 11.11.2010 Wabern, Suisse
Colloque « CT et radioprotection: état de la situation » 25.09.2010 CHUV, Lausanne
International Conference on Radiation Protection in Medicine 01.09.2010 Varna, Bulgaria


Associated projects

Number Title Start Funding scheme
100794 Investigation of new developments in diagnostic and interventional radiology and establishment of the related dose distribution among the Swiss population 01.05.2003 Project funding (Div. I-III)

Abstract

Background: There is no need any more to demonstrate the importance of x-rays as an extremely useful tool in diagnostic and interventional radiology. However, the sound advantage of using x-rays may be offset by the associated radiological risk, which became recently, when the media took hold of it, a burning issue for some specific cases: e.g. CT modality and exposure of children. The radiological risk to the patient is dealt with by means of two principles of radiation protection: justification and optimisation. These principles, when properly applied, are able to guarantee the best use of x-ray: to obtain the required diagnostic information with the lowest dose cost, preventing deterministic effects and keeping stochastic effects of radiation as low as possible. Aim and Objectives: The aim of this work is to develop a new methodology for assessing the exposure of the Swiss population by medical x-rays, using an automated method for surveying the frequency of diagnostic and interventional examinations and more appropriate radiological risk quantifiers. The objectives of the project are: a) to explore the appropriateness of the Tarmed coding system as an automatic tool for surveying the frequency of diagnostic and interventional examinations in Switzerland, and to compare this method to the traditional “paper questionnaire” method; b) to review the frequency and dosimetric data for the year 2008 and update the collective detriment to the Swiss population due to medical x-ray exposure; c) to develop new quantifiers of radiological risk more adapted to medical irradiation; and d) to compare the medical irradiation of the Swiss population in 2008 with other countries. Methods: The appropriateness of the Tarmed coding system will be assessed based on the SantéSuisse database, which will be validated by a comparison with other sources of data: the Vaud Medical Association, the Vaud Hospital Federation, as well as the results of the 2003 Review of the exposure of the Swiss population by radiodiagnostics. The Tarmed data will be used in conjunction with the annual statistics collected mainly from hospitals, a sample of medical practices and other healthcare providers such as dentists and chiropractors. The dose data collected over the past five years will be adapted and used and ad hoc investigations will be conducted for the modalities and types of examinations for which the doses must be updated. The use of basic dose quantities such as the dose equivalent in the exposed organs and tissues and the peak skin dose will be considered. Comparisons with European and international data will be performed using the methodologies of the European group Dose Datamed and the UNSCEAR. Expected results and importance: The main results of this work will be a validation of the method of using the Tarmed system for automatic collection of x-ray frequency data in Switzerland, allowing for better accuracy in the establishment of the collective radiological detriment, gain in time and resources, and less work load for the practitioners. New radiological risk quantifiers accounting for both stochastic and deterministic effects and better suited to medical irradiation will be tested and introduced. The level of exposure of the Swiss population by medical x-rays in the year 2008 will be determined and compared to the situation in other countries. The study will impact the implementation of the Database of medical radiological examinations (DAMEX) set up based on a recent revision of the Swiss Ordinance on Radiological Protection, as well as the establishment / updating of national diagnostic reference levels. It will also prompt a debate on the necessity of integrating the radiological statistics to the Swiss out-patient medical statistics. The scientific information obtained from this study is of great interest for the scientific community dealing with the exposure of the population by diagnostic and interventional radiology, and is also of practical use for many national and international bodies dealing with public health in general, and radiation protection in particular.
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