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The Current Status of Uptake of European BSS Directive (2013/59/Euratom) Requirements - Results of a Pilot Survey in European Radiology Departments with a Focus on Clinical Audit.

ABSTRACT: The recently implemented European Council Basic Safety and Standards Directive (BSSD), 2013/59/Euratom lays down core radiation protection standards for European radiology departments, with a mandatory requirement for supporting clinical audit processes.A survey on behalf of the European Society of Radiology (ESR) was undertaken in November 2018 involving the ESR EuroSafe Imaging Star department network to assess compliance with selected key BSSD requirements, with emphasis also on clinical audit/re-audit.64% of invited departments participated and the survey results revealed a lack of compliance with BSSD requirements even when allowing for work in progress within departments. Justification processes showed the lowest rates of compliance overall, with varying results relating to dose limits, patient information and significant accidental exposure notification. Questions around implementation of diagnostic reference levels (DRLs) revealed generally far higher compliance with requirements.The survey findings confirm a lack of compliance with key BSSD radiation protection indicators and also a lack of supporting clinical audit structures. These findings are likely to be representative of the wider radiological community in Europe. There is a need for a co-ordinated response, involving relevant European agencies, national bodies and societies and also individual radiology departments to address these issues. ESR publications on clinical audit (Esperanto) and the 2018 EuroSafe Imaging Call for Action will be important components of this response.

SUBMITTER: European Society of Radiology (ESR)

PROVIDER: S-EPMC6509314 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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The Current Status of Uptake of European BSS Directive (2013/59/Euratom) Requirements - Results of a Pilot Survey in European Radiology Departments with a Focus on Clinical Audit.

Insights into imaging 20190509 1

The recently implemented European Council Basic Safety and Standards Directive (BSSD), 2013/59/Euratom lays down core radiation protection standards for European radiology departments, with a mandatory requirement for supporting clinical audit processes.A survey on behalf of the European Society of Radiology (ESR) was undertaken in November 2018 involving the ESR EuroSafe Imaging Star department network to assess compliance with selected key BSSD requirements, with emphasis also on clinical audi ...[more]

PMID: 31073803

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Project description:ObjectivesTo study the impact of COVID-19 on chest CT practice during the different waves using Dose Archiving and Communication System (DACS).MethodsRetrospective study including data from 86,136 chest CT acquisitions from 27 radiology centers (15 private; 12 public) between January 1, 2020, and October 13, 2021, using a centralized DACS. Daily chest CT activity and dosimetry information such as dose length product (DLP), computed tomography dose index (CTDI), and acquisition parameters were collected. Pandemic indicators (daily tests performed, incidence, and hospital admissions) and vaccination rates were collected from a governmental open-data platform. Descriptive statistics and correlation analysis were performed.ResultsFor the first two waves, strong positive and significant correlations were found between all pandemic indicators and total chest CT activity, as high as R = 0.7984 between daily chest CT activity and hospital admissions during the second wave (p < 0.0001). We found differences between public hospitals and private imaging centers during the first wave, with private centers demonstrating a negative correlation between daily chest CT activity and hospital admissions (-0.2819, p = 0.0019). Throughout the third wave, simultaneously with the rise of vaccination rates, total chest CT activity decreased with significant negative correlations with pandemic indicators, such as R = -0.7939 between daily chest CTs and daily incidence (p < 0.0001). Finally, less than 5% of all analyzed chest CTs could be considered as low dose.ConclusionsDuring the first waves, COVID-19 had a strong impact on chest CT practice which was lost with the arrival of vaccination. Low-dose protocols remained marginal.Key points• There was a significant correlation between the number of daily chest CTs and pandemic indicators throughout the first two waves. It was lost during the third wave due to vaccination arrival. • Differences were observed between public and private centers, especially during the first wave, less during the second, and were lost during the third. • During the first three waves of COVID-19 pandemic, few CT helical acquisitions could be considered as low dose with only 3.8% of the acquisitions according to CTDIvol and 4.3% according to DLP.

Project description:BackgroundThe European Working Time Directive (EWTD) became law in 1993 but only applied to doctors in training in the United Kingdom in 2004. The trainees have in consequence had a reduction in their working hours but also a change to a shift pattern of working. For craft specialities, such as anaesthesia, there are concerns that a reduction in working hours has also led to a reduction in the time available for learning and that ultimately this may affect patient care. However, there is scant research on the perceptions of trainees concerning the impact of the EWTD on their training and working lives. This study investigated what the anaesthetic Specialist Registrars (SpRs) on the Mersey Deanery SpR rotation perceived to be training and also what effect the EWTD has had on that training and their quality of life, both within and outside work.MethodsThe project was a cross sectional survey, using a quantitative questionnaire with qualitative free text comments which were aggregated into overarching themes and sub themes.Results117 SpRs were sent questionnaires in April 2005; 73 completed questionnaires were returned (response rate 62.4%). Hierarchies of training opportunities emerged with training by consultants being most valued. 71.8% (95% CI 60.7-81.3) of trainees believed the EWTD has had a deleterious effect on their training and experience and 74.3% (95% CI 63.2-83.4) thought that they will be less prepared for a consultant post. 69.9% (95% CI 58.7-79.5) considered that their quality of life outside work had deteriorated, with only 15% (95% CI 8.3-24.6) finding improvement. 38.6% (95% CI 27.8-50.3) felt that they were not functioning as well as doctors, only 14.3% (95% CI 7.6-23.9) noting improvement. The trainees were still positive about anaesthesia and 73.2% (95% CI 62.2-82.5) would recommend this specialty to a student.ConclusionThe majority of anaesthetic SpRs in the Mersey Deanery have not welcomed the changes brought by the EWTD to their training, experience and quality of life outside work.

Project description:The study aimed to explore the use of diagnostics for febrile children presenting to European emergency departments (EDs), the determinants of inter-hospital variation, and the association between test use and hospitalization. We performed a secondary analysis of a cross-sectional observational study involving 28 paediatric EDs from 11 countries. A total of 4560 children < 16 years were included, with fever as reason for consultation. We excluded neonates and children with relevant comorbidities. Our primary outcome was the proportion of children receiving testing after primary evaluation, by country and by focus of infection. Variability between hospitals and effects of blood testing on patient disposition were explored by multilevel regression analyses, adjusting for patient characteristics (age group, triage level, appearance, fever duration, focus of infection) and hospital type (academic, teaching, other). The use of routine diagnostics varied widely, mostly in the use of blood tests, ranging from 3 to 75% overall across hospitals. Age < 3 months, high-acuity triage level, ill appearance, and suspicion of urinary tract infection displayed the strongest association with blood testing (odds ratios (OR) of 8.71 (95% CI 5.23-14.53), 19.46 (3.66-103.60), 3.13 (2.29-4.26), 10.84 (6.35-18.50), respectively). Blood testing remained highly variable across hospitals (median OR of the final model 2.36, 1.98-3.54). A positive association was observed between blood testing and hospitalization (OR 13.62, 9.00-20.61).Conclusionthe use of diagnostics for febrile children was highly variable across European EDs, yet patient and hospital characteristics could only partly explain inter-hospital variability. Focus groups of participating sites should help define reasons for unexpected variation.What is known• Although previous research has shown variation in the emergency department (ED) management of febrile children, there is limited information on the use of diagnostics in European EDs. • A deeper knowledge of variability and its determinants can steer optimization of care.What is new• The use of diagnostics for febrile children was highly variable across European EDs, yet patient and hospital characteristics could only partly explain inter-hospital variability. • Data on between-centre comparison offer opportunities to further explore factors influencing unwarranted variation.

Project description:Introduction: Radiology plays a crucial role in the emergency care setting by delivering early and precise diagnoses under pressure of time, right at the beginning of patient treatment. Although there is a need for postgraduate education in emergency radiology, most of the national bodies responsible do not offer it in a uniform fashion and a general proof of qualification is missing in Europe. Therefore, the European Society of Radiology (ESR) has founded the (Sub-)Society of Emergency Radiology (ESER), prompting them to develop a European curriculum. This trend, which is currently also encouraged in many other non-radiological specialties which demand the highest professional qualifications, often lacks expertise in medical education. Goals: The goal of this article is the general description of the curricular planning process for a European postgraduate subspecialisation programme, using the example of Emergency Radiology (European Diploma in Emergency Radiology, EDER), including the utilisation of TOOLS and recommendations derived from comparable projects. Project description: The project was divided into partial steps: the timeline displayed in a GANTT chart, and tasks and responsibilities assigned in a RASCI matrix. The curriculum was iteratively developed using the KERN approach and steps were prioritised using the PARETO principle. Furthermore, the following TOOLS were used: limitations and needs assessment, SWOT analysis, formulating learning objectives and categorising them after MILLER and SCLO, and using BLOOM's taxonomy for cognitive learning objectives and operationalising them according to MAGER. Psychomotoric and affective learning objectives were assigned to CANMEDS roles, grouped by topic using CLUSTERING, and then mapped by MATRIX analysis to appropriate learning and evaluation methods. Striving for continuous improvement, the curriculum was finally embedded in curricular quality management. Results: The standardisation of the EDER access, considering the different national conditions, the minimisation of European learners' attendance phases, restricting expenses by best possible use of existing structures, respecting the requirements and retaining the support of the European umbrella society ESR, finishing the project by a specific deadline and the demands of continuous improvement were particular challenges. A curriculum with the eligibility of five years' speciality training in general radiology has evolved on schedule. The subspeciality training lasts at least one year and is divided into webinars, workshops during congresses (e.g. the annual ESR and ESER congresses) and one year practical training at the individual learner's corresponding local hospitals, which adhere to a catalogue of requirements, comparable to national educational policies. The curriculum is completed by passing a written and oral exam (diploma) and re-accreditation every five years. Conclusions: Despite complex requirements, the TOOLS utilised allowed an almost seamless, resource-minimised, professional, location-independent distributed development of a European subspeciality curriculum within one year. The definitive implementation is still due. If any deviations from the draft presented should become necessary in the future, the embedment in the curricular quality management will lead to a redirection in the right way and, furthermore, secure a continuous improvement in the best way possible.

Dataset Information

The Current Status of Uptake of European BSS Directive (2013/59/Euratom) Requirements - Results of a Pilot Survey in European Radiology Departments with a Focus on Clinical Audit.

Publications

The Current Status of Uptake of European BSS Directive (2013/59/Euratom) Requirements - Results of a Pilot Survey in European Radiology Departments with a Focus on Clinical Audit.

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