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ISRRT | Book Of Abstracts

30 8.23. Have clinical audits been effective in Finland? Presenter: Kirsi Miettunen, Labquality Ltd. Author: Kirsi Miettunen Introduction: Clinical audit is a way to find out if healthcare is being provided in line with standards. In this study I will focus on clinical audits of x-ray departments in Finland. Clinical audit definition; a systematic examination or review of medical radiological procedures which seeks to improve the quality and the outcome of patient care through structured review whereby radiological practices, procedures and results are examined against agreed standards for good medical radiological procedures, with modification of practices where indicated and the application of new standards if necessary (www.clinicalaudit.net) The concept of Clinical Audit was introduced by the European Commission Directive 97/43/Euratom (so called MED directive), 30 June 1997. First clinical audits have been made in Finland in March 2002. So far all radiological departments have been audited at least two times, part of them already three times. In Finland clinical audits are guided by the Finnish Advisory Committee for Clinical Audit. The Advisory Committee gives guidelines on what should be assessed in clinical audits. This study will find out about if clinical audits have been effective in Finland. Methods: In the study, improvement recommendations of clinical audits from the first, second and third audit rounds have been compared by samples. From every round (first, second and third) twenty audit results were collected , ten from smaller routine type radiological departments, and ten from demanding radiological departments. Demanding department means that there is either CT, angiography or similar kind of advanced imaging. The audit results have been compared in a matrix. Results: In the first and second rounds the number of improvement suggestions was at the same level, while in third round there were fewer suggestions. The area of the most common suggestion was changing at every round. Also the dispersion of findings was smaller at every round. In the first round, the most common type of improvement suggestions was given for the quality manual. In the second round the most frequent improvement suggestions concerned the instructions, and in the third round self-assessment and imaging practices. The findings of audit show the impact from the various individual auditing teams, especially in the first round. For the second auditing round Clinical Audits Advisory Committee gave more specific instructions and probably because of that results were somewhat more homogeneous. Conclusions: It is clear that clinical audits have improved the quality of practice in radiological departments in Finland. However, given the diversity of the reports, no significant conclusion about the content, development or effectiveness can be made. Each auditing team seems to make different kinds of findings. More specific instructions are needed for clinical audits, including more training for auditors to make clinical audit findings comparable. Typically, a quality system follows a plan-do-checkact (PDCA) cycle for continuous improvement. Nowadays for clinical audits there is no system in place to make sure that corrective actions are taken after the audit report. In my opinion we need a systematic approach for check and act to make sure that clinical audits are effective. 8.24. The professional association and the history of the ISRRT Presenter: David Collier, Australia Author: David Collier Introduction: The key values of a Profession are status, shared values, altruism, affiliation, advocacy and representation, social Interaction, information provision and products and services. There is a long history behind today’s professional associations in which special skills and knowledge has always had a unique place in society. Method: This paper is the outcome of a series of observations and learning gained from the writing of the history of the ISRRT during the previous three years. In the process of the exploration of the archives a number of valuable conclusions can be made which are relevant to the running of any professional association. Discussion: Specialists belonged to recogniseable groups of like-minded professional people and in mediaeval times these professional groups were called ‘Guilds’. The guilds set standards for their professions and protected the interests of their members. The Professional Association today provides a range of measurable or tangible benefits as well as intangible benefits which recognise and confirm the status and reputation of that profession. These intangible benefits can extend far beyond that of the membership and reach into the whole profession itself. This extended reach provides both and opportunity and a challenge for all professional associations and the history, the story of the ISRRT since its first meeting with 25 attendees in July 1959 in Munich, held at the same time as the 9th international Congress of Radiologists provides a valuable insight into what a professional association is and what being part of that association means. The relationship between the ISRRT and other bodies has always been at the centre of the success of the international body. A number of the Council members over time have had strong working relationships with a variety of the suppliers of equipment and technology and those companies have shown extraordinary generosity and support. This was most noticeable in the early days of the society and has, in no small measure, contributed to the continued survival particularly during the first twenty years. Results: The paper then covers the story of the ISRRT with a number of examples and images, and concludes with a brief summary of the challenges of writing such a history. 9. INTERVENTIONAL 9.1. The utilization of ultrasound during interventional procedures in optimization of radiation dose -a case of Uganda, a low income resource country Presenter: Rogers Kalende, Uganda Radiography Association / Ernest Cook Ultrasound Research And Education Institute (Ecurei) Mengo Hospital Author: Kalende Rogers Introduction: The rational for optimization in radiological practice remains keeping radiation exposure and consequent dose as low as reasonably achievable (ALARA) without compromising diagnostic quality. Although various patients derive great benefit from interventional procedures, a serious disadvantage associated with interventional procedures is patient radiation dose. It is therefore, prudent for every radiation technologist to innovate ways of reducing the radiation dose during these procedures. One way is to substitute fluoroscopy guidance for non-ionizing procedures. I present cases of how Uganda has managed to adhere to the principle in interventional Radiology by using Ultrasound and conventional x-ray in absentia of fluoroscopy to perform guided interventions without compromising diagnostic image quality. This case study sites 3 types of procedures in which this approach to optimization was used: • 33 Ultrasound guided chest biopsies. • 67 Ultrasound guided Percutaneous Trans Hepatic Cholangiography (PTHC) • 16 Ultrasound guided nephrostomy and antegrade pyelography. In all these, ultrasound was substituted for fluoroscopy hence cutting down on the radiation dose the patient would have received. Methods: This was a retrospective case study. A total of 116 case notes for patients who had undergone interventional procedures using a combination of ultrasound and radiography investigations were studied. Results: Ultrasound guided intervention remains one of the most practiced time saving, cost effective and dose minimizing alternatives to fluoroscopy guided procedures in optimizing patient dose while maintaining diagnostic quality, in low resource income countries like Uganda. 9.2. How is the correlation between modality given doseparameters (DAP and AK) in cardiac interventional procedures and actuall maximum skin doses (MSD) to the patients Presenter: Tommy Berglund, St. Olavs Hospital, Trondheim Norway Author: Tommy Berglund Introduction: The amount of interventional procedures have been increasing rapidly. Technological development in the equipment used together with more complexed procedures leads to an increasing risk of potential high doses given both to the working staff and even more, the patients. (Panuccio et al, 2010). The first confirmed case of radiation induced skin damage appeared in 1990. FDA published guidelines and counseling in how to avoid skin damage during fluoroscopic procedures in 1994. (Balter et al, 2010) The ionizing radiation has enough energy to be able to change the molecular structur in the cells of the body, including the DNA. Some of these molecular changes can be so complexed that it is difficult for the repair mechanism of the body to correct this. (BEIR, 2006). Effects caused by damages on a population of cells are called deterministic effects. Early tissue reactions can be inflammatoric, the late effects can be


ISRRT | Book Of Abstracts
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