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THE PRINCIPLES AND THE PRACTICABILITY OF QUALITY CONTROL AND QUALITY ASSURANCE IN PEDIATRIC RADIOLOGY

Objectif

THE STUDY HAS THE OBJECTIVE TO SCREEN AND ASSESS PROBLEMS RELATED TO RADIATION PROTECTION IN PAEDIATRIC RADIOLOGY. GENERALLY CHILDREN ARE MORE SENSITIVE TO IONIZING RADIATION THAN ADULTS. THE POTENTIAL FOR MANIFESTATION OF POSSIBLE HARMFUL RADIATION EFFECTS IN CHILDREN IS HIGHER THAN IN ADULTS BECAUSE OF THEIR LONGER LIFE EXPECTANCY. CHILDREN ARE ALSO POTENTIAL PARENTS WHICH NO LONGER APPLIES TO MOST ADULT PATIENTS. HEREDITARY EFFECTS OF IONIZING RADIATION, THEREFORE, ARE MUCH MORE SIGNIFICANT IN THESE AGE GROUPS.

OPTIMIZATION OF RADIOLOGICAL IMAGING STUDIES OF NEWBORNS, INFANTS AND CHILDREN, THEREFORE, IS MANDATORY IN TERMS OF RADIATION PROTECTION FOR THE POPULATION. HOWEVER, RECOMMENDATIONS AND REGULATIONS OF RADIOLOGICAL-DIAGNOSTIC OPTIMIZATION FOR ADULTS PATIENTS ARE NOT DIRECTLY APPLICABLE FOR THE PAEDIATRIC POPULATION. THERE ARE SPECIFIC PROBLEMS FOR QUALITY ASSURANCE IN PAEDIATRIC RADIOLOGY BUT THERE ARE PRESENTLY NO GENERALLY RECOGNIZED AND SUFFICIENTLY DETAILED RECOMMENDATIONS AVAILABLE. FURTHERMORE, THERE IS NEITHER ADEQUATE KNOWLEDGE ON HOW INDIVIDUAL OPTIMIZATION MEASURES ARE EFFECTIVE IN DAILY ROUTINE, NOR EXPERIENCE AS TO WHAT EXTENT THEY ARE PRACTICAL. A STUDY ON THE PRINCIPLES AND PRACTICABILITY OF OPTIMIZATION MEASURES WILL DEFINITELY RESULT IN A CONSIDERABLE REDUCTION OF PATIENT EXPOSURE IN PAEDIATRIC RADIOLOGY.
Work has been done to survey radiographic technique and surface entrance dose for frequent paediatric X-ray examinations in routine practice, to determine how individual optimization measures can be effective in daily routine and, in addition, to what extent they are practicable with the final goal of establishing standards for quality control and quality assurance in paediatric radiology. A survey has been done of equipment, paediatric radiographic technique and phantom measurements within X-ray departments. In a parallel study with on patient thermoluminescent dosimetry (TLD), frequent paediatric X-ray examinations for a defined Eurababy of 10 months of age were similarly surveyed. Data analysis of the first survey showed that variations in radiographic technique and especially for surface entrance dose in departments and private practices not headed by a paediatric radiologist were considerably greater than those found in departments headed by a paediatric radiologist. It was also determined that, in general, patient exposure could have been significantly reduced if the appropriate equipment was selected and an optimized radiographic technique was used. Special knowledge in paediatric radiology is necessary for both.

In the TLD study, a comparative analysis of equipment, radiographic technique, image quality and patient dose has been made and wide variations in technique and dose were also found. There was a significant negative correlation between patient dose and the number criteria fulfilled.

Image quality of the original X-ray films collected during the survey was generally good and not dependent on dose. The guidelines for good radiographic technique, prepared by an expert group of paediatric radiologists, were found to be very practicable.

A second phase of the study is in progress to confirm these results and to examine intradepartment variations.
THE STUDY WILL BEGIN WITH A SURVEY ON THE CONDITIONS UNDER WHICH CHILDREN ARE PRESENTLY X-RAYED. FOR THIS AN ASSAY OF THE TECHNICAL-APPARATIVE PROVISIONS WILL BE MADE WITH A SUFFICIENT NUMBER OF PHYSICIANS IN PRIVATE PRAXIS AND HOSPITALS IN WHICH RADIOLOGICAL EXAMINATIONS OF CHILDREN ARE PERFORMED. THESE STEPS INVOLVE DETAILED DESCRIPTION OF;

A. THE APPLIED X-RAY DEVICES INCLUDING THE AVAILABLE IMAGING SYSTEMS, AIDS FOR THE IMMOBILIZATION OF NON-COOPERATIVE CHILDREN, FOR GONAD SHIELDING AND ADDITIONAL PROTECTIVE DEVICES, INCLUDING THE MANNER IN WHICH THESE ARE ACTUALLY USED;

B. DARK ROOM CONDITIONS AND FILM DEVELOPMENT;

C. AGE SPECIFIC METHODS FOR PERFORMING SELECTED X-RAY EXAMINATIONS IN CHILDREN.

IN THESE SURVEYED SETTINGS SUITABLE PHANTOM MEASUREMENTS AND CALCULATIONS OF DOSE REQUIREMENTS FOR CHOSEN X-RAY EXAMINATIONS WILL FOLLOW, ALLOWING A DETERMINATION OF RADIATION EXPOSURE OF PATIENTS, STAFF AND ACCOMPANYING PERSONS (PARENTS ETC.).

A PREDETERMINED NUMBER OF X-RAY FILMS FROM CHOSEN RADIOLOGICAL EXAMINATIONS WILL BE COLLECTED AT EACH SURVEY CENTER AND BE ANALYZED ON THE BASIS OF YET TO BE SELECTED CRITERIA OF IMAGE QUALITY.

GRADUALLY, AFTER ANALYSIS OF THIS SURVEY AND THESE MEASUREMENTS AND ASSESSMENTS, NECESSARY OR RECOMMENDED MEASURES FOR THE OPTIMIZATION OF THE X-RAY EXAMINATION AT THE PARTICULAR INSTITUTION WILL BE CARRIED OUT AND THEIR EFFECT ON QUALITY ASSURANCE AND REDUCTION OF THE EXPOSURE OF PATIENTS, STAFF AND ACCOMPAGNYING PERSONS WILL BE DETERMINED AND DEMONSTRATED.

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Appel à propositions

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Régime de financement

CSC - Cost-sharing contracts

Coordinateur

Ludwig-Maximilians-Universität München
Contribution de l’UE
Aucune donnée
Adresse
Lindwurmstraße 4
80337 München
Allemagne

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