Internationale Aktivitäten zur sicheren Anwendung von ... · 13. APT-Seminar Remscheid, 19. –...

Internationale AktivitInternationale Aktivitääten zur ten zur

sicheren Anwendung von sicheren Anwendung von

Strahlen in der MedizinStrahlen in der Medizin

Ferid Shannoun

13. APT-Seminar Remscheid, 19. – 20. Juni 2009

International Radiation ProtectionInternational Radiation Protection

Basic Scientific StudiesBasic Scientific Studies

Scientific Evaluations (UNSCEAR, BEIR etc.)Scientific Evaluations (UNSCEAR, BEIR etc.)

Regional & Topical Standards (ILO, WHO, FAO, PAHO, CEC, NEA)

Regional & Topical Standards (ILO, WHO, FAO, PAHO, CEC, NEA)

InternationalSafety Standards (IAEA)

InternationalSafety Standards (IAEA)

National RegulationsNational Regulations

Industry Standards(ISO, IEC)

Industry Standards(ISO, IEC)

ICRP RecommendationsICRP Recommendations


International key players in radiation safetyInternational key players in radiation safety

UNSCEAR, ICRP

IAEA

WHO, AMRO/PAHO

International Professional Societies (IOMP, ISR, ASTRO, ESTRO, etc)

others


IAEAIAEA

The IAEA has 146 Member States. 18 countries wait for ratifications.

Set up as the world´s"Atoms for Peace" Organizationin 1957.

2200 multi-disciplinary professionals


IAEAIAEA


http://rpop.iaea.org


The International Action Plan for the Radiation Protection of Patients


Oct 1999 IAEA GC Resolution– To organize, in close collaboration with WHO, an international meeting

on the radiological protection of patients for the purpose of:• An exchange of information• Development of recommendations

the RP of patients

March 2001 Malaga Conference– Hosted by Government of Spain– Co-sponsored by:

• IAEA, WHO, PAHO, EU– Organized in co-operation with:

• UNSCEAR, ICRP, IOMP, IRPA, ISRO, ISRRT, ISR, WFNMB

– Many recommendations for radiation protection of patients


Following the Malaga conference– IAEA Technical Meeting, 2002

• Experts from 16 Member States• Representatives from

– WHO, PAHO, EU, UNSCEAR, ICRP, ICRU, ISO, IEC, IOMP, ISRO, ISRRT, ISR, WFNMB

• Using the findings of the Malaga Conference• Recommended the International Action Plan for the Radiological Protection of

Patients

International Action Plan approved by IAEA Board of Governors, 2002

Steering Panel established 2003– To review the implementation and to give guidance on a continuing

basis




To make progress in radiation protection of the patient as a whole, which includes:

– Recognizing the benefits of & the need for medical radiation• Promoting RPoP but without limiting the medical benefits• Ensuring that RPoP is an integral part of medical practice• Ensuring the level of RP is commensurate with the risk

– Collaboration with international organizations and professional societies

– Using mechanisms including education & training, technical assistance, research and information exchange

– Addressing new and evolving technologies



Objectives


Approved Training PackageIAEA Training Material on

Radiation Protection in Nuclear Medicine

in collaboration with

Version: January 2005 (reprint August 2007)

Shall the patient be hospitalized?Shall the patient be hospitalized?

Can the patient leave?Can the patient leave?Any restrictions?Any restrictions?

READY FOR A NEW PATIENTREADY FOR A NEW PATIENT

A “Radiation Safe” sign is posted at the door after decontamination and clearing of room

King Faisal Specialist Hospital and Research Center, Riyadh

SAFE ADMINISTRATIONSAFE ADMINISTRATION

Avoid mis-administration

BREASTFEEDINGBREASTFEEDING PATIENT SURVEYPATIENT SURVEYTypical Graph of the Exposure Rate at 1 m from the Patient

Administered with of 5.5 GBq I-131

0

2

4

6

8

10

12

14

1 2 3 4 5

Days of Isolation

Expo

sure

Rat

e (m

R/h

r)

Abdalla Al-Haj

PREGNANCY AFTER PREGNANCY AFTER THERAPYTHERAPY

Radiopharmaceutical All activities Avoid pregnancyup to (MBq) (months)

Au-198 colloid 10000 2I-131 iodide (thyroid ca) 5000 4I-131 iodide (thyrotoxicosis) 800 4I-131 MIBG 5000 4P-32 phosphate 200 3Sr-89 chloride 150 24Y-90 colloid (arthritic joints) 400 0Y-90 colloid (malignancy) 4000 1

http://rpop.iaea.org

Example training CDExample training CD


Cardiology Training Courses


Basic Safety Standards – BSS 115

International Basic Safety Standards for Protection against Ionizing Radiation and for the Safety of Radiation Sources

International CooperationIAEA, WHO, PAHO, FAO, ILO, OECD/NEA

Published 1996

A “Requirements” level standard


Basic Safety Standards – BSS 115

BSS – gives requirements– Under revision– Medical exposures section

• Drafted by WHO, PAHO & IAEA• Reflects recommendations from IAP and

subsequent Steering Panel meetings

Review 2006

Revision commenced 2007

Draft v2.0 July 2009


Help expand radiotherapy capacity in Help expand radiotherapy capacity in developing countries to address the developing countries to address the huge disparities that exist in cancer huge disparities that exist in cancer care services by:care services by:

Establishing a well coordinated IAEA cancer Establishing a well coordinated IAEA cancer programme with programme with harmonised strategyharmonised strategyIntegrating IAEAIntegrating IAEA’’s radiotherapy assistance s radiotherapy assistance into into public health public health andand cancer control cancer control systemssystemsAdvocating a country level Advocating a country level bottombottom--up up approachapproach

IAEA/PACTIAEA/PACT

Placing cancer on the global health agenda

Improving cancer survival in developing countries

WHO-IAEA Joint Programme for Cancer Control

WHO-IAEA Joint Programme for Cancer Control


IAEA & WHO collaborationIAEA & WHO collaborationIAEA & WHO collaboration

– Secondary Standards Dosimetry Laboratories (SSDL)– Directory of Radiotherapy Centers (DIRAC)


WHO StructureWHO Structure

147 Country Offices

6 Regional Offices

193 Member States Ministries of Health

HeadquartersGeneva

IARC+


WHO Regional and Country offices


PAHO

EHT/DIM

6 Regional and 147 Country

Offices

Family and Community Health

(FCH)

Health Systems and Services

(HSS)

HIV, TB, Malaria, Neglected Tropical

Diseases, (HTM)

General Management(GM)

Director General Office (DGO)

WHO HQ

WHO Radiation and HealthWHO Radiation and Health

Health Action inCrises(HAC)

Health Security and Environment

(HSE)

Cancer Control Program

IAEA/PACT

PHE/RAD

IARC/Lyon

Non-communicable Diseases & Mental Health

(NMH)

Evidence and Information for Policy

(EIP)


1972:

WHA 25.57 resolution to assist MS in promotion to radiation medicine and to cooperate with IAEA and UNSCEAR

1982: UNSCEAR/WHO joint survey onradiological equipment and frequency of diagnostic and therapeutic procedures

WHO Radiation and HealthWHO Radiation and Health


Diagnostic Imaging WorldwideDiagnostic Imaging Worldwide


WHIS-RAD System


Global Steering Group for Education and Training in Diagnostic Imaging

Global Steering Group for Education Global Steering Group for Education and Training and Training in Diagnostic Imaging

Established 1999

'Train the trainers'

Local 'centres of excellence'

Representatives from major global and regional societies and organizations:

– Permanent members: ISR, ISRRT, WFUMB, WFNMB– Regional societies: ESR, CIR, RSNA, MASU, AFSUMB,

AOSR, SFR, ACR, ARRS– Temporary members: related to activities


The use of radiation in health care is by far the largest contributor to the exposure of the general population from

artificial sources

Annually worldwide

3,600 million X-ray exams (> 300 million in children)

37 million nuclear medicine procedures

7.5 million radiation oncology treatments

WHO's Global InitiativeWHO'sWHO's Global InitiativeGlobal Initiative

http://www.google.fr/imgres?imgurl=http://nlcfn.org.uk/Portals/0/radiotherapy.jpg&imgrefurl=http://www.nlcfn.org.uk/-_radiotherapy.aspx&h=321&w=512&sz=137&tbnid=3hPDyIluUkUJ::&tbnh=82&tbnw=131&prev=/images%3Fq%3Dradiotherapy%2B%2Bphoto&hl=fr&usg=__mnWbnqjRKSjbxc4QKbdKllPawqg=&sa=X&oi=image_result&resnum=1&ct=image&cd=1



Diagnostic radiology

ACTIONS ON

Interventional radiology

Radiotherapy Nuclear Medicine

Focusing on Public HealthPublic Health aspects related to the risks and benefits of the use of radiation in health care

http://www.google.com/imgres?imgurl=http://www.arfpc.com/images/examroom.jpg&imgrefurl=http://www.arfpc.com/interventional_radiology.html&usg=__KaYUnqJQZl4skU_LmkQ8FVoPyHI=&h=309&w=363&sz=18&hl=en&start=1&tbnid=_hBjPHbloTJL-M:&tbnh=103&tbnw=121&prev=/images%3Fq%3Dinterventional%2Bradiology%2Bphotos%26hl%3Den%26sa%3DG

http://classroomclipart.com/cgi-bin/kids/imageFolio.cgi?action=view&link=Health_Care_and_Medicine&image=treatment_radiationA.jpg&img=&tt=


The Global Initiative aims to improve implementation of BSS in medical settings, and to mobilize the health sector towards safersaferand effectiveeffective use of radiation in medicine


The Global Initiative The Global Initiative seeks to complement the seeks to complement the International Action Plan for Radiological International Action Plan for Radiological

Protection of Patients established by the IAEAProtection of Patients established by the IAEA



Collect and share information on the use of radiation in health care, including surveys on population dose distribution .

Shape and promote a research agenda on adverse health effects ofmedical radiation exposure (focusing on children)

Risk assessmentRisk assessment

Reduction on unnecessary radiation exposures through justification of medical procedures (i.e. use of referral guidelines) and optimization of protection

Advocacy tools and guidance for health authorities and policy makers (including regulatory aspects)

Clinical audit and quality improvement

Occupational health in radiological medical facilities

Capacity building (education, training)

Strategy to address staffing needs (medical physicists, radiographers, radiation technologists)

Harmonization of error reporting systems and severity scale grades

Risk managementRisk management

Communication strategy for information and awareness raising (including risk communication to patients)

Risk Risk communicationcommunication


Step 1

Outline of the strategy

Step 2

Development of the work plan

Step 3

Implementation of the GI

Step 4

Monitoring, evaluation

•Develop proposal

•Internal/external consultation

•Identify/consult stakeholders

•Build partnership

• Platform

•Terms of reference

•Projects/activities

•Working groups

•Task Coord. Team

•Budget, fundraising

•Priorities

•Pilot experience

•Task execution

•Working groups operating

•Monitor implementation

•Evaluate the impact

•Feedback and results communication

Dec. 2008 June 2009 June 2011 Dec. 2011

We are here now



http://www.who.int/ionizing_radiation


PAHO/AMROPAHO/AMRO


DPC/CD

DPC/NC

DPC/NC

FCH/WM

Conventional RadiologyInterventional RadiologyComputed Tomography

MammographyUltrasound, MRINuclear Medicine

Cobalt UnitsLinear AcceleratorsLDR BrachytherapyHDR Brachytherapy

CANCERCONTROL

Pregnancy; Breast Pathologies; TB; Cancer; Traumatology; Cerebral,

Cardiovascular and Respiratory Diseases, etc

Professional SocietiesALATRO

ALFIMCIR

ALATRAISRRTIRPA

WHO IAEAInternational PartnersIACRS, IARCNA, RASSC

IAP for RP of PatientsJoint Emergency Plan

BSS Secretariat

TCNAHUNSRWPACT

PHE/RADEHT/DIMCHP/CPM

ACCESS-QUALITY-SAFETYImaging Services

Radiotherapy Services

Technology Management

Radiation Safety

PAHO/WHO Collaborating Centers

Breast ImagingUltrasound

Biological Effects of EMFRadiological Emergencies

PAHO/WHO COUNTRY OFFICES

HSE/PHE

HSS/EHTPlanningPurchase

MaintenanceCost AnalysisInfrastructures

Human Resources

Patients SafetyWorkers SafetyPublic Safety

PED


Training courses for Medical Physicists and Radiation Oncologists

Training courses for Medical Physicists and Radiation Oncologists

1992 Cuba 1998 Ecuador2002 Colombia2004 Uruguay (Clinical QA)2005 Brazil2007 Cuba2007 Colombia2008 Mexico (Clinical QA)


• Strengthening the Performance in the Area of Medical Physics for the Professional Staff in Latin America

• Expand the experience to other parts of the world

• Translate and disseminate this report to as much as possible languages and countries in the world

IAEA cooperation with PAHO/WHO


Thank you for your attentionThank you for your attention

Internationale Aktivitäten zur sicheren Anwendung von ... · 13. APT-Seminar Remscheid, 19. –...

Documents

Transcript of Internationale Aktivitäten zur sicheren Anwendung von ... · 13. APT-Seminar Remscheid, 19. –...