The use of Dose Management Systems in Europe: Results of an ESR EuroSafe Imaging Questionnaire.

Dose management systems (DMS) are an essential tool for quality assurance and optimising patient radiation exposure. For radiologists and medical physicists, they are important for managing many radiation protection tasks. In addition, they help fulfil the requirements of Directive 2013/59/EURATOM regarding the electronic transmission of dosimetric data and the detection of unintended patient exposures.

[Use of patient radiation shielding in diagnostic and interventional radiology].

The use of patient contact shielding provides an opportunity to reduce patient radiation exposure. Recently, the use has been the subject of controversy. The Radiation Protection Committee has published a recommendation on the use of patient radiation shields by considering the recent findings on dose savings but also the risks of incorrect use.

How to establish and use local diagnostic reference levels: an ESR EuroSafe Imaging expert statement.

Abstract: Although the Diagnostic Reference Levels (DRLs) have been shown to be an important tool for optimising patient radiation protection, there are still difficulties related to the methodology that should be used to establish and use local DRL values. This statement represents the current view of the EuroSafe Imaging ‘Clinical DRLs’ working group formed with the purpose to produce scientific and educational material on DRLs and promote the concept of local DRLs. Guidelines on how to establish and how to use local DRLs presented herein can be implemented using a multidisciplinary team approach.

[Information, informed consent, and communication with patients].

The transposition of EU Directive 2013/59/Euratom into German law requires that patients be informed about the radiation risk of radiological procedures. Such information is not the same as a medical informed consent about immediate risks associated with the procedure, such as deterministic radiation damage, risks of contrast media, or complications. The sole use of X‑rays in diagnostic procedures therefore requires no informed consent in most cases.

[Radiation protection during fluoroscopic interventions].

Facts and figures about the frequencies of fluoroscopically guided interventions (FGI), typical patient exposures and occupational exposures are listed. Limits of radiation exposure do not exist for patients but only for occupationally exposed medical personnel. Measures for radiation protection of patients and personnel are explained.

Assessment of tuberculosis disease activity in people infected with and living with HIV: A longitudinal cohort study.

Background: Early detection of asymptomatic incipient tuberculosis (TB) could improve clinical outcomes and reduce the spread of infection, particularly in HIV endemic settings. This study assessed TB disease activity over 5 years in people living with HIV co-infected with using a surrogate biomarker.

Methods: Between Jan 1, 2013 and Aug 31, 2018, 2014 people living with HIV were screened annually for active TB using the Xpert MTB/RIF diagnostic assay in 11 clinics in Kenya, Tanzania, Uganda, and Nigeria.

Notifications and alerts in patient dose values for computed tomography and fluoroscopy-guided interventional procedures.

The terms "notifications" and "alerts" for medical exposures are used by several national and international organisations. Recommendations for CT scanners have been published by the American Association of Physicists in Medicine. Some interventional radiology societies as well as national authorities have also published dose notifications for fluoroscopy-guided interventional procedures.

Dosimetric quantities and effective dose in medical imaging: a summary for medical doctors.

This review presents basic information on the dosimetric quantities used in medical imaging for reporting patient doses and establishing diagnostic reference levels. The proper use of the radiation protection quantity "effective dose" to compare doses delivered by different radiological procedures and different imaging modalities with its uncertainties and limitations, is summarised. The estimates of population doses required by the European Directive on Basic Safety Standards is commented on.

Statement of the German Roentgen Society, German Society of Neuroradiology, and Society of German-speaking Pediatric Radiologists on Requirements for the Performance and Reporting of MR Imaging Examinations Outside of Radiology.

Background:  Magnetic Resonance Imaging (MRI) is a very innovative, but at the same time complex and technically demanding diagnostic method in radiology. It plays an increasing role in high-quality and efficient patient management. Quality assurance in MRI is of utmost importance to avoid patient risks due to errors before and during the examination and when reporting the results.

Cumulative effective dose from recurrent CT examinations in Europe: proposal for clinical guidance based on an ESR EuroSafe Imaging survey.

In recent years, the issue of cumulative effective dose received from recurrent computed tomography examinations has become a subject of increasing concern internationally. Evidence, predominantly from the USA, has shown that a significant number of patients receive a cumulative effective dose of 100 mSv or greater. To obtain a European perspective, EuroSafe Imaging carried out a survey to collect European data on cumulative radiation exposure of patients from recurrent computed tomography examinations.

How to Measure/Calculate Radiation Dose in Patients?

Patients in fluoroscopically guided interventions (FGI) may be exposed to substantial radiation dose levels (SRDL). The most commonly reported adverse reactions are skin injuries with erythema or necrosis. It is therefore important for the interventional radiologist to know deterministic effects with their threshold doses.

ESR EuroSafe Imaging and its role in promoting radiation protection - 6 years of success.

This article introduces the European Society of Radiology's EuroSafe Imaging initiative in the year of its 6th anniversary. The European and global radiation protection frameworks are outlined and the role of the EuroSafe Imaging initiative's Call for Action in successfully achieving international radiation protection goals as set out by those frameworks is detailed.

Radiation dose management systems-requirements and recommendations for users from the ESR EuroSafe Imaging initiative.

The European Directive 2013/59/Euratom requires member states of the European Union to ensure justification and optimisation of radiological procedures and store information on patient exposure for analysis and quality assurance. The EuroSafe Imaging campaign of the European Society of Radiology created a working group (WG) on "Dose Management" with the aim to provide European recommendations on the implementation of dose management systems (DMS) in clinical practice. The WG follows Action 4: "Promote dose management systems to establish local, national, and European diagnostic reference levels (DRL)" of the EuroSafe Imaging Call for Action 2018.

The new radiation protection framework since 2019 - Implementation in Germany and comparison of some aspects in seven European countries.

Purpose:  The implementation of EU Directive 2013/59 EURATOM (EU-BSS) of 2014 led to a reorganization of radiation protection legislation in Germany in the form of a new radiation protection law Strahlenschutzgesetz (StrlSchG) of 2017 and a new radiation protection ordinance Strahlenschutzverordnung (StrlSchV) of 2018. For application of ionizing radiation in medicine these changes affect radiology, nuclear medicine and radiotherapy. A comparison between the old and the new legal system analyses changes that are relevant for diagnostic and interventional radiology.

Harmonisation of imaging dosimetry in clinical practice: practical approaches and guidance from the ESR EuroSafe Imaging initiative.

The European Directive 2013/59/EURATOM requires member states of the European Union to ensure justification and optimisation of the radiological procedures and to include information on patient exposure as part of the report of the examinations. The EuroSafe Imaging campaign of the European Society of Radiology created a working group (WG) on "Dosimetry for imaging in clinical practice" with the aim to help with the dosimetry aspects required by European and national regulations. The primary focus topics were selected and a survey among the experts of the WG, allowed suggesting some initial consensus approaches.

Vulnerable sandstone reefs: Biodiversity and habitat at risk.

Sandstone reefs may be considered a unique geomorphologic feature within the subtropical Southwestern Atlantic Ocean region; however, biodiversity on these reefs has received little to no attention. Herein, we recorded the fish assemblage and benthic cover of sandstone reefs between 23 and 29 m depth in Southern Brazil and evidenced potential threats to habitat health. Video analysis and underwater censuses recorded 30 fish species.

[What are the implications of the new radiation protection ordinance?].

The new regulatory basis in Germany for medical radiation protection ("Strahlenschutzverordnung" and "Strahlenschutzgesetz") went into effect on 31 December 2018 and has brought many changes. A system for record keeping and analysis of unintended exposures must be established and the occurrence of significant events must be reported to the competent authority. In the future, medical physics experts have to be consulted for equipment with high doses.

Diagnostic Reference Levels for Diagnostic and Interventional X-Ray Procedures in Germany: Update and Handling.

Purpose:  Recent developments in medical technology have broadened the spectrum of X-ray procedures and changed exposure practice in X-ray facilities. For this reason, diagnostic reference levels (DRLs) for diagnostic and interventional X-ray procedures were updated in 2016 and 2018, respectively. It is the aim of this paper to present the procedure for the update of the DRLs and to give advice on their practical application.

Whole-Body CT in Multiple Trauma Patients: Clinically Adapted Usage of Differently Weighted CT Protocols.

Purpose:  Whole-body CT (wbCT) has been established as an internationally accepted diagnostic modality in multiple trauma. Until 2011, a uniform CT scanning protocol was used for all multiple trauma patients (pat.) at our hospital (OLD protocol = OP).

Phenotypic Changes on Mycobacterium Tuberculosis-Specific CD4 T Cells as Surrogate Markers for Tuberculosis Treatment Efficacy.

The analysis of phenotypic characteristics on (MTB)-specific T cells is a promising approach for the diagnosis of active tuberculosis (aTB) and for monitoring treatment success. We therefore studied phenotypic changes on MTB-specific CD4 T cells upon anti-tuberculosis treatment initiation in relation to the treatment response as determined by sputum culture. Peripheral blood mononuclear cells from subjects with latent MTB infection ( = 16) and aTB ( = 39) at baseline, weeks 9, 12, and 26 (end of treatment) were analyzed after intracellular interferon gamma staining and overnight stimulation with tuberculin.

First record of Pomacanthus maculosus (Perciformes, Pomacanthidae) in the south-western Atlantic Ocean.

A single Pomacanthus maculosus was filmed during a scuba diving survey on a rocky reef from southern Brazil. The body shape and coloration pattern confirmed the species identification. The biological and ecological characteristics of P.

ICRP Publication 139: Occupational Radiological Protection in Interventional Procedures.

In recent publications, such as Publications 117 and 120, the Commission provided practical advice for physicians and other healthcare personnel on measures to protect their patients and themselves during interventional procedures. These measures can only be effective if they are encompassed by a framework of radiological protection elements, and by the availability of professionals with responsibilities in radiological protection. This framework includes a radiological protection programme with a strategy for exposure monitoring, protective garments, education and training, and quality assurance of the programme implementation.

Human introduction or natural dispersion? Atlantic Ocean occurrence of the Indo-Pacific whitetip reef shark Triaenodon obesus.

Occurrence of multiple whitetip reef sharks Triaenodon obesus in the Atlantic Ocean is reported for the first time from near a sunken ferry off the Paraná coast in south-eastern Brazil. This occurrence is hypothesized to have been caused by either a human introduction or a remarkably long oceanic displacement.