TSA 3

RADIATION PROTECTION IN MEDICAL EXPOSURE

Guidance for your Country Status Report presentation

This presentation is based on answering the following questions and completing the following tables. The country information will be used for RASIMS and to give context for RAF9044 activities. LEGISLATIVE AND STATUTORY FRAMEWORK 3.1 Regulations for Medical Exposure (1 slide answering questions & presenting the table)
1. Are there regulations in your country for radiation protection in medical exposure (patient protection)? 2. In your country, do facilities need to be authorized (licensed) by the (radiation protection) regulatory body if they wish to use ionizing radiation in medicine complete the table:
Facility type Radiation therapy Nuclear medicine Image guided interventional procedures Diagnostic radiology facilities, as below: Large hospital, with CT, radiography, fluoroscopy, mammography Medium-sized hospital2, with CT, radiography, fluoroscopy, mammography Small hospital with radiography only Private medical facility Dental only facility
1 2

Number of facilities in your country1

Required to be licensed? Y or N

Inspected periodically by the regulatory body? Y or N

Approximate numbers for the various diagnostic radiology facilities are acceptable. Such facilities may not have all modalities, but they have more than just radiography.

3. Has your country established national Diagnostic Reference Levels (DRLs) for common imaging procedures? If yes, which examinations, and which age groups?

PATIENT PROTECTION IN DIAGNOSTIC RADIOLOGY 3.2 Qualified Experts (1 slide, presenting the table)
Percentage1 of facilities with Radiologists Percentage2 of facilities with Radiographers3 Percentage4of facilities with Medical Physicists available5

4. What is the availability of qualified experts in diagnostic radiology complete the table:
Facility type Large hospital, with CT, radiography, fluoroscopy, mammography Medium-sized hospital6, with CT, radiography, fluoroscopy, mammography Small hospital with radiography only Private medical facility
1, 2, 4

Approximate values (e.g. 100, 75, 50, 25, or 0%) e.g. 100% means all such facilities would have the expert; 50% means only about half of the facilities would have such an expert; 0% means none of the facilities would have such an expert.
3

Radiographer is used here to mean any of radiographer, radiologic technologist, etc. a person with recognized training in using medical radiation technology.
5

This means there is a formal relationship between the facility and the medical physicist. This would include part-time employment by the facility or a contract for services and advice.
6

Such facilities may not have all modalities, but they have more than just radiography.

3.3

Optimization slides, presenting the tables)

Radiography, fluoroscopy, CT, mammography (4

5. What aspects of optimization of protection are being implemented in diagnostic radiology in your country complete the following tables for the respective categories of facilities in your country.
1. LARGE HOSPITALS Approximate number: 4

Optimization activities:

Percentage of facilities that:

Perform X-ray equipment performance testing1: New equipment2 Radiography Fluoroscopy CT Mammography
1

Modality

Periodically perform patient dose surveys4

Use DRLs5

Have an established QA programme for:6

Have developed specific examination protocols7 for optimization of protection for: Adult patients yes yes yes Paediatric patients yes yes yes

Routine3 no no no no no no no no adhoc adhoc adhoc adhoc

yes yes yes yes

Adult patients yes

Enter approximate percentages (e.g. 100, 75, 50, 25, or 0%) of large teaching hospital facilities in your country that perform X-ray equipment performance testing on new equipment and routinely, respectively, for each of the modalities radiography, fluoroscopy, CT and mammography. E.g. 100 means all such facilities are performing such tests for that modality; 75means that about threequarters of such facilities are; etc.
2 3 4

These are acceptance tests performed on X-ray equipment prior to their clinical use. These are routine tests, performed periodically to assess compliance and constancy.

Enter approximate percentages of large teaching hospital facilities in your country that perform patient dose surveys, for each of the modalities respectively. Dose surveys here means determining typical patient doses for common procedures in that modality.
5

Enter approximate percentages of large teaching hospital facilities in your country that use DRLs, for each of the modalities respectively. These may be national DRLs or relevant published DRLs that are being used by facilities to review their doses.
6

Enter the approximate percentages of large teaching hospital facilities in your country that have an established QA programme for diagnostic radiology, covering each of the modalities, respectively.
7

Enter the approximate percentages of large teaching hospital facilities in your country that have developed specific protocols for examinations in each of the modalities, respectively. These are protocols that have been developed using appropriate techniques and parameters to deliver a medical exposure of the patient that is the minimum necessary to achieve an acceptable image quality for adults and children, respectively.

2. MEDIUM-SIZED HOSPITALS1 Approximate number: 23

Optimization activities:

Percentage of facilities that:

Perform X-ray equipment performance testing2: New equipment3 Radiography Fluoroscopy CT Mammography
1 2

Modality:

Periodically perform patient dose surveys5

Use DRLs6

Have an established QA programme for:7

Have developed specific examination protocols8 for optimization of protection for: Adult patients Paediatric patients

Routine4

Adult patients

These facilities may not have all modalities, but they do have more than just radiography.

Enter approximate percentages (e.g. 100, 75, 50, 25, or 0%) of medium-sized facilities in your country that perform X-ray equipment performance testing on new equipment and routinely, respectively, for each of the modalities radiography, fluoroscopy, CT and mammography. E.g. 100 means all such facilities are performing such tests for that modality; 75means that about threequarters of such facilities are; etc.
3 4 5

These are acceptance tests performed on X-ray equipment prior to their clinical use. These are routine tests, performed periodically to assess compliance and constancy.

Enter approximate percentages of medium-sized facilities in your country that perform patient dose surveys, for each of the modalities respectively. Dose surveys here means determining typical patient doses for common procedures in that modality.
6

Enter approximate percentages of medium-sized facilities in your country that use DRLs, for each of the modalities respectively. These may be national DRLs or relevant published DRLs that are being used by facilities to review their doses.
7

Enter the approximate percentages of medium-sized facilities in your country that have an established QA programme for diagnostic radiology, covering each of the modalities, respectively.
8

Enter the approximate percentages of medium-sized facilities in your country that have developed specific protocols for examinations in each of the modalities, respectively. These are protocols that have been developed using appropriate techniques and parameters to deliver a medical exposure of the patient that is the minimum necessary to achieve an acceptable image quality for adults and children, respectively.

3. SMALL HOSPITALS RADIOGRAPHY ONLY Approximate number: 20

Optimization activities:

Percentage of facilities that:

Perform X-ray equipment performance testing1: New equipment2 Radiography
1

Modality

Periodically perform patient dose surveys4

Use DRLs5

Have an established QA programme6

Have developed specific examination protocols7 for optimization of protection for: Adult patients Paediatric patients yes

Routine3 no no no No, but adhoc

yes

yes

Enter approximate percentages (e.g. 100, 75, 50, 25, or 0%) of radiography-only facilities in your country that perform X-ray equipment performance testing on new equipment and routinely, respectively, for each of the modalities radiography, fluoroscopy, CT and mammography. E.g. 100 means all such facilities are performing such tests for that modality; 75means that about threequarters of such facilities are; etc.
2 3 4

These are acceptance tests performed on X-ray equipment prior to their clinical use. These are routine tests, performed periodically to assess compliance and constancy.

Enter approximate percentages of radiography-only facilities in your country that perform patient dose surveys, for each of the modalities respectively. Dose surveys here means determining typical patient doses for common procedures in that modality.
5

Enter approximate percentages of radiography-only facilities in your country that use DRLs, for each of the modalities respectively. These may be national DRLs or relevant published DRLs that are being used by facilities to review their doses.
6

Enter the approximate percentages of radiography-only facilities in your country that have an established QA programme for radiography.
7

Enter the approximate percentages of radiography-only facilities in your country that have developed specific protocols for examinations in each of the modalities, respectively. These are protocols that have been developed using appropriate techniques and parameters to deliver a medical exposure of the patient that is the minimum necessary to achieve an acceptable image quality for adults and children, respectively.

4. PRIVATE MEDICAL FACILITIES1 Approximate number: 10

Optimization activities:

Percentage of facilities that:

Perform X-ray equipment performance testing2: New equipment3 Radiography Fluoroscopy CT Mammography
1 2

Modality

Periodically perform patient dose surveys5

Use DRLs6

Have an established QA programme for:7 Adhoc Adhoc Adhoc Adhoc

Have developed specific examination protocols8 for optimization of protection for: Adult patients yes yes yes Paediatric patients yes yes yes

Routine4 periodic periodic periodic periodic no no no no

yes yes yes 1

Adult patients yes

These facilities may not have all modalities.

Enter approximate percentages (e.g. 100, 75, 50, 25, or 0%) of private medical facilities in your country that perform X-ray equipment performance testing on new equipment and routinely, respectively, for each of the modalities radiography, fluoroscopy, CT and mammography. E.g. 100 means all such facilities are performing such tests for that modality; 75means that about threequarters of such facilities are; etc.
3 4 5

These are acceptance tests performed on X-ray equipment prior to their clinical use. These are routine tests, performed periodically to assess compliance and constancy.

Enter approximate percentages of private medical facilities in your country that perform patient dose surveys, for each of the modalities respectively. Dose surveys here means determining typical patient doses for common procedures in that modality.
6

Enter approximate percentages of private medical facilities in your country that use DRLs, for each of the modalities respectively. These may be national DRLs or relevant published DRLs that are being used by facilities to review their doses.
7

Enter the approximate percentages of private medical facilities in your country that have an established QA programme for diagnostic radiology, covering the modalities, respectively.
8

Enter the approximate percentages of private medical facilities in your country that have developed specific protocols for examinations in each of the modalities, respectively. These are protocols that have been developed using appropriate techniques and parameters to deliver a medical exposure of the patient that is the minimum necessary to achieve an acceptable image quality for adults and children, respectively.

General radiography: (1 slide, presenting the table) 6. Details on image receptors and processing for general radiography in your country complete the following table:
Facility type Large hospital Mediumsized hospital Small hospital Private medical facility
1, 2

Image receptors Film1 yes yes yes yes Digital2 no no no no

If film-based: processing: Automatic3 yes yes yes yes Manual4 no no no no

If film-based: intensifying screens: Not rare Rare earth5 earth6 yes yes yes yes yes yes yes yes

Enter approximate percentages (e.g. 100, 75, 50, 25, or 0%) of facilities in your country that use film and digital imaging, respectively. E.g. 100 and 0 means all such facilities are using film only; 50 and 50 means about half such facilities are using film and about half using digital; and 0 and 100 means all such facilities are digital. The 2 numbers must add up to 100.
3, 4

For film-based facilities, enter approximate percentages that use automatic and manual processing, respectively.
5, 6

For film-based facilities, enter approximate percentages that use rare earth screens and non rare earth screens, respectively.

PATIENT PROTECTION IN IMAGE GUIDED INTERVENTIONAL PROCEDURES

3.4

Qualified Experts (1 slide, presenting the table)

7. What is the availability of qualified experts for image guided interventional procedures complete the table: N/A in Malawi
FACILITIES PERFORMING IMAGE GUIDED INTERVENTIONAL PROCEDURES Percentage1 of facilities where: Facility type Approximate number of facilities The specialist doctors have had formal training in radiation protection2 Radiographers3 are present during the procedures A medical physicist is available4

Interventional Cardiology Interventional Radiology Image guided interventional procedures performed by other specialists (not radiologists, not cardiologists)
1

Approximate values (e.g. 100, 75, 50, 25, or 0%) where, 100% means all such facilities would have such experts; 50% means only about half of the facilities would have such experts; 0% means none of the facilities would have such an expert.
2

This means that the specialists have had either radiation protection training as part of their specialist training or they have had specific additional training in radiation protection.
3

Radiographer is used here to mean any of radiographer, radiologic technologist, etc. a person with recognized training in using medical radiation technology.
4

This means there is a formal relationship between the facility and the medical physicist. This would include part-time employment by the facility or a contract for services and advice.

3.5 Optimization of protection in image guided interventional procedures - (1 slide, presenting the table) N/ A in Malawi
8. What aspects of optimization of protection are being implemented in facilities performing image guided interventional procedures in your country complete the following tables for the respective types of image guided interventional procedures.
FACILITIES PERFORMING IMAGE GUIDED INTERVENTIONAL PROCEDURES Optimization activities:

Percentage of facilities that:

Perform X-ray equipment performance testing1: New equipment2 Interventional Cardiology Interventional Radiology Image guided interventional procedures performed by other specialists
1

Facility

Periodically perform patient dose surveys4

Have an established QA programme5

Have developed specific examination protocols6 for optimization of protection for: Adult patients Paediatric patients

Routine3

Enter approximate percentages (e.g. 100, 75, 50, 25, or 0%) of facilities in your country that perform X-ray equipment performance testing on new equipment and routinely, on equipment used, respectively, for interventional cardiology, interventional radiology and other image guided interventional procedures. E.g. 100 means all such facilities are performing such tests for that type of interventional procedures; 75 means that about three-quarters of such facilities are; etc.
2 3 4

These are acceptance tests performed on X-ray equipment prior to their clinical use. These are routine tests, performed periodically to assess compliance and constancy.

Enter approximate percentages of facilities in your country that perform patient dose surveys, for each of the types of interventional procedures respectively. Dose surveys here means determining typical patient doses for common interventional procedures.
5

Enter the approximate percentages of facilities in your country that have an established QA programme covering the types of interventional procedures, respectively.
6

Enter the approximate percentages of facilities in your country that have developed specific protocols for the different types of interventional procedures, respectively. These are protocols that have been developed using appropriate techniques and parameters to deliver a medical exposure of the patient that is the minimum necessary to fulfil the clinical purpose, for adults and children respectively.

PATIENT PROTECTION IN NUCLEAR MEDICINE 3.6 Qualified Experts - (1 slide, presenting the table) N / A

9. What is the availability of qualified experts in nuclear medicine facilities in your country complete the table:
FACILITIES PERFORMING NUCLEAR MEDICINE PROCEDURES Percentage1 of facilities with: Facility type Number of facilities A nuclear medicine physician2 Radiographers3 involved in performing the procedures A medical physicist being available4

Diagnostic only Diagnostic and therapeutic

1

Approximate values (e.g. 100, 75, 50, 25, or 0%) where, 100% means all such facilities would have such experts; 50% means only about half of the facilities would have such experts; 0% means none of the facilities would have such an expert.
2 3

The physician has had formal recognized training in the specialty of nuclear medicine.

Radiographer is used here to mean any of radiographer, nuclear medicine technologist, radiologic technologist, etc. a person with recognized training in using medical radiation technology.
4

This means there is a formal relationship between the facility and the medical physicist. This would include part-time employment by the facility or a contract for services and advice.

3.7

Optimization - (1 slide, presenting the table)

10. What aspects of optimization of protection are being implemented in nuclear medicine facilities in your country complete the following tables for the respective types of nuclear medicine facilities. N / A
FACILITIES PERFORMING NUCLEAR MEDICINE PROCEDURES Optimization activities:

Percentage of facilities that:

Perform equipment performance testing1: New equipment2 Diagnostic only Diagnostic and therapeutic
1

Facility type

Perform patient dose assessments4

Have an established QA programme5

Have developed specific examination protocols6 for optimization of protection for: Adult patients Paediatric patients

Routine3

Enter approximate percentages (e.g. 100, 75, 50, 25, or 0%) of nuclear medicine facilities in your country that perform equipment performance testing on new equipment and routinely, respectively. E.g. 100 means all such facilities are performing such tests for that type of facility; 75 means that about three-quarters of such facilities are; etc.
2 3 4

These are acceptance tests performed on equipment prior to their clinical use. These are routine tests, performed periodically to assess compliance and constancy.

Enter approximate percentages of nuclear medicine facilities in your country that perform patient dose assessments. This means determining periodically typical patient doses for common diagnostic nuclear medicine procedures, and individual patient doses for therapeutic nuclear medicine procedures.
5

Enter the approximate percentages of nuclear medicine facilities in your country that have an established QA programme.
6

Enter the approximate percentages of nuclear medicine facilities in your country that have developed specific protocols for their nuclear medicine procedures. These are protocols that have been developed using appropriate techniques and parameters to deliver a medical exposure of the patient that is the minimum necessary to fulfil the clinical purpose, for adults and children respectively.

PATIENT PROTECTION IN RADIOTHERAPY 3.8 Qualified Experts - (1 slide, presenting the table)

11. What is the availability of qualified experts in radiation therapy facilities in your country complete the table: N/ A in Malawi
FACILITIES PERFORMING RADIATION THERAPY Percentage1 of facilities with: Facility type Number of facilities A radiation oncologist2 Radiographers3 are involved in performing the procedures A medical physicist being present4

External beam only External beam and brachytherapy Brachytherapy only

1

Approximate values (e.g. 100, 75, 50, 25, or 0%) where, 100% means all such facilities would have such experts; 50% means only about half of the facilities would have such experts; 0% means none of the facilities would have such an expert.
2 3

The physician has had recognized formal training in the specialty of radiation oncology.

Radiographer is used here to mean any of radiographer, therapist, radiologic technologist, etc. a person with recognized training in using medical radiation technology.
4

This means the medical physicist is employed by the facility.

3.9

Optimization - (1 slide, presenting the table)

12. What aspects of optimization of protection are being implemented in radiation therapy facilities in your country complete the following tables for the respective types of radiation therapy.

FACILITIES PERFORMING RADIATION THERAPY Optimization activities:

Percentage of facilities that:

Perform equipment performance testing1: Facility type New equipment2 External beam only External beam and brachytherapy Brachytherapy only
1

Perform dose calibrations4

Routine3

Have an established QA programme5

Have an established system for investigating & reporting unintended and accidental medical exposures in radiotherapy6

Enter approximate percentages (e.g. 100, 75, 50, 25, or 0%) of radiation therapy facilities in your country that perform equipment performance testing on new equipment and routinely, respectively. E.g. 100 means all such facilities are performing such tests for that type of facility; 75 means that about three-quarters of such facilities are; etc.
2 3 4

These are acceptance tests performed on equipment prior to their clinical use. These are routine tests, performed periodically to assess compliance and constancy.

Enter approximate percentages of radiation therapy facilities in your country that perform dose calibrations. The arrangements for such dose calibrations would include traceability, frequency, protocols, dosimeters, and independent verification.
5

Enter the approximate percentages of radiation therapy facilities in your country that have an established QA programme.
6

Unintended and accidental medical exposures in radiation therapy include treatment of the wrong individual or the wrong tissue of the patient, or a dose or dose fractionation differing substantially from (over or under) the prescribed values or that could lead to unduly severe secondary effects, or any inadvertent exposure of the embryo or foetus in the course of performing a treatment, or any failure of the equipment, software failure or system failure, or accident, mishap or other unusual occurrence with the potential for subjecting the patient to a medical exposure that is substantially different from what was intended.