Η εκπαίδευση στην ακτινοπροστασία στην Ευρωπαική Ένωση

1. Η εκπαίδευση στην ακτινοπροστασία στην Ευρωπαική Ένωση ΔΠΜΣ «Ενδαγγειακές Τεχνικές» 31 Ιανουαρίου 2014 Τριαντάφυλλος Γιαννακόπουλος ESVS EVST Radiation Protection Training Committee EVST Executive Committee EVST Councilor – Greece Αγγειοχειρουργός Επιμελητής Αγγειοχειρουργικής Κλινικής Ν.Ν.Α.

2. Ενδαγγειακές επεμβάσεις στην Ευρώπη 73% των αορτικών ενδαγγειακών επεμβάσεων διενεργούνται από Αγγειοχειρουργούς Liapis CD, et al Vascular training and endovascular practice in Europe.Eur J Vasc Endovasc Surg. 2009 Jan;37(1):109-15

3. Are we aware of Radiation Risk Importance? Systematic Review of PubMed publications regarding radiation exposure Marked Increase since 2007 Radiology 58% Vascular Surgery 16%

4. What is our focus in Radiation Exposure? Systematic Review of PubMed publications regarding radiation exposure in Vascular Surgery The Aorta 72% Interventional DSA 67%

5. Do we consider Education & Training in Radiation Exposure? Systematic Review of PubMed publications regarding radiation exposure in Vascular Surgery Surgeon Education Decreased PSD by 16% (p<0.001) 122 Fluoro Guided procedures Pre vs Post Education • Only 9% of publications considered the effect of Education • (Training / Experience) Kirkwood ML et al. Surgeon education decreases radiation dose in complex endovascular procedures and improves patient safety. Journal of Vascular Surgery. 2013 Sep;58(3):715–21.

6. EU Radiation Protection Training Background • Member States govern Radiation Protection Guidelines (National Policies apply) • RP116 European Directive On Radiological Protection Training (2000) • Accreditation/Certification not addressed • Does not provide standardized learning outcomes • Does not provide requirements for new specialists using ionizing radiation

7. EU Radiation Protection Training Background • The MEDRAPET Project (will revise RP116) • WP1: Survey (ProfessionalSocieties, Authorities, Institutions) • WP2: Workshop • WP3: Final report received by EC (Aug 2013) • Accreditation/Certification of Specialists in RP • Standardized learning outcomes • Requirements for new specialists using ionizing radiation √ ESVS Participant √ √ ESVS Observer/Participant ESVS NOT Surveyed Because target was National auth/soc/inst

8. MEDRAPET Consortium

9. Αποτελέσματα MEDRAPET

10. Ποια είναι η πραγματικότητα;

11. European Vascular Surgeons in Training (EVST) Radiation Protection Training Survey Results Triantafillos G. Giannakopoulos MD EVST Radiation Protection Training Committee EVST Executive Committee EVST Councilor - Greece

12. George Hamilton, ESVS President • Simon Parvin, ESVS Secretary General • Christos Liapis, ESVS Advisor to MEDRAPET • Hubert Stepak, EVST Secretary General • Makis Avgerinos, Past EVST Secretary General • Olufemi Oshin, EVST Radiation Protection Training Committee • Vladimir Zelinskiy, EVST Radiation Protection Training Committee • All EVST Council Members • Randi Wilson, ESVS Marketing Manager

13. Methods – Statistics - Accuracy ESVS Newsletter Introduction • Increase awareness • Establish RP Status Statistical Significance of Results Confidence Level: 99% Confidence Interval: ±4,78% (Margin of Error) Wimmer RD, Mass Media Research: Introduction 9TH EDITION. Wadsworth, Inc,2011; EVST Radiation Protection Training Committee (Bologna 2012) ESVS wide Electronic Survey Full Members Trainee Members Eastern European Members E-mail Based, Online 3051 Recipients – 583 Responders 19.1% Response Rate - 60 Days 37 Multiple Choice Questions “Skip Logic” SurveyMonkey, IBM SPSS v21, SISA

14. Methods – Statistics - Accuracy • Increase awareness • Establish RPT Status Van Bennekom FC. Customer surveying: a guidebook for service managers. Bolton, MA: Customer Service Press; 2002. Statistical Significance of Results Confidence Level: 99% Confidence Interval: ±4,78% (Margin of Error) Wimmer RD, Mass Media Research: Introduction 9TH EDITION. Wadsworth, Inc,2011; EVST Radiation Protection Training Committee (Bologna 2012) ESVS wide Electronic Survey Full Members Trainee Members Eastern European Members E-mail Based, Online 3051 Recipients – 583 Responders 19.1% Response Rate - 60 Days 37 Multiple Choice Questions “Skip Logic” SurveyMonkey, IBM SPSS v21, SISA

15. Response Rate Analysis Response Rate 19,1% (95% CI 17,7-20,5) Co-Operation Rate 19,8% Contact Rate 96,5% Refusal Rate 0,75% The American Association for Public Opinion Research. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. Lenexa, Kansas: The American Association for Public Opinion Research, 2000. Lynn P, Beerten R, Laiho J, Martin J. Recommended Standard Final Outcome Categories and Standard Definitions of Response Rate for Social Surveys. Colchester, Essex: The Institute for Social and Economic Research, 2001 Uitenbroek, Daan G, Binomial. SISA. 1997. http://www.quantitativeskills.com/sisa/distributions/binomial.htm. (1 Jan. 2013).

16. Responses per Country

17. Responses over time Launch Reminder Sent NewsLetter

18. Respondents Profile Young Specialists (1-5yr) 36% (double the size of older 5yr groups) Vascular Surgeons 69,8% Vascular Trainees 27%

19. Respondents Profile Public Hospital 47% Academic Institution 43% Private Sector 9%

20. Respondents Practice Profile 10% NO Endovascular 90% get exposed to radiation during Endovascular procedures NO ENDO TRAINING SOMEONE ELSE DOES NO FACILITIES

21. Endovascular Practice Profile O.R. + C-Arm is the most popular mode of operation Vascular Surgery alone 52,8% Co-operation with I.R. 47,2%

22. Endovascular Training Profile ENDO in VS Curricula 55,5% Most Popular ENDO Training Provider 71,7% 75% were ENDO trained (but 90% get exposed during ENDO) VS CURRICULUM STAND ALONE VS AS A SPECIALIST WORKING WITH VS IR Stand Alone Organized by AS A SPECIALIST WORKING WITH IR

23. Endovascular Training Profile 41,5% of ENDO training programs DO NOT include Radiation Protection modules

24. Radiation Protection Training 56,5% was a STAND-ALONE RP Training Program 69% were Radiation Protection trained (but 90% get exposed during ENDO) STAND ALONE VS CURRICULUM IR PART OF VS ENDO

25. Stand Alone RP Training 71% Received STAND ALONE RP Training within the last 5 years 82% because it was MANDATORY NATIONAL REGULATION INSTITUTIONAL REGULATIONS

26. Stand Alone RP Training Radiation Physicists 83% Within Countries 99,1% EUROPEAN?

27. Stand Alone RP Training Level Course Certificate 68% 16-30 Teaching Hours most Frequent 68% COURSE CERTIFICATE I DON’T HAVE AN RP SPECIFIC CERTIFICATE 14,4% 14,1% WORKSHOP 5,5% MSc NATIONAL CERTIFICATE OTHER PhD

28. Practice Patterns by Training Vascular Trainees Vascular Surgeons 4,6%get exposed without having trained (worst scenario9,2%) 14,9% get exposed without having trained 65,4 39,2 24,3 13,5 14,5 14,9 7,6 4,6

29. RP Education by Training Even after training in RP 41,5% remained unfamiliar with the meaning of ALARA 53% unfamiliar with the meaning of ALARA RP Trained Not RP Trained

30. Vascular Surgeons RP Education by Training 24,4% Unfamiliar with ALARA although trained 9% Unfamiliar with DoseLimitalthough trained 9 24,4 7,45 11,8 2,6 5,1 5,9 7,4

31. Importance of Radiation Protection Training 89% consider Radiation Protection Training a Prerequisite BUT 11% Training is not necessary

32. Awareness Level of RP Training Policy > European16,8% National 78,2%

33. MEDRAPET 86,4% Unaware of the MEDRAPET Project

34. Importance of Independent Use of Radiation 88% Independent Use of Radiation by Vascular Surgeons an absolute necessity BUT 12% Independent use is not necessary

35. Accreditation & Certification Damilakis J, The MEDRAPET Project: European Guidance on RP E&T of Medical Professionals results. EFOMP- European Medical Physics and Engineering Conference. Sofia, Bulgaria, October 18-20, 2012 Accreditation of a Training Provider to give Certification of a Professional

36. Accreditation National /Regional 64,3% European 27%

37. Certification Certification by National Authorities was the most popular (50.8%) 50.8% Committee of VS+IR+Phys

38. RP Training Certification Mandatory Agree 82% NO/Not Sure 18% Young VS & Trainees are more reluctant ?

39. Αποτελέσματα MEDRAPET KSC: Knowledge, Skill, Competence EQF: European Qualifications Framework LLL: Lifelong Learning LO: Learning Objective CPD: Continuing Professional Development SPECIALTY Discipline 1 Discipline 2 ……..3 EQF Required for entry EQF Required for entry KSC table (LOs) KSC table (LOs)

40. Ο Αγγειοχειρουργός είναι… Discipline 3 Non-Radiological Specialist Employing ionising radiation in Interventional techniques Discipline 1 Discipline 2 HealthCare Professional Referrer HIGH Dose LOW Dose

41. MEDRAPET Final Report on “Non – Radiological Specialties” Vascular Surgery is listed with Cardiology as High-dose users Accreditation/Certification are defined Who should provide them remains vague Potential Political implications recognized

42. Master of Science “Endovascular Techniques” University of Athens + University Milano Bicocca 30 VS + 5 IR + 2 RP http://www.endovasculartechniques.gr/

43. Συμπεράσματα • Radiation Risk and Consequences are far from negligible for the Vascular Surgeon in the Endovascular Era • EVAR is the “tip of the arrow” for Radiation Exposure in Vascular Surgery • European Radiation Protection Training is mainly supplied within each member state, by radiation physicists and is mandatory • Vascular Surgeons prefer to retain the current National model of Radiation Protection Training and Certification • However, Radiation Protection Training is ineffective in its current form • There is currently an “empty space” for European Level Training and Certification in Radiation Protection for Vascular Surgery and ESVS should fill this void

44. Ευχαριστω