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Reduction of irradiation of the Belgian population which progress has been made?

Reduction of irradiation of the Belgian population which progress has been made?. Guy Marchal. Strategic committee starting point. Over the last years the level of irradiation of the Belgian population has increased dramatically due to diagnostic examinations .

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Reduction of irradiation of the Belgian population which progress has been made?

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  1. Reduction of irradiation of the Belgianpopulationwhichprogress has been made? Guy Marchal

  2. Strategiccommitteestarting point Over the last years the level of irradiation of the Belgianpopulation has increaseddramaticallydue to diagnosticexaminations. As a resultBelgium is one of the worldchampions in thisregard.

  3. Overall objectives • The firstobjective of the strategiccommittee is to reducethisgrowth and to bring the irradiation level back to the level of the neighboringcountries . • The secondobjective of the strategiccommittee is to improve the quality of the examinationsperformed. • Pure costsavingscannotbe the goal. The money savedwillbeneeded to preserve the quality of the diagnosticimaging service. (equipmentthat is neededbutnotfullyused) • In additionit is important to keep up with the fasttechnologicalevolution in medicalimaging. The newtechnologies offer notonlynewdiagnosticpossibilities, but are oftenalsolessinvasive and potentiallylessirradiating.

  4. Strategy • To act efficiently, a welldefined long term strategy is needed. Thisstrategy is definedby a strategiccommittee. • The strategiccommittee is composedbyrepresentatives of different parties and analyses potentialdifficultiesthatcouldariseduring the practical implementation and suggestspossiblesolutions. • The strategiccommitteerefers to threesubcommitteesfor the practical implementation of the overall objectives. Members of the strategiccommittee are also part of the core of the different subcommittees.

  5. Subcommittee “guidelines” • The task of thissubcommittee is to formulateguidelinesfor the proper use of ionizingirradiationfordiagnosticpurposes. • Thisgroup is composedbymembers of the FOD, the RIZIV, the FANC, the Consilium Radiologicum, BELNUC, representatives of other user groups, and the Belgian society of hospitalPhysicists. • Currentmembers of the committee : Guy Marchal (president), Lodewijk Van Bladel, Wim Janssens, Aldo Perissino and Nils Reynders-Frederix

  6. Current situation • Initial document: existingFrenchguidelines (2005) • Actualization (2010) by • Sections of KBVR • BELNUC • Radiology : DifferencesbetweenFlemish and Frenchversions. Correlationneeded as well as complete rewriting of Flemishversion. Nuclearmedicine: Document notreadyyet • Furthercorrelationbetweentwodocumentsprobablynotfeasible.

  7. Current situation • Initial document: existingFrenchguidelines (2005) • Actualization (2010) by • Sections of KBVR • BELNUC • Radiology : DifferencesbetweenFlemish and Frenchversions. Correlationneeded as well as complete rewriting of Flemishversion. Nuclearmedicine: Document notreadyyet • Furthercorrelationbetweentwodocumentsprobablynotfeasible. Potential negative financial impact of guidelines remains a major problem for many to fully collaborate!

  8. Proposalfor a newprescription order • containing • Demographic patient data • Clinical information • Information needed for proper diagnosis or therapy expected from imaging study • Suggested examination • Referring physician • Expected irradiation dose?

  9. Proposalfor a newprescription order • Expected from radiologist • Prescription accepted or changed • Argumentation if changed • Registration number of equipment used • Responsible radiologist • Level of accreditation imaging department?

  10. Subcommittee “sensibilisation” • The mainobjective is to increase the awareness of both the radiologist as well as the prescribingphysicianfor the high level of diagnosticirradiation of the Belgianpopulationby a sensibilisationcampaign. • The ultimate goal of thissensibilisationcampaign is to reduce the overall irradiationdosefor the population • Thisgroup is composedbymembers of the FOD, the RIZIV, the FANC, the Consilium Radiologicum, BELNUC, representatives of other user groups, representatives of the GP’s, “hoge gezondheidsraad”,… • Currentmembers of the committee : Aldo Perissino and Wim Janssens (president), Lodewijk Van Bladel, Guy Marchal, Nils Reynders-Frederix, Hilde Engels, Jan Eyckmans and Corinne Souwer.

  11. Current situation • Sensibilisation of public and patients • Information, per specialism about the level of diagnostic irradiation in their region • Publicity about the guidelines • Relevant individual information of each prescribing physician • A change in the procedures and criteria for reimbursement

  12. Current situation • Sensibilisation of public and patients • Information, per specialismabout the level of diagnosticirradiation in theirregion • The level of irradiation per inhabitant • The relativecontribution of eachspecialism in the prescription of the irradiatingexaminations • The examinationsthatcontribute most to the irradiation per specialism • Publicityabout the guidelines • Relevant individualinformation of eachprescribingphysician • A change in the procedures and criteria forreimbursement

  13. Current situation • Sensibilisation of public and patients • Information, per specialismabout the level of diagnosticirradiation in theirregion • Publicityabout the guidelines • Integration in the software of the medical record management (2010) • Didactic brochures (2011) • Involvement of medicalfaculties, highschoolsmedicaltechnology • Relevant individualinformation of eachprescribingphysician • A change in the procedures and criteria forreimbursement

  14. Current situation • Sensibilisation of public and patients • Information, per specialismabout the level of diagnosticirradiation in theirregion • Publicityabout the guidelines • Relevant individualinformation of eachprescribingphysician • The principle of precaution • The unnecessaryexaminations • The uselessprescriptions • The erroneousprescriptions • A change in the procedures and criteria forreimbursement

  15. Current situation • Sensibilisation of public and patients • Information, per specialismabout the level of diagnosticirradiation in theirregion • Publicityabout the guidelines • Relevant individualinformation of eachprescribingphysician • A change in the procedures and criteria forreimbursement • Standardizedprescriptionform • Electronic communication of reports towardsreferringphysicians • The patient management software must allow to calculate the cumulativepatientdose (2010). • Possibilityforradiologists to changerequests in function of existingguidelines (2010).

  16. Subcommitteeaccreditation and optimalisation • Thisworkgroupwilltry to formulateincentives to motivate the hospitals to promotedosereduction. These incentivesare needed to support the use of the guidelinesand to reach the strategic goals. • Thisgroup is composedbymembers of the FOD, the mutualities, the RIZIV, the FANC, the Consilium Radiologicum, medicalphysicists. • Currentmembers of the committee : Guy Marchal (president), Aldo Perisinno, Greet Haelterman, An Fremout, Pascal Meeus, Nils Reynders-Frederix, Françoise Malchair, Julien Struyven, Denis Tack and Hilde Bosmans.

  17. Financial incentives? • Alternative for current mainly “fee for service model” towards a larger degree of forfaitarisation? • Financial co-responsabilisation of prescribers? • Extra financial compensation in function of quality parameters. • ….

  18. Current situation • Optimalisation both by improved techniques as well as better training and optimal use • Collaboration between FANC, physicists, academia, radiologists, via working groups, round tables, etc.. • Accreditation • COMPREHENSIVE CLINICAL AUDITS OF DIAGNOSTIC RADIOLOGY PRACTICES (IAEA)

  19. Proposed audit tool COMPREHENSIVE CLINICAL AUDITS OF DIAGNOSTIC RADIOLOGY PRACTICES: A TOOL FOR QUALITY IMPROVEMENT QUALITY ASSURANCE AUDIT FOR DIAGNOSTIC RADIOLOGY IMPROVEMENT AND LEARNING (QUAADRIL) INTERNATIONAL ATOMIC ENERGY AGENCY VIENNA, 2010

  20. COMPREHENSIVE CLINICAL AUDITS OF DIAGNOSTICRADIOLOGY PRACTICES Document contains 4 chapters: • QUALITY MANAGEMENT PROCEDURES AND INFRASTRUCTURE • PATIENT RELATED PROCEDURES • TECHNICAL PROCEDURES • EDUCATION, TRAINING AND RESEARCH PROGRAMS

  21. COMPREHENSIVE CLINICAL AUDITS OF DIAGNOSTICRADIOLOGY PRACTICES • document contains 4 chapters: • QUALITY MANAGEMENT PROCEDURES AND INFRASTRUCTURE • PATIENT RELATED PROCEDURES • TECHNICAL PROCEDURES • EDUCATION, TRAINING AND RESEARCH PROGRAMS The intention is to reduce this audit book towards a for Belgium clinically relevant accreditation instrument (2010)

  22. Conclusion • There is a cleardemandfrom the authorities to reduce the number of uselessexaminations • There is a positiveevolution in the collaborationbetween the FANC, the radiologists and the medicalphysicistsworkingtowards a more clinically relevant approach. • What has to beavoided is toomuchemphasisonadministration and paperwork, uselessexpenses, and no time leftforbetter patient care.

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