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Fission and radiation protection

Safety and Efficacy for New Techniques and Imaging Using New Equipment to Support European Legislation: Supporting Digital Medicine

The SENTINEL project deals with radiation protection, safety and related issues arising from the introduction of digital technologies to replace film and fluoroscopy equipment in many diagnostic techniques. The project scope covers over 90% of patient examinations, 60% of the collective dose from medical sources, and approximately 50% of the collective dose from man-made sources received by a typical European citizen.

Expert approach to new safety challenges

Interventional Radiology Suite © Courtesy of Eliseo Vano, San Carlos University Hospital, Madrid, Spain
Interventional Radiology Suite
© Courtesy of Eliseo Vano, San Carlos University Hospital, Madrid, Spain
The main objectives of this coordination action relate to new digital radiology equipment being introduced by medical institutions in Europe. The project will establish both clinical and physical image quality criteria, and the link between the two, perform a series of dosimetry studies and develop good practice guidelines for radiation protection and training material. These actions will address international standardisation issues, evaluate ethical issues in radiation protection, and develop resources and harmonised approaches to radiation protection training for high dose procedures.

The research group comprises clinical partners and medical physicists working in hospitals, industry and universities, and government scientists. The consortium has close links to industry and national/international professional societies.

Dose data to bring consensus on standards

Coordination activities will take place to refine quality criteria for new technologies. Various surveys of equipment and practice will be undertaken and patient/staff dose data will be collated. A series of consensus meetings, supported by literature reviews, will be held to develop common perspectives on various topics. Optimisation approaches will be reviewed, particularly in relation to screening procedures. Existing acceptance, status and consistency test protocols will be critically reviewed and evaluated, and the consortium will contribute to standardisation activities. Consensus on the use of the Digital Imaging and Communications in Medicine (DICOM) header for information on patient dosimetry and quality control will be addressed. A review of ethical considerations in various procedures will be undertaken, which will involve meetings with ethicists from major religions and secular traditions. Training meetings will also be held and training material written.

Quality assessment for digital guidelines

SENTINEL will develop novel approaches to image quality assessment for digital technology, which will lead to the development of international standards for new imaging technologies and software covering a wide range of medical-related equipment. The project will work to obtain a shared consensus on image quality and dose management in digital radiology. It will evaluate image-processing algorithms and produce a consensus document on referral criteria for cardiac procedures.

The research will establish reference dose levels for new detectors used in digital radiology, cardiology and interventional radiology, and develop image quality criteria for new detectors in cardiology, interventional radiology and mammography applications. The group will derive a consensus on the acceptance, status and consistency test protocols for cardiology and interventional radiology, and develop approaches to undertaking national patient dose surveys. Guidelines on minimising patient and staff doses in interventional radiology will be produced and a workshop examining the justification of relevant ethical issues and safety will be organised. In addition, a number of focus meetings on ethical issues associated with reproductive and screening digital radiological techniques will be organised and will include public participation. SENTINEL will also identify any training requirements that emerge from the research and publish appropriate training materials.

Maximising patient benefit, minimising dose

This Coordination Action brings together a series of research studies into medical digital imaging in all its forms. These studies concentrate on the justification and optimisation of new and emerging imaging techniques, all associated with relatively high individual doses or the application of radiology techniques to more sensitive patient groups.

European manufacturers are at the forefront of developing new imaging technologies in radiology. Standardisation issues are crucial to supporting these new developments. Digital radiology, digital fluoroscopy, digital mammography and nuclear medicine can be used to replace many surgical techniques. Public awareness of and support for these techniques will be jeopardised if adverse affects of radiation become a concern. The Coordination Action intends to improve benefit/risk ratios, avoid deterministic injuries, and improve clinical outcomes - all benefiting patients.

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