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3. SP-0031 Understanding late effects of radiation exposure in paediatrics: The HARMONIC and MEDIRAD projects

Author

Thierry-Chef, I., primary, Timmermann, B., additional, Journy, N., additional, Bernier, M., additional, Mcnally, R., additional, Dabin, J., additional, Brualla, L., additional, Haghdoost, S., additional, Sarukan, A., additional, Cardis, E., additional, Hierath, M., additional, Frija, G., additional, Consortium, H., additional, and Consortium, M., additional

Published
2023
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4. Notifications and alerts in patient dose values for computed tomography and fluoroscopy-guided interventional procedures

Author

Vano, E. Loose, R. Frija, G. Paulo, G. Efstathopoulos, E. Granata, C. Corridori, R. Torresin, A. Andersson, J.S. Tsapaki, V. Ammon, J. Hoeschen, C. On behalf of the European Society of Radiology

Abstract

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. Notifications and alerts may also be useful for optimisation and to avoid unintended and accidental exposures. The main interest in using these values for high-dose procedures (CT and interventional) is to optimise imaging procedures, reducing the probability of stochastic effects and avoiding tissue reactions. Alerts in X-ray systems may be considered before procedures (as in CT), during procedures (in some interventional radiology systems), and after procedures, when the patient radiation dose results are known and processed. This review summarises the different uses of notifications and alerts to help in optimisation for CT and for fluoroscopy-guided interventional procedures as well as in the analysis of unintended and accidental medical exposures. The paper also includes cautions in setting the alert values and discusses the benefits of using patient dose management systems for the alerts, their registry and follow-up, and the differences between notifications, alerts, and trigger levels for individual procedures and the terms used for the collective approach, such as diagnostic reference levels. Key Points: • Notifications and alerts on patient dose values for computed tomography (CT) and fluoroscopy-guided interventional procedures (FGIP) allow to improve radiation safety and contribute to the avoidance of radiation injuries and unintended and accidental exposures. • Alerts may be established before the imaging procedures (as in CT) or during and after the procedures as for FGIP. • Dose management systems should include notifications and alerts and their registry for the hospital quality programmes. © 2022, The Author(s).

Published
2022

6. Medical imaging and nuclear medicine: a Lancet Oncology Commission

Author

Hricak, H, Abdel-Wahab, M, Atun, R, Lette, MM, Paez, D, Brink, JA, Donoso-Bach, L, Frija, G, Hierath, M, Holmberg, O, Khong, P-L, Lewis, JS, McGinty, G, Oyen, WJG, Shulman, LN, Ward, ZJ, Scott, AM, Hricak, H, Abdel-Wahab, M, Atun, R, Lette, MM, Paez, D, Brink, JA, Donoso-Bach, L, Frija, G, Hierath, M, Holmberg, O, Khong, P-L, Lewis, JS, McGinty, G, Oyen, WJG, Shulman, LN, Ward, ZJ, and Scott, AM

Abstract

The diagnosis and treatment of patients with cancer requires access to imaging to ensure accurate management decisions and optimal outcomes. Our global assessment of imaging and nuclear medicine resources identified substantial shortages in equipment and workforce, particularly in low-income and middle-income countries (LMICs). A microsimulation model of 11 cancers showed that the scale-up of imaging would avert 3·2% (2·46 million) of all 76·0 million deaths caused by the modelled cancers worldwide between 2020 and 2030, saving 54·92 million life-years. A comprehensive scale-up of imaging, treatment, and care quality would avert 9·55 million (12·5%) of all cancer deaths caused by the modelled cancers worldwide, saving 232·30 million life-years. Scale-up of imaging would cost US$6·84 billion in 2020-30 but yield lifetime productivity gains of $1·23 trillion worldwide, a net return of $179·19 per $1 invested. Combining the scale-up of imaging, treatment, and quality of care would provide a net benefit of $2·66 trillion and a net return of $12·43 per $1 invested. With the use of a conservative approach regarding human capital, the scale-up of imaging alone would provide a net benefit of $209·46 billion and net return of $31·61 per $1 invested. With comprehensive scale-up, the worldwide net benefit using the human capital approach is $340·42 billion and the return per dollar invested is $2·46. These improved health and economic outcomes hold true across all geographical regions. We propose actions and investments that would enhance access to imaging equipment, workforce capacity, digital technology, radiopharmaceuticals, and research and training programmes in LMICs, to produce massive health and economic benefits and reduce the burden of cancer globally.

Published
2021

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

Author

Vano, E. Frija, G. Stiller, W. Efstathopoulos, E. Granata, C. Loose, R. Paulo, G. Pekarovic, D. Sjöberg, J. Donoso-Bach, L. on behalf of the European Society of Radiology (ESR)

Abstract

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. For information on patient exposure, it was agreed to include the dosimetric values reported by the imaging modalities (validated by a medical physics expert). It was also suggested to prepare educational material on dosimetric quantities for patients. Individual optimisation was considered a challenge, especially for interventional procedures. In these cases, patient and occupational doses should be part of the global optimisation process and trigger levels should be defined to avoid skin radiation injuries. Diagnostic Reference Levels (DRLs) always need to be considered for comparison with periodic patient dose audits. In the case of accidental or unintended exposures, a report should be produced for the Quality Assurance programme, together with an educational note to avoid the repetition of incidents. Dose registry and management systems should allow fulfilling the regulatory requirements of national and European regulations. In a second step, and after the initial experience with the Directive implementation, a wider survey will be considered. © 2020, The Author(s).

Published
2020

12. Referral guidelines for medical imaging in children: an ESR-EuroSafe Imaging survey on availability, awareness and use in clinical practice among European radiologists.

Author

Granata, C., Frija, G., Damilakis, J., Foley, S. J., De Bondt, T., and Owens, C. M.

Abstract

Objectives: Justification of medical exposures from medical imaging is fundamental to radiation protection. Referral guidelines are intended to help physicians decide when an imaging study is justified. For two decades, referral guidelines have been a legally binding requirement for European Union member states. Recently, the European Society of Radiology (ESR) developed iGuide tool, which provides evidence-based referral guidance for imaging inclusive of children. The aim of this survey was to assess the availability, use and familiarity of referral guidelines for medical imaging in children and knowledge about the availability of ESR iGuide among ESR member radiologists. Methods: Over a 2-month period (15 September–15 November 2019), 33,257 ESR member radiologists were invited to respond to an anonymised web-based questionnaire, which consisted of 12 multiple-choice questions. Results: In total, 2067/33,257 responses (6.3%) were received from 52 countries. A total of 1068 out of 2067 (51.7%) respondents were aware that imaging referral guidelines are a legal requirement. One thousand five (48.6%) of all respondents did not know whether dedicated guidelines for imaging in children were available, and only 653 (31.2%) were aware of the mainstays of the available guidelines. Similarly, just 746 (36.1%) of all respondents were aware of ESR iGuide availability and features. Conclusions: The information gathered confirms that effective and widespread adoption of imaging referral guidelines is lacking, especially in children. Further work is required to improve uptake and awareness. Key Points: • Justification of medical exposures is fundamental to radiation protection and evidence-based referral guidelines are crucial for practical implementation of this principle. • About half of survey respondents are aware that the availability of imaging referral guidelines is a legal requirement, despite this being mandated since 1997. • The information gathered from this survey confirms that, especially in children, an effective and widespread adoption of imaging referral guidelines is lacking. [ABSTRACT FROM AUTHOR]

Published
2021
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17. Contrast media

Author

Schouman-Claeys, E., Frija, G., Vanel, Daniel, editor, Mc Namara, Michael T., editor, Arcangioli, O., editor, Arrive, L., editor, Aubert, B., editor, Bénacerraf, R., editor, Bigot, J.-M., editor, Bittoun, J., editor, Blangy, S., editor, Bonnin, A., editor, Broussin, J., editor, Buthiau, D., editor, Buy, J.-N., editor, Cabée, A.-E., editor, Caille, J.-M., editor, Chagnon, S., editor, Chateil, J.-F., editor, Chevrot, A., editor, Coffre, C., editor, Couanet, D., editor, Desprès, E., editor, De Tœuf, J., editor, Ecoiffier, J., editor, Engelholm, L., editor, Frija, G., editor, Gires, F., editor, Grenier, N., editor, Grenier, P., editor, Guinet, C., editor, Héran, F., editor, Idy-Peretti, I., editor, Jean-Mart, J., editor, Kien, P., editor, Kressel, H., editor, Lavayssière, R., editor, Leclère, J., editor, Leroy-Willig, A., editor, Malbec, L., editor, Marichez, M., editor, Masselot, J., editor, Meary, E., editor, Menu, Y., editor, Pallardy, G., editor, Parienty, R.-A., editor, Piekarski, J.-D., editor, Roucayrol, J.-C., editor, Schouman-Claeys, E., editor, Segebarth, C., editor, Sibert, A., editor, Somveille, E., editor, Taieb, A., editor, Tavière, V., editor, Vadrot, D., editor, Vallée, C., editor, Vanel, D., editor, Zalcman, M., editor, and Wybier, M., editor

Published
1989
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18. Heart

Author

Frija, G., Schouman-Claeys, E., Vanel, Daniel, editor, Mc Namara, Michael T., editor, Arcangioli, O., editor, Arrive, L., editor, Aubert, B., editor, Bénacerraf, R., editor, Bigot, J.-M., editor, Bittoun, J., editor, Blangy, S., editor, Bonnin, A., editor, Broussin, J., editor, Buthiau, D., editor, Buy, J.-N., editor, Cabée, A.-E., editor, Caille, J.-M., editor, Chagnon, S., editor, Chateil, J.-F., editor, Chevrot, A., editor, Coffre, C., editor, Couanet, D., editor, Desprès, E., editor, De Tœuf, J., editor, Ecoiffier, J., editor, Engelholm, L., editor, Frija, G., editor, Gires, F., editor, Grenier, N., editor, Grenier, P., editor, Guinet, C., editor, Héran, F., editor, Idy-Peretti, I., editor, Jean-Mart, J., editor, Kien, P., editor, Kressel, H., editor, Lavayssière, R., editor, Leclère, J., editor, Leroy-Willig, A., editor, Malbec, L., editor, Marichez, M., editor, Masselot, J., editor, Meary, E., editor, Menu, Y., editor, Pallardy, G., editor, Parienty, R.-A., editor, Piekarski, J.-D., editor, Roucayrol, J.-C., editor, Schouman-Claeys, E., editor, Segebarth, C., editor, Sibert, A., editor, Somveille, E., editor, Taieb, A., editor, Tavière, V., editor, Vadrot, D., editor, Vallée, C., editor, Vanel, D., editor, Zalcman, M., editor, and Wybier, M., editor

Published
1989
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19. General reportrecommendations in predictive, preventive and personalised medicine 2012: white paper of the European Association for Predictive, Preventive and Personalised Medicine

Author

Golubnitschaja, O, Costigliola, V, Benini, A, Kastrup, J, Berliner, L, Boecker, H, Yeghiazaryan, K, Bowis, J, Bubnov, R, Butler, P, Roelandse, M, Cafiero, C, Chan, W.S.H, Characiejus, D, Coelho, J, Danesi, R, Rovigatti, U, De Meester, F, Desiderio, D.M, Dimitrov, D, Dundar, M, Egorova-Zachernyuk, T, Evans, P, Everaus, H, Ferrari, M, González-Neira, A, Frija, G, Gerner, C, Krapfenbauer, K, Gluud, C, Gozes, I, Marcus-Kalish, M, Grech, G, Greuel, J, Grosios, N, Grossman, I, Hadder, M, Hagan, S, Hewitt, R, Ionescu, J, Iso, H, Kokubo, Y, Jansen, A, Joos, T, Josifova, T, Kapalla, M, Kinkorova, J, Kiper, N, Kovalenko, S, Krestin, G, Krishna, R, Kzhyshkowska, J, Kunin, A, Larionova, V.I, Legg, M, Lemke, H, Lieb, W, Major, T, Mandel, S, Marshall, T, Marzan, M.D, Spiru, L, Mendive, J, Mozaffari, M, Németh, G, Orr, M, Paltsev, M.A, Paul, F, Pinçon-Raymond, M, Pelsers, M, Podbielska, H, Polivka, J, Radojkovic, D, Richter, K, di Sarsina, P.R, Rosolova, H, Rubio, C.A, Safonicheva, O, Suchkov, S, Rukhadze, T, Salminen, L, Scarpa, M, Shabo, A, Shapira, N, Swanton, C, Tasker, R.A, Topolcan, O, Trovato, G.M, Tsangaris, G.T, Vittadini, G, Walkenhorst, J, Yamagishi, K, Yatsuya, H, Zhan, X., and Çocuk Sağlığı ve Hastalıkları

Subjects
integrative medicine, medicine.medical_specialty, MEDLINE, Alternative medicine, preventive and personalised medicine, well-being concept, White paper, Daily practice, Report, Drug Discovery, Health care, medicine, common/rare disease, Product (category theory), predictive, health care economics and organizations, Medical education, education, research, business.industry, Health Policy, Biochemistry (medical), diabetes/cancer/cardiovascular/neurodegenerative diseases, healthcare, ethics, co-morbidities, economy, Integrative medicine, Knowledge deficit, business
Abstract

This report is the collective product of word-leading experts working in the branches of integrative medicine by predictive, preventive and personalised medicine (PPPM) under the coordination of the European Association for Predictive, Preventive and Personalised Medicine. The general report has been prepared as the consortium document proposed at the EPMA World Congress 2011 which took place in Bonn, Germany. This forum analyzed the overall deficits and trends relevant for the top-science and daily practice in PPPM focused on the patient. Follow-up consultations resulted in a package of recommendations for consideration by research units, educators, healthcare industry, policy-makers, and funding bodies to cover the current knowledge deficit in the field and to introduce integrative approaches for advanced diagnostics, targeted prevention, treatments tailored to the person and cost-effective healthcare.

Published
2012

21. Latest Maastrichtian Rudist association of Apulia (Italy, Croatia, Greece): Implications for the Extinction of the Hippuritoidea

Author

Steuber, Thomas, Parente, M., Korbar, Tvrtko, Hagmaier, M., van der Kooji, B., Frija, G., Filkorn, H.F., Johnson, C.C., Molineux, A., and Scott, R.W.

Subjects
strontium isotope stratigraphy, Maastrichtian, rudist, Adria, Apulia, extinction
Abstract

Based on biostratigraphy, a Late Maastrichtian age of rudist limestones of the Adriatic microplate, or Apulia, was reported previously, but according to the present state of knowledge, the latest Maastrichtian rudist associations of the region are rather species-poor. This is supported by Sr-isotope stratigraphy (SIS) for inner platform deposits of the Island of Brac (Croatia). However, SIS indicated a numerical age of c. 66 Ma for the Ciolo Limestone of Salento (southern Italy), and for rudists from megabreccias exposed on the Ionian Islands (Greece). Both types of deposits contain species-rich rudist associations (Pironaea, Hippurites, several genera of Radiolitidae, Mitrocaprina). Large shells of ?Pseudosabinia are particularly abundant. The Ciolo Limestone was deposited at the margin of the Apulian platform and is unconformably followed by Tertiary limestones, while the megabreccias of the Ionian Islands accumulated at the toe-of-slope and are overlain by pelagic mudstones, which contain the K/P boundary. These results indicate that species-rich rudist associations existed in the central Mediterranean Tethys during the latest Maastrichtian. This is important for further evaluations of the pattern and causes of extinction of the group at the end of the Cretaceous.

Published
2005

22. EURORAD, the EAR database project

Author

Sigal, R, Caramella, Davide, Kurdziel, Jc, Gandon, Y, Lemort, M, Salcito, G, Frija, G, Ringertz, H, Baert, A, and Passariello, R.

Published
1999

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