Transcript EVST Radiation Protection Training Survey

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.
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
Are we aware of Radiation Risk
Importance?
Systematic Review of PubMed publications regarding radiation exposure
Marked Increase
since 2007
Radiology
Vascular Surgery
58%
16%
What is our focus in Radiation
Exposure?
Systematic Review of PubMed
publications regarding radiation exposure in Vascular Surgery
The Aorta 72%
Interventional DSA 67%
Do we consider Education &
Training
in
Radiation
Exposure?
Systematic Review of PubMed
publications regarding radiation exposure in Vascular Surgery
Only 9% of publications
considered the effect of
Education
(Training / Experience)
Surgeon Education Decreased
PSD by 16% (p<0.001)
122 Fluoro Guided procedures Pre vs Post Education
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.
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
EU Radiation Protection
Training Background
• The MEDRAPET Project (will revise RP116)
• WP1: Survey (Professional Societies, Authorities, Institutions)
• WP2: Workshop
ESVS NOT Surveyed
Because target was
National auth/soc/inst
ESVS Participant
• WP3: Final report received by EC (Aug 2013)
•
•
•
ESVS
Accreditation/Certification of Specialists in RP
Observer/Participant
Standardized learning outcomes
Requirements for new specialists using ionizing radiation
MEDRAPET Consortium
Αποτελέσματα MEDRAPET
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
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
Methods – Statistics - Accuracy
EVST Radiation Protection Training
Committee (Bologna 2012)
ESVS wide Electronic Survey
Full Members
Trainee Members
Eastern European Members
•
•
ESVS Newsletter Introduction
Increase
awareness
Establish
RP Status
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
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;
Methods – Statistics - Accuracy
EVST Radiation Protection Training
Committee (Bologna 2012)
ESVS wide Electronic Survey
Full Members
Trainee Members
Eastern European Members
•
•
Increase
awareness
Establish
RPT Status
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
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;
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).
Responses per Country
Launch
Responses over time
Reminder Sent
NewsLetter
Respondents Profile
Vascular Surgeons
Vascular Trainees
69,8%
27%
Young Specialists (1-5yr) 36%
(double the size of older 5yr groups)
Respondents Profile
Public Hospital
Academic Institution
Private Sector
47%
43%
9%
Respondents Practice Profile
10% NO Endovascular
90% get exposed to
radiation during
Endovascular procedures
NO ENDO TRAINING
SOMEONE ELSE DOES
NO FACILITIES
Endovascular Practice Profile
O.R. + C-Arm is the most
popular mode of operation
Vascular Surgery alone
Co-operation with I.R.
52,8%
47,2%
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
AS A SPECIALIST
WORKING WITH VS
AS A SPECIALIST
WORKING WITH IR
VS
IR
Stand Alone
Organized by
Endovascular Training Profile
41,5% of ENDO training
programs DO NOT include
Radiation Protection
modules
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
Stand Alone RP Training
71% Received STAND ALONE RP
Training within the last 5 years
82% because it was MANDATORY
NATIONAL REGULATION
INSTITUTIONAL
REGULATIONS
Stand Alone RP Training
Radiation Physicists
Within Countries
99,1%
EUROPEAN?
83%
Stand Alone RP Training Level
Course Certificate
68%
COURSE CERTIFICATE
14,4%
I DON’T HAVE AN RP SPECIFIC
CERTIFICATE
14,1%
WORKSHOP
5,5%
MSc
NATIONAL CERTIFICATE
OTHER
PhD
68%
16-30 Teaching Hours most Frequent
Practice Patterns by Training
Vascular Trainees
14,9% get exposed without
having trained
Vascular Surgeons
4,6% get exposed without
having trained
(worst scenario 9,2%)
65,4
39,2
24,3
13,5
14,5
14,9
7,6
4,6
RP Education by Training
53% unfamiliar with the meaning
of ALARA
Even after training in RP
41,5% remained unfamiliar with
the meaning of ALARA
RP Trained
Not RP
Trained
Vascular Surgeons
RP Education by Training
24,4% Unfamiliar with
ALARA although trained
9% Unfamiliar with
Dose Limit although trained
9
24,4
11,8
5,1
7,4
7,45
2,6
5,9
Importance of Radiation
Protection Training
89% consider Radiation
Protection Training a
Prerequisite
BUT
11% Training is not necessary
Awareness Level of
RP Training Policy
National
78,2%
European
16,8%
MEDRAPET
86,4% Unaware of the MEDRAPET Project
Importance of Independent
Use of Radiation
88% Independent Use of
Radiation by Vascular Surgeons
an absolute necessity
BUT
12% Independent use is not
necessary
Accreditation & Certification
Damilakis J, The MEDRAPET Project:
European Guidance on RP E&T of
Medical Professionals results. EFOMPEuropean Medical Physics and
Engineering Conference. Sofia,
Bulgaria, October 18-20, 2012
Accreditation of a
Training Provider
to give
Certification of a
Professional
Accreditation
National/Regional
European
64,3%
27%
Certification
Certification by National
Authorities was the
most popular (50.8%)
50.8% Committee of VS+IR+Phys
Agree
NO/Not Sure
RP Training Certification
Mandatory
82%
18%
Young VS & Trainees are more reluctant ?
Αποτελέσματα MEDRAPET
KSC:
EQF:
LLL:
LO:
CPD:
Knowledge, Skill, Competence
European Qualifications Framework
Lifelong Learning
Learning Objective
Continuing Professional Development
SPECIALTY
Discipline 1
EQF
KSC
Required table
for entry (LOs)
Discipline 2 ……..3
EQF
KSC
Required table
for entry (LOs)
Ο Αγγειοχειρουργός είναι…
Discipline 1
HealthCare
Professional
Discipline 2
Referrer
Discipline 3
Non-Radiological Specialist
Employing ionising radiation in
Interventional techniques
HIGH Dose
LOW Dose
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
Master of Science
“Endovascular Techniques”
University of
Athens
+
University
Milano
Bicocca
30 VS + 5 IR
+ 2 RP
http://www.endovasculartechniques.gr/
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