Transcript static.sdu.dk

RAPID "Risk Assessment from Policy to
Impact Dimension" survey
Chaired by Gabriel Gulis and Odile Mekel on
behalf of the RAPID group
General objectives
 Policies and strategies influence the wider determinants of
health. These determinants have their impact on a range of
different risk factors which then directly affect human health.
The main aim of the project is to develop methodologies for
conduct of "full chain" risk assessment and implement them
on a case study application on selected EC policy and via a
series of national workshops.
Strategic relevance and contribution to
the public health programme
 The proposal addresses the following areas of the health program
and annual work plan:
 Risk assessment thematic networks and training of risk assessors.
The thematic network will address the "full-chain" approach on
broad field of determinants of health including all elements of risk
management cycle.
 Moreover as secondary area our proposal contributes significantly
to area 3.3.1 and specifically "Public health capacity building by
having academic partners on board who will implement the
knowledge developed to their routine public health curricula.
 The strategic relevance is given by full-chain approach itself and by
geographical coverage of partners.
Methods and means
 Each partner will choose a policy and conduct assessment on
impact on policy on determinants of health, impact of determinants
of health on prevalence of risk factors and impact of risk factors on
health effect (top-down approach). Similarly, each partner will
choose a health effect and conduct the assessment process up to
policies (the bottom-up approach). Based upon them a merged
assessment guidance document will be developed and tested on a
case of a European Commission policy. National workshops will be
conducted to train experts in participating countries on the
developed method.
Policy analysis, questionnaire survey (on risk perception), project
meetings, focus group discussions, database searches, workshops
will be the main methods to conduct the project.
Expected outcomes
 Pilot tested model methodologies will be produced for
bottom-up and top-down risk assessment in range of the full
chain between policy-health effects. Based upon them, a
general assessment methodology will be presented for fullchain approach. In addition, via national workshops a set of
national experts will be trained on the developed methods.
Aim of the Project
 RAPID grew-out from a previous project “health impact
assessment in new member states and accession countries”
(HIA NMAC). HIA NMAC identified a lack of risk assessment
methods for conducting policy health impact assessments
across areas of broad determinants of health.
 The main aim of the project is therefore to develop, pilot test
and implement risk assessment methodology for full chain risk
assessment (policy-determinants of health-risk factors-health
effect).
Specific objectives
 Establish a policy risk assessor database
 Conduct risk assessment case studies from policy to health
effect and from health effect to policy
 Summarize the methodologies from national case studies and
develop a “common methodology guidance”
 Implement the new methodology guidance via conducting a
case study of a selected EU policy and series of national
workshops
General overview
By Ph.D. student Stella R.J. Kræmer
SDU Esbjerg, Denmark
 As first step of the “Risk assessment from Policy to Impact
Dimension – RAPID” project the project group aimed to
establish a thematic network of risk assessors and develop a
database where interested users can find information about
those who do risk assessment in partner countries.
 The project working group developed a survey tool which has
been translated to each participant country language and used
for data collection.
 The collected data was then entered into a Access database.





359 records
Policy oriented risk assessors – 25/359
Public health – 169/359
Policy and public health – 6/359
Research on risk assessment, policy & law, – 71/359
Doing risk assessment within pre-defined
disciplines by partner country, absolute
numbers
N (% in
some
cases)
Italy
Denmark
Slovenia
Slovak
Republic
Hungary
Spain
Romania
Gernamy
Poland
Lithuania
Economics
1
1
4
2
1
1
5
6
15
1
Engineerin
g
Environme
nt
Law &
policy
Social
science
Public
health
Toxicology
5
9
3
5
4
5
18
10
14
1
3
4
6
3
8
9
22
16
16
4
2 (4.1%)
2 (14.2%)
3 (23%)
2 (3.4%)
0 (0)
3 (3.75%)
13 (11.4%)
0 (0)
1 (1.8%)
2 (13.3%)
5 (20.8%)
0
2
0
1
2
6
9
4
0
10
1 (7.1%)
7
52 (89.7%)
5
59
22
27
15
12
4
0
1
3
3
9
2
10
13
1
Epidemiolo
gy
Spatial
planning
Other
6
0
2
7
2
9
6
16
3
4
0
0
1
0
1
0
2
5
1
2
4
2
0
1
4
2
32
11
9
0
Total
number of
responses
24
14
13
59
18
80
114
58
54
15
Main area of work by partner country,
absolute numbers
N (% in
some
cases)
Governme
nt
Italy
Denmark
Slovenia
Slovak
Republic
Hungary
Spain
Romania
Germany
Poland
Lithuania
6
3
0
38
2
68
23
10
9
Industry
1
4
0
1
4
58
(72.5%)
3
18
2
3
0
Medicine
7
1
7
31
3
9
32
9
7
2
University
6
0
1
3
4
10
3
23
17
1
Other
research
Private
business
Other
4
0
1
2
1
6
4
3
30
0
1
4
2
8
5
2
5
5
5
0
3
4
3
1
2
1
1
5
8
4
Total
number of
responses
24
14
13
59
18
80
114
58
54
15
Elements of risk assessment by partner
country, absolute numbers
N (% in some
cases)
Hazard
identification
Hazard
characterization
Exposure
assessment
Dose-response
Italy
Denmark
Slovenia
Slovak
Republic
Hungary
Spain
Romania
Germany
Poland
Lithuania
9
5
7
32
12
53
70
28
45
2
10
4
5
27
12
32
69
0
39
12
9
5
5
31
6
40
53
30
34
5
4
1
3
9
4
13
24
23
16
3
Risk
characterization
Risk management
12
8
7
32
9
33
18
30
41
11
11
8
4
31
9
37
70
24
31
3
Economic costbenefit
Risk policy &law
0
4
4
2
2
5
17
8
12
1
7
5
5
3
3
6
19
23
8
1
Health
intelligence
Quantitative
methods
Other
3
0
8
33
3
4
15
11
2
10
3
4
4
1
2
4
5
23
11
1
3
4
4
1
2
4
5
23
11
1
Total number of
responses
24
14
13
59
18
80
114
58
54
15
Level of documentation by partner
country, absolute numbers
N (% in
some
cases)
Strategy
Italy
Denmark
Slovenia
Slovak
Republic
Hungary
Spain
Romania
Germany
Poland
Lithuania
4
4
5
8
7
11
45
25
16
3
Policy
5
2
4
3
3
8
27
13
13
2
Project
16
8
6
25
7
35
42
46
37
11
Plan
8
4
6
14
5
27
30
21
20
6
Concrete
action
Other
9
4
3
45
10
46
37
16
37
11
5
0
0
4
3
4
14
16
10
1
Total
number of
responses
24
14
13
59
18
80
114
58
54
15
Participation in RAPID
Yes
% of
total
Total
Italy
Denmark
Slovenia
Slovak
Republic
Hungary
Spain
Romania
Germany
Poland
Lithuania
Total
21
6
12
43
13
73
91
58
54
15
386
87.5
42.85
92.3
72.88
72.21
91.25
79.8
100
100
100
85.9
24
14
13
59
18
80
114
58
54
15
449
Interest to participate in workshops in last phase
of RAPID
Yes
% of
total
Total
Italy
Denmark
Slovenia
Slovak
Republic
Hungary
Spain
Romania
Germany
Poland
Lithuania
Total
21
6
12
43
16
55
91
50
43
12
349
87.5
42.85
92.3
72.88
88.89
88.75
79.8
86.2
79.6
80
77.7
24
14
13
59
18
80
114
58
54
15
449
Cross-tabulation of doing risk assessment
within public health and policy & law area
Public health
policy & law
Total
No
Yes
No
191
48
239
Yes
178
32
210
Total
369
80
449
7.1% of respondents claimed doing RA on these
two areas
Public health RA within different
institutional settings, absolute numbers
N (% in
some cases)
Government
Italy
Denmark
Slovenia
Slovak
Republic
Hungary
Spain
Romania
Germany
Poland
Lithuania
2
0
0
34
2
48
20
17
5
8
Industry
0
0
0
0
0
1
0
1
1
0
Medicine
6
0
7
30
3
7
3
5
7
1
University
1
0
0
3
2
5
1
8
5
1
Other
research
Private
business
Other
0
0
1
2
0
1
0
2
9
0
0
0
0
6
0
1
0
1
1
0
1
0
0
1
0
0
0
0
3
3
This table summarizes cases where a respondent answered “yes”
both to doing public health risk assessment and within enlisted
branches (settings). Most of public health related risk assessment
is clearly done within governmental institutions, medicine and
universities
 The collected data has been made available to the executive
agency
 Throughout the project risk assessors will be added to this
continued improved Database
 At the conclusion of the project the Database will be made
publically available and maintained
“Risk assessment form policy to
impact dimension – RAPID”
project funded by
Executive Agency for Health and Consumers (EAHC)
of DG SANCO
Risk assessor survey; country
differences and similarities
Authors:
Joanna Kobza - Silesian Medical University,
Public Health Department, Piekarska 18, 41-902
Bytom, Poland
Razvan Chereches - Center for Health Policy and
Public Health, Babes-Bolyai University, Cluj,
Romania
Piedad Martin-Olmedo & Inés García Sánchez
Escuela Andaluza de Salud Pública, Cuesta del
Observatorio 4. 18080 Granada, Spain
Presenting author: Joanna Kobza
Background
Public health systems and practices do
differ across Europe including
differences among EU member states
Summarizing our results we try to find
the answer if these differences influence
the way how we collect research data
and are there differences in approaches
to risk assessment
We try to answer these questions by
looking at methods used to collect data
within risk assessor survey of RAPID
project and results of the survey in three
countries: Poland, Romania and Spain
Methods
The RAPID risk assessor survey tool has been employed to
collect data administered on electronic way (e-mail and direct
online survey tool), translated and retranslated by each partner
and collected among risk assessors
The approaches to identify them were different in all
partner-countries of the project
Recrutation -Who is a risk assessment expert?
Data were uploaded to a Microsoft Access database and
analyzed with STATA statistical software
• Poland identified the risk
assessors through the
institutions, key for risk
assessment, especially in
environmental health area
and then by individual,
personal contact with
experts sending e-mails
• Romania developed a
national health and
environmental system
structure and used it to
distribute the survey tool
• Spain used a combined
approach of personal
contacts and mailing sent
around throughout the
executive boards of main
national scientific societies
Poland - chosen institutions
National Institute of Public Health
2 Institutes of Occupational Medicine
Institute for Ecology of Industrial Areas
Central Institute for Labour Protection-National Research
Institute
Institute of Environmental Protection
Central Mining Institute
Institute of Agriculture Medicine
Universities
Associations – for ex.: Polrisk (Polish Association of Risk
Assessors)
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Romania- chosen institutions
Environment Ministry
Environment Guard headquarters
non-governmental organisation
Environmental protection agency
Environmental Direction in the Local County of the Municipality of Cluj-Napoca
Ministry of the Economy
Ministry of Transport, Construction and Tourism
A private company from the top 10 quoted at the Romanian Stock Exchange
Agency for Development North-West
3 private companies
Ministry of Education and Research
The Institute for the Research of the Quality of Life
The Institute of Sociology of the Romanian Academy
The Faculty of Sociology and Social Work of the University of Bucharest
1 regional portal based in the Municipality of Cluj-Napoca
Direction of Communication and Public Relations of the Local Council of the
Municipality
Ministry of Health
National School for Public Health and Health Services Management, Bucharest
4 Institute of Public Health
3 Public Health Directions based in the residences of the Regional Development
Agencies
4 hospitals
Presidential Administration
National Agency for Governmental Strategies
7 County Councils based in the residences of Regional Development Agencies
Spain- chosen institutions
• Spanish Society of Environmental
Health
• Spanish Society of Food Safety
• Spanish Society of Toxicology
• Spanish Society of Epidemiology
• Ministry of Health
• Regional Health Authorities
• Group of experts
Results
The highest percentage of risk assessors who reported to be involved
in public health risk assessment at certain extent was identified in:
Spain - 73,75%
Poland - 27,78%
Romania - 19,3%
The extension of risk assessment methodology into policy was
more often applied in:
Poland - 24,1%
Romania - 23,7%
Spain – 10%
Results
POLAND
ROMANIA
SPAIN
56 questionnaire surveys
collected
RR=33%
115 questionnaire surveys
collected
RR=65%
80 questionnaire surveys
collected
51% of the surveyed are
environmental assessors
49% engaged in the
financial risk assessment
process
80% of surveyed were
dealing with health risk
assessment
58% respondents involved
in Environmental Health
issues at Governmental
Institutions
45-35% respondents are
involved in any of the Risk
assessment steps, being
risk quantification the
greatest barrier pointed out
Why differences
The differences could be explained partially by
the data collection process used in each country
but also by important differences on how risk
assessment is being understood across Europe,
for instance the tradition of education,
research in risk assessment domain in each
country.
Different approaches existing to refer to Risk
Assessment  confusion among professionals
to identify their role in the process (Spain)
Why differences
Examples:
Poland- risk assessment, risk management in environmental
health high developed during decades
public health relatively new sciences/specialization
Poland and Romania –new Member States (perhaps local
politicians more open for new strategies)
RomaniaSpain-Risk assessment is being introduced in different policy
actions for several years but there is no an official procedure
to tackle quantification of health impacts a part from those
done by research institutions
Conclusions
The experience gathered via risk assessor survey
confirms existing differences in public health
systems and approaches across EU member states.
This implies a need for careful planning of
methodology development and training content
and method selection expected in last phase of the
RAPID project
Thank you for your
attention
HIA framework to investigate
additional cancer risk from Ionizing
Radiation in Medical Imaging
Top-Down case study – Italian partner
Nunzia Linzalone, Elisa Bustaffa, Liliana Cori, Fabrizio Bianchi and
IFC cardio-staff
Prepared for the project
Risk Assessment from Policy to Impact Dimension (RAPID) 2009-2012
EU (DG-SANCO) Grant agreement No 20081105
HIA framework
•
To develop effective precautionary
policies, policy-makers and
stakeholders need evidences based on
an integrated risk assessment
•
To match this need RAPID project have
included a case study to develop and
test a framework and methodology for
“full chain” impact assessment
•
The aim of this work is to incorporate
existing models of risk management
and quantitative risk assessment, into
a framework of health impact
assessment
POLICY SELECTION
Patient Safety from Ionizing Radiation (IR)
•
•
•
•
European directive 97/43 (D. Lgs. 187/00)
Legislative Decree 187/00
Regional Health Plan 2008-2010
Tuscan Region funded projects on
medical use of IR
– “Communication of patient dose”
– “Stop Useless Ionizing Testing in
Heart Disease” (SUITheart)
• Guidelines
–
–
–
–
EU, 2001
Italy, 2006 last update
American College of Radiology 2007,
International Atomic Energy Agency 2008
Reducing Environmental Cancer
Risk, What We Can Do Now :
2008-2009 Annual Report,
President’s Cancer Panel
FOCUS ON CARDIOVACULAR IMAGING
An emerging concern at local and international level
Computed tomography (CT) was
introduced into medical imaging in the
1970s and has grown exponentially
particularly in cardiovascular clinical
test for a wide variety of cardiovascular
conditions. Cardiovascular CT use has
recently been tempered by a string of
high-impact publications raising concern
about the increase in radiation
exposure to the population from
medical procedures and the potential
cancer risk.
The current cardiological practice is
based on a deregulated, radiationinsensitive, and imaging prescription
policy.
(Brenner, 2007)
RAPID
Top-down risk
assessment
model
Determinants of health
Communication and consultation
• Core determinants of
health influenced by
the policy
• Risk factors linked to
determinants of
health
• Health effects linked
to selected risk factor
• Risk perception and
communication on
each level
Policy
Environmental, , Biological,
Clinical, Economic determinants
Medical
practice
Risk factors
Pediatric and adult
population
Gender, age, diagnosis
Health outcomes
Greatest
social
benefit
at
lowest
cost
Ionizing radiation in medical practice:
exposure and health
•
•
•
•
Medical imaging is the largest
controllable source of radiation
exposure in the population of
industrialized countries
One out of two examinations is
completely or partially inappropriate
(i.e. risk outweighs benefit) and
cardiologists are often unaware of the
radiological dose of the examination
they prescribe or practice
This avoidable exposure is associated
with increased, significant cancer
risk at both the individual and
population levels
Exposure can be minimized through a
knowledge-based intervention targeted
to increasing radiological
awareness of prescribers and
practitioners.
Risk-benefit balance
• Exposures for medical purposes account for a variable percentage
of cases of cancer between 1 and 3 per cent of all those observed
in developed countries (underestimated risk)
• 30% of tests involving ionizing radiation are inappropriate—that is,
patients take a long term risk without a commensurate acute
benefit.
• Need to know the risk for each test and balance it with the benefits
of diagnosis
• Better knowledge of risks will help to avoid small individual risks
translating into substantial population risks.
Individual risk
Population risk
RAPID Model: the full chain assessment
Tuscany Policy on Radiprotection 2008-2010
• How do they account for the
associated attributable long
term cancer risk.
• Is estimated individual risk
comprehensive of cumulative
exposures?
Proximal health determinants (physical environment)
Communication and consultation
• How do different policies,
focused to the issue of
awareness in diagnostic use of
ionizing radiation, correspond
to changes in individual
exposure to cumulative dose?
Current guideline,
technological updating,
continuing training, patient
and operator awareness,
etc…….
Workplace environment
and community
environment
Cumulative individual dose, working tasks, technologies
availability, co-morbidity,…
Pediatric and
adult population
Gender, age,
diagnosis
Fatal and non fatal cancer, other non cancer outcomes
Gre
ates
t
soci
al
ben
efit
at
low
est
cost
Levels of investigation
1. Main factors in the causation chain.
2. Percent of cancers avoided depending on
the different medical practice used in the
context of heart disease (IFC – SUIT Heart
Project).
The inquiry methodology
1. Main factors in the causation chain
To make an overall assessment of the policy
effects on health, most important determinants
and risk factors are identified by:
– Review of literature
– Experts consultation
1.1. Review of literature
• What?
– Higher Impact Factor Scientific Journal focused to MI
and/or CT use
– Scientific Association Guidelines and
Recommandations
• How many?
– Selected references are primary study or most
updated reviews, published from 2004 to 2010. They
totally sum to #69
1.2. Experts consultation
• Who are they?
– Inner resources from IFCCNR and collaborative
consultants from University
and Helth care Dept.s
• What they are
requested to do?
– Identify and rank the most
important determinants and
risk factors. A scoring
system helps to prioritize
them from “high relevant”
to “not relevant”.
– Cardiologist (Senior Researcher, ICPNRC Pisa-Italy)
– Radiologist (Technical Consultant, ICPNRC Pisa-Italy)
– Hemodynamist (Research Director, ICPNRC Pisa-Italy)
– Pulmonologist (Researcher, ICP-NRC
Pisa-Italy)
– Nuclear physicist (Principal Investigator,
ICP-NRC Pisa-Italy)
– Geneticist (Researcher, ICP-NRC PisaItaly)
– GP (Generic Physician)
– Manager and Scientific Coordinator,
Physical co-worker (USL Lucca, Livorno
– Italy
Informing policy actions
very relevant
Are
determinants
Health
determinants
Presentof
medical practice
Training strategies
Technological
Age (p)
health as relevant
as updating
relevant Technological updating
Training
already known
riskstrategies moderate
Patient/operator awareness
Present medical practice
factors?
Workplace environment
Gender (p)
Main cathegories
Community environment
Age (a)
ants Present medical practice
Training
strategies
Commercial/Economic
reasons
Patient/operator19awareness
Technological
updating
Age slight
(p) effect Workplace environment
17
Risk
factors
Training
strategiesAge
Technological updating
15
Pediatric
population
Gender (a)
Patient/operator awareness
Present medical practice
Gender
Diagnosis (a) 11
Workplace environment
Gender (p)
Diagnosis
Diagnosis (p) 11
Community environment
Age not
(a) relevant Commercial/Economic
11
Other (Familiarity)
reasons
Commercial/Economic
8
Adult
population
Age reasons Patient/operator awareness
Other (Familiarity)
Workplace environment
7
Gender
Community Environment
tion Age
Gender (a)
7
Diagnosis
Gender
Diagnosis (a)
5
Other (Familiarity)
Diagnosis
Diagnosis (p)
1
Other (Familiarity)
Commercial/Economic reasons -3
Age
Other (Familiarity)
-3
Gender
Community Environment
-5
19
17
15
11
11
11
8
7
7
5
1
-3
-3
-5
The inquiry methodology
2. Percent of cancers avoided
The risk of cancer associated with diagnostic
imaging is quantified by:
– A developed software based on three main subcomponents of exposure: natural,diagnostic,
professional. The result is the amount of cumulative
risk.
– The simulated risk is associated with current
indications of appropriateness.
2.1. RADIORISK Software – IFC Tool
Awareness of radiological risk is
low among cardiologists, who
prescribe the majority (60-80%)
of ionizing test examinations
(totaling today the dose
equivalent of about 150 chest xrays per head per year) and are
the most exposed among health
professionals (250-300 chest xrays per head per year for most
active interventional
cardiologists)
Dose reference and Cancer Risk estimates
•
Reference European guideline (2001)
•
Guidelines of Italian Minister of Health
•
Peer reviewed journal
•
Government Agency
•
From each exam data file (if available)
BEIR VII, 2006
•
The estimation is base on 100000 studies, including 87000 Hiroshima and
407000 nuclear workers
•
2 to 3 confidence intervals of attributable risks estimate
•
X-rays and gamma-rays are a proven carcinogen (WHO’s International
Agency of Research of Cancer)
•
Epidemiological evidence up to now above 50 mSv
•
Re-affirm Linear No-Threshold hypothesis
Risk report: cancer incidence and mortality
Individual
informations
Exposure, charts, risk estimation
Table of risk and extra
cancer risk from
medical exposure
History of exposure
to ionizing radiation
Communication of risk
Comparison to other risks: all data are transferred into
images Travelling by car
Cigarette smoking
Rock climbing
Coal miner working
Stay near Hiroshima
on 6 August 1945
2.2. Considerations on appropriateness
• Why to reduce useless imaging
– Economic
• cut direct costs
• reducing waiting lists
• avoid radiation risks
– Biology
• teratogenesis
• cancer
• hereditary defects
– Ethic
• misunderstood risk percepion
• “disinformed” consent
• underestimation of doses to patient
Decision-making in Clinical Practice
Standard approach in guidelines:
Clinical Practice (CP)
CP 1
CP 2
more conservative
LV function:
Myocardial viability:
Cardiac Stress Imaging in pediatric patients:
CP 3
less conservative
Echo or MRI or MSCT or RNA
Echo or MRI or Scinty or PET
Echo or MRI
Risk of cancer
or CT
(Canadian 2006)
(ESC, 2004)
or Nuclear (AHA guidelines, 2006)
The same for physicians, not for patient or the society!
Legend:
Echo: Echocardiography or Echocardiogram
MRI: Magnetic Resonance Imaging
CT: Computed Tomography
MSCT: Multisclice Computed Tomography
PET: Positron Emission Tomography
Scinty: Scintigraphy
RNA: Radionuclide Angiography
Disclosing “medical practice” box
Choosing the right test for the right patient, and performing it
with the lowest possible radiation dose
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Same individual: different possible
diagnostic approach
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– Reduction in cumulative dose
EX: differences in cancer risks
Different individual: different
possible diagnostic pathway
– Free from radiation possible
Sample 100000 persons
Age 40-50
Males 50 %
Females 50%
Scintigrafy Sestamibi Tc-99m
Scintigrafy Tallium
Incidence 58.1 (45,6-74,2)
1/1721 (1/2193 - 1/1348)
Incidence 264,9 (207,9-337,8)
1/378 (1/481-1/296)
Mortality 33,2 (26,0-41,0)
1/3012 (1/3846 - 1/2439
Mortality 151,5 (118,5-186,6)
1/662 (1/844 - 1/538)
TC-chest
Incidence 45.2 (35,5-57,7)
1/2212 (1/2817 - 1/1733)
Mortality 25,9 (20,2-31,9)
1/3861 (1/4951 - 1/3135)
Integrating levels of knowledge
Assessing impacts in a socio-environmental context
Research communication
Regional Health Plan 2008-2010
on radioprotection
Financial local trends
Health
determinants
Medical Referral Guide lines
Medical equipe
shift
Medical Lobbies
Business leverage
Tecnological updating
Education on risks
Volume of prescription
by centers
Working
environment
regulation
Social and health
equity
Trained/skilled
operators
Risk perseption
in medical staff
Determininstic effects
Volume of MI
prescriptions
Medical practice
Air flights duration
Age
Gender
Free time activities
Exposure estimates
All cancers patterns in the population
Individual
mean dose
levels
Dose
response
model
Professional exposure
Risk
factors
Health
outcomes
Patient survey
and data storing
Updated form for
Informed consent
Suspected diagnosis
Pediatric/adult
population
Research in a third level
referral medical center
Place of residence
Individual
extra risk for
long term
cancer
Profiling risks to population
Advice on the Regional Health Plan 2010-2012
• Further recommendations and guidelines fueled by IFC
research on:
 level of appropriateness of the main ionizing cardiological
examinations in a high-tech tertiary care referral center;
 calculation of the patient and population dose from reference
and actual radiological exposures al local level;
 user-friendly software for dose and risk calculation by patient;
 preparation of an informative, transparent template of informed
consent form for radiological examinations;
 estimate of the number of avoidable cancers produced by
current levels of inappropriate testing.
RAPID key features
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Literature consultation
Experts rating
Risk estimates comparison
Overall consideration for best practice
Reinforcement of communication on
risks