Η εκπαίδευση στην ακτινοπροστασία στην

Ευρωπαική Ένωση

Τριαντάφυλλος ΓιαννακόπουλοςESVS EVST Radiation Protection Training Committee

EVST Executive CommitteeEVST Councilor – Greece

ΑγγειοχειρουργόςΕπιμελητής Αγγειοχειρουργικής Κλινικής Ν.Ν.Α.

ΔΠΜΣ «Ενδαγγειακές Τεχνικές»31 Ιανουαρίου 2014

73% των αορτικών ενδαγγειακών επεμβάσεων διενεργούνται από Αγγειοχειρουργούς

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

Ενδαγγειακές επεμβάσεις στην Ευρώπη

Marked Increase since 2007

Systematic Review of PubMed publications regarding radiation exposure

Radiology 58%Vascular Surgery 16%

Are we aware of Radiation Risk Importance?

The Aorta 72%

Systematic Review of PubMed publications regarding radiation exposure in Vascular Surgery

Interventional DSA 67%

What is our focus 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)

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.

Do we consider Education & Training in Radiation Exposure?

• 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

• WP3: Final report received by EC (Aug 2013)

• Accreditation/Certification of Specialists in RP• Standardized learning outcomes• Requirements for new specialists using ionizing radiation

ESVS NOT SurveyedBecause target was

National auth/soc/inst

ESVS Participant

ESVS Observer/Participant

EU Radiation Protection Training Background

MEDRAPET Consortium

Αποτελέσματα MEDRAPET

European Vascular Surgeons in Training (EVST)

Radiation Protection Training Survey Results

Triantafillos G. Giannakopoulos MDEVST Radiation Protection Training Committee

EVST Executive CommitteeEVST 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

EVST Radiation Protection Training Committee (Bologna 2012)

ESVS wide Electronic SurveyFull Members Trainee MembersEastern European Members

E-mail Based, Online

3051 Recipients – 583 Responders19.1% Response Rate - 60 Days

37 Multiple Choice Questions “Skip Logic”

SurveyMonkey, IBM SPSS v21, SISA

Confidence Level: 99%

Confidence Interval: ±4,78%(Margin of Error)

Confidence Level: 99%

Confidence Interval: ±4,78%(Margin of Error)

Statistical Significance of ResultsStatistical Significance of Results

Wimmer RD, Mass Media Research: Introduction 9TH EDITION. Wadsworth, Inc,2011;

Methods – Statistics - AccuracyESVS Newsletter IntroductionESVS Newsletter Introduction

• Increase awareness

• Establish RP Status

EVST Radiation Protection Training Committee (Bologna 2012)

ESVS wide Electronic SurveyFull Members Trainee MembersEastern European Members

E-mail Based, Online

3051 Recipients – 583 Responders19.1% Response Rate - 60 Days

37 Multiple Choice Questions “Skip Logic”

SurveyMonkey, IBM SPSS v21, SISA

Confidence Level: 99%

Confidence Interval: ±4,78%(Margin of Error)

Confidence Level: 99%

Confidence Interval: ±4,78%(Margin of Error)

Statistical Significance of ResultsStatistical Significance of Results

Wimmer RD, Mass Media Research: Introduction 9TH EDITION. Wadsworth, Inc,2011;

Methods – Statistics - Accuracy

• Increase awareness

• Establish RPT Status

Van Bennekom FC. Customer surveying: a guidebook for service managers. Bolton, MA: Customer Service Press; 2002.

Response Rate AnalysisResponse Rate 19,1%

(95% CI 17,7-20,5)Response Rate 19,1%

(95% CI 17,7-20,5)

Co-Operation Rate 19,8% Co-Operation Rate 19,8%

Refusal Rate 0,75% Refusal Rate 0,75%

Contact Rate 96,5% Contact Rate 96,5%

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

Responses over timeReminder Sent

Launch

NewsLetter

Respondents ProfileVascular Surgeons 69,8%Vascular Trainees 27%Vascular Surgeons 69,8%Vascular Trainees 27%

Young Specialists (1-5yr) 36%(double the size of older 5yr groups)

Young Specialists (1-5yr) 36%(double the size of older 5yr groups)

Respondents Profile

Public Hospital 47%Academic Institution 43%Private Sector 9%

Public Hospital 47%Academic Institution 43%Private Sector 9%

Respondents Practice Profile

90% get exposed to radiation during

Endovascular procedures

90% get exposed to radiation during

Endovascular proceduresNO ENDO TRAINING

SOMEONE ELSE DOES

NO FACILITIES

10% NO Endovascular10% NO Endovascular

Endovascular Practice ProfileO.R. + C-Arm is the most

popular mode of operationO.R. + C-Arm is the most

popular mode of operationVascular Surgery alone 52,8%Co-operation with I.R. 47,2%Vascular Surgery alone 52,8%Co-operation with I.R. 47,2%

Endovascular Training Profile

VS CURRICULUM

STAND ALONE

AS A SPECIALIST WORKING WITH VS

Stand Alone Organized byAS A SPECIALIST

WORKING WITH IR

75% were ENDO trained(but 90% get exposed during ENDO)

75% were ENDO trained(but 90% get exposed during ENDO)

ENDO in VS Curricula 55,5%Most Popular ENDO Training Provider 71,7%ENDO in VS Curricula 55,5%Most Popular ENDO Training Provider 71,7%

VS

IR

Endovascular Training Profile

41,5% of ENDO training programs DO NOT include

Radiation Protection modules

41,5% of ENDO training programs DO NOT include

Radiation Protection modules

Radiation Protection Training

69% were Radiation Protection trained(but 90% get exposed during ENDO)

69% were Radiation Protection trained(but 90% get exposed during ENDO)

STAND ALONE

VS CURRICULUM

IR

PART OF VS ENDO

56,5% was a STAND-ALONE RP Training Program56,5% was a STAND-ALONE RP Training Program

71% Received STAND ALONE RP Training within the last 5 years71% Received STAND ALONE RP Training within the last 5 years

Stand Alone RP Training

NATIONAL REGULATION

INSTITUTIONALREGULATIONS

82% because it was MANDATORY82% because it was MANDATORY

Stand Alone RP Training

Within Countries 99,1%Within Countries 99,1%

Radiation Physicists 83%Radiation Physicists 83%

EUROPEAN?

Stand Alone RP Training Level

COURSE CERTIFICATE

I DON’T HAVE AN RP SPECIFIC CERTIFICATE

WORKSHOP

MSc

NATIONAL CERTIFICATE

OTHER

PhD

68%

14,4%

14,1%

5,5%

Course Certificate 68%Course Certificate 68% 16-30 Teaching Hours most Frequent16-30 Teaching Hours most Frequent

Practice Patterns by Training Vascular TraineesVascular Trainees Vascular SurgeonsVascular Surgeons

4,67,6

14,5

65,4

14,913,5

24,3

39,2

14,9% get exposed without having trained

14,9% get exposed without having trained

4,6% get exposed without having trained

(worst scenario 9,2%)

4,6% get exposed without having trained

(worst scenario 9,2%)

RP Trained

Not RP Trained

53% unfamiliar with the meaning of ALARA

53% unfamiliar with the meaning of ALARA

Even after training in RP 41,5% remained unfamiliar with

the meaning of ALARA

Even after training in RP 41,5% remained unfamiliar with

the meaning of ALARA

RP Education by Training

Vascular Surgeons RP Education by Training

7,4

24,4

11,85,1

24,4% Unfamiliar with ALARA although trained24,4% Unfamiliar with

ALARA although trained9% Unfamiliar with

Dose Limit although trained9% Unfamiliar with

Dose Limit although trained

5,9

9

7,452,6

Importance of Radiation Protection Training

89% consider Radiation Protection Training a

Prerequisite

BUT

11% Training is not necessary

89% consider Radiation Protection Training a

Prerequisite

BUT

11% Training is not necessary

Awareness Level of RP Training Policy

National 78,2%National 78,2% European 16,8%European 16,8%

MEDRAPET86,4% Unaware of the MEDRAPET Project86,4% 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

88% Independent Use of Radiation by Vascular Surgeons

an absolute necessity

BUT

12% Independent use is not necessary

Accreditation & Certification

Accreditation of a Training ProviderAccreditation of a Training Provider

Certification of a Professional

Certification of a Professional

to give

Damilakis J, The MEDRAPET Project: European Guidance on RP E&T of Medical Professionals results. EFOMP- European Medical Physics and Engineering Conference. Sofia, Bulgaria, October 18-20, 2012

Accreditation

National/Regional 64,3%European 27%National/Regional 64,3%European 27%

CertificationCertification by National

Authorities was the most popular (50.8%)

Certification by National Authorities was the

most popular (50.8%)50.8% Committee of VS+IR+Phys50.8% Committee of VS+IR+Phys

RP Training Certification MandatoryAgree 82%

NO/Not Sure 18%Agree 82%NO/Not Sure 18% Young VS & Trainees are more reluctant ?Young VS & Trainees are more reluctant ?

Αποτελέσματα MEDRAPET

Discipline 1

EQF Required for entry

KSC table (LOs)

KSC: Knowledge, Skill, CompetenceEQF: European Qualifications FrameworkLLL: Lifelong LearningLO: Learning ObjectiveCPD: Continuing Professional Development

SPECIALTY

Discipline 2

EQF Required for entry

KSC table (LOs)

……..3

Ο Αγγειοχειρουργός είναι…

Discipline 1Discipline 2

Discipline 3

HealthCareProfessional Referrer

Non-Radiological SpecialistEmploying ionising radiation in

Interventional techniques

HIGH Dose

LOW Dose

Accreditation/Certification are definedWho should provide them remains vaguePotential Political implications recognized

Vascular Surgery is listed with Cardiology as High-dose users

MEDRAPET Final Report on “Non – Radiological Specialties”

University of Athens

+ University

Milano Bicocca

30 VS + 5 IR + 2 RP

University of Athens

+ University

Milano Bicocca

30 VS + 5 IR + 2 RP

http://www.endovasculartechniques.gr/

Master of Science “Endovascular Techniques”

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