IAEA survey of paediatric computed tomography practice in 40 countries in Asia, Europe, Latin America and Africa: procedures and protocols.

OBJECTIVE: To survey procedures and protocols in paediatric computed tomography (CT) in 40 less resourced countries. METHODS: Under a project of the International Atomic Energy Agency, 146 CT facilities in 40 countries of Africa, Asia, Europe and Latin America responded to an electronic survey of CT technology, exposure parameters, CT protocols and doses. RESULTS: Modern MDCT systems are available in 77 % of the facilities surveyed with dedicated paediatric CT protocols available in 94 %. However, protocols for some age groups were unavailable in around 50 % of the facilities surveyed. Indication-based protocols were used in 57 % of facilities. Estimates of radiation dose using CTDI or DLP from standard CT protocols demonstrated wide variation up to a factor of 100. CTDI(vol) values for the head and chest were between two and five times those for an adult at some sites. Sedation and use of shielding were frequently reported; immobilisation was not. Records of exposure factors were kept at 49 % of sites. CONCLUSION: There is significant potential for improvement in CT practice and protocol use for children in less resourced countries. Dose estimates for young children varied widely. This survey provides critical baseline data for ongoing quality improvement efforts by the IAEA.

IAEA survey of pediatric CT practice in 40 countries in Asia, Europe, Latin America, and Africa: Part 1, frequency and appropriateness.

OBJECTIVE: The purpose of this study was to assess the frequency of pediatric CT in 40 less-resourced countries and to determine the level of appropriateness in CT use. MATERIALS AND METHODS: Data on the increase in the number of CT examinations during 2007 and 2009 and appropriate use of CT examinations were collected, using standard forms, from 146 CT facilities at 126 hospitals. RESULTS: The lowest frequency of pediatric CT examinations in 2009 was in European facilities (4.3%), and frequencies in Asia (12.2%) and Africa (7.8%) were twice as high. Head CT is the most common CT examination in children, amounting to nearly 75% of all pediatric CT examinations. Although regulations in many countries assign radiologists with the main responsibility of deciding whether a radiologic examination should be performed, in fact, radiologists alone were responsible for only 6.3% of situations. Written referral guidelines for imaging were not available in almost one half of the CT facilities. Appropriateness criteria for CT examinations in children did not always follow guidelines set by agencies, in particular, for patients with accidental head trauma, infants with congenital torticollis, children with possible ventriculoperitoneal shunt malfunction, and young children (< 5 years old) with acute sinusitis. In about one third of situations, nonavailability of previous images and records on previously received patient doses have the potential to lead to unnecessary examinations and radiation doses. CONCLUSION: With increasing use of CT in children and a lack of use of appropriateness criteria, there is a strong need to implement guidelines to avoid unnecessary radiation doses to children.

Case report: A novel model for educating radiation therapists in small countries: Case study of the "Train the Trainer" initiative in Israel.

INTRODUCTION: Israel, as a small country faces many challenges to deliver quality RTT education. As technologies evolve, the need for RTT education becomes acute. This resulted in the Ministry of Health, IAEA and ESTRO running the train the trainers (TTT) program in a unique format. METHOD: An expanded TTT program was run in Israel. This resulted in the establishment of the National Center for Radiotherapy Education (NCRE). Key elements of the NCRE include national leadership, high-tech teaching environment, simulation based teaching methodologies, and evidence based education.Educational outcomes of the RTT course run in the NCRE were measured and statistically analysed. RESULTS: The measurement of educational outcome was highly significant (p < 0.00001). The feedback from the course was very positive, with a high aggregate data mean score for all questions pertaining to the effect the course has on work, and efficient use of time. DISCUSSION: The success of the RTT course of the NCRE is evident from the results. The impact of the TTT program went beyond RTT education, as the NRCE is a national radiotherapy education resource, utilized by all radiotherapy professionals. CONCLUSION: More knowledgeable RTTs may be able to work in advanced roles, taking on tasks from other sectors in the department; this could improve the efficiency of patient care and improve the safety of radiotherapy delivery.