[Questionnaire Survey of Radiation Protection Education in Hospitals].

PURPOSE: The present study aimed to investigate the current situation of radiation protection education for designated radiation workers in hospitals. METHODS: A web-based questionnaire survey was conducted at 1,883 hospitals nationwide with 200 or more beds. RESULTS: Responses from 186 hospitals were included in the analysis. Seven hospitals (6.7%) regulated by the Act on the Regulation of Radioisotopes and six hospitals (7.4%) regulated by only the Ordinance on Prevention of Ionizing Radiation Hazards did not implement radiation protection education. In approximately 6% of the hospitals, designated radiation workers-including physicians, nurses, and radiological technologist-did not attend the education program. The education program attendance rate of physicians was lower than that of nurses. In more than 90% of the hospitals, the frequency of the periodical education program was once every year and lecture time spanned one or less than one hour. The topics of lecture in more than 90% of the hospitals were health effects of radiation and methods of radiation protection for occupational exposure. The radiological technologist was the instructor of the education program in approximately 70% of the hospitals. CONCLUSION: The implementation of radiation protection for designated radiation workers varied from hospital to hospital, and some hospitals did not comply with laws and regulations. Effective and efficient radiation protection education models should be implemented in hospitals.

A JROD survey: nationwide overview of radiotherapy data from 2015 to 2021.

The purpose of this survey was to examine the status of radiotherapy in Japan based on the cases registered in the Japanese Radiation Oncology Database (JROD), from 2015 to 2021, and to provide basic data to help improve the usefulness of the JROD in the future. The study population consisted of patients who underwent radiotherapy between 2014 and 2020 and did not opt out of the study. The survey item data analyzed in this study were entered into the database at each radiotherapy institution by referring to medical records from the preceding year. Our results show that the number of registered radiotherapy institutions and cases increased by ~50% in 2019 compared to those in 2015 (to 113 institutions and 60 575 cases, respectively). Among the survey item categories, the registration rate was lowest for prognostic information (13.9% on average over the 7-year period). In terms of the Japanese Society for Radiation Oncology disease site, the breast; lung, trachea and mediastinum and urogenital sites accounted for >50% of the total cases. The average survival and mortality rates over the 7-year study period were 67.4 and 17.4%, respectively. The X-ray radiotherapy completion rate exceeded 90% for all years and across all disease categories. 192Ir-based brachytherapy and 223Ra-based radionuclide therapy accounted for an average of 61.9 and 44.6%, respectively, of all corresponding cases over the 7-year period. In conclusion, this survey enables us to infer the actual status of radiotherapy in Japan based on the analysis of relevant nationwide data.

Japanese structure survey of radiation oncology in 2015.

This article describes the ongoing structure of radiation oncology in Japan in terms of equipment, personnel, patient load and geographic distribution to identify and overcome any existing limitations. From May 2016 to August 2018, the Japanese Society for Radiation Oncology conducted a questionnaire based on the Japanese national structure survey of radiation oncology in 2015. Data were analyzed based on the institutional stratification by the annual number of new patients treated with radiotherapy per institution. The estimated annual numbers of new and total (new plus repeat) patients treated with radiation were 225 000 and 271 000, respectively. Additionally, the estimated cancer incidence was 891 445 cases with approximately 25.2% of all newly diagnosed patients being treated with radiation. The types and numbers of treatment devices actually used included linear accelerator (linac; n = 936), Gamma Knife (n = 43), 60Co remote afterloading system (RALS; n = 21), and 192Ir RALS (n = 129). The linac system used dual-energy functions in 754 units, 3D conformal radiotherapy functions in 867, and intensity-modulated radiotherapy (IMRT) functions in 628. There were 899 Japan Radiological Society/Japanese Society for Radiation Oncology-certified radiation oncologists (RO), 1213.9 full-time equivalent (FTE) ROs, 2394.2 FTE radiotherapy technologists (RTT), 295.7 FTE medical physicists, 210.2 FTE radiotherapy quality managers, and 906.1 FTE nurses. The frequency of IMRT use significantly increased during this time. In conclusion, the Japanese structure of radiation oncology has clearly improved in terms of equipment and utility although there was a shortage of personnel in 2015.

Japanese structure survey of radiation oncology in 2013.

This paper describes the ongoing structure of radiation oncology in Japan in terms of equipment, personnel, patient load and geographic distribution to identify and overcome any existing limitations. From December 2014 to July 2017, the Japanese Society for Radiation Oncology conducted a questionnaire based on the Japanese national structure survey of radiation oncology in 2013. Data were analyzed based on institutional stratification by the annual number of new patients treated with radiotherapy per institution. The estimated annual numbers of new and total (new plus repeat) patients treated with radiation were 216 000 and 257 000, respectively. Additionally, the estimated cancer incidence was 862 452 cases with ~25.0% of all newly diagnosed patients being treated with radiation. The types and numbers of treatment devices actually used included linear accelerator (LINAC; n = 880), Gamma Knife (n = 45), 60Co remote afterloading system (RALS; n = 23) and 192Ir RALS (n = 128). The LINAC system used dual-energy functions in 675 units, 3D conformal radiotherapy functions in 785 and intensity-modulated radiotherapy (IMRT) functions in 494. There were 831 Japan Radiological Society/Japanese Society for Radiation Oncology-certified radiation oncologists, 1130.6 full-time equivalent (FTE) radiation oncologists, 2214.6 FTE radiotherapy technologists, 196.6 FTE medical physicists, 183.8 FTE radiotherapy quality managers and 856.7 FTE nurses. The frequency of IMRT use significantly increased during this time. In conclusion, the Japanese structure of radiation oncology has clearly improved in terms of equipment and utility although there was a shortage of personnel in 2013.

[Analysis of Workflow and Structuring of the Problem Element for Workflow Database Construction of Radiological Technologists in Radiation Therapy].

The work of radiological technologists is changing and more complicated because of the development of medical technology and implementation of information technology (IT). Although the cases of incident and accident have been reported, they have not been comprehensively analyzed in the workflow for radiotherapy. In this study, we visualized the workflow of radiological technologists in radiotherapy and revealed the causes of incidents and accidents. The work process was visualized by drawing workflow map. The structuring of problem was performed with interpretive structural modeling (ISM) method based on graph theory by analyzing of work categorized by safety management. Our results may be able to clarify the work of radiological technologists leads to the reduction of incidents and accidents in radiation therapy.

[Survey of the Requested Function for Quality Assurance System for Images (Kenzo System)].

As the use of filmless examination images, using various systems, has increased, and became common to perform KAKUTEI and save the images. In particular, the use of quality assurance system for images (Kenzo system) has increased to ensure the efficient performance of confirmed image. However, there has been no report showing what kind of function should be used or how to write the specifications of such a function in introducing the Kenzo system. Therefore, this study conducted a survey to the in-charge medical staff of medical institutions to provide "information included in the specifications when introducing medical systems". As a result, it is possible, through analyzing and clarifying the necessary functions of the Kenzo system, to apply it in medical institutions with various scales and workflows. The results indicate the person in charge was looking for functions, such as "coordination of information and image processing, securing the consistency of the information, and clarifying responsibility using the records of confirmed persons". We showed examples of how to describe these in the specifications.

AUTOMATIC ACQUISITION OF CT RADIATION DOSE DATA: USING THE DIAGNOSTIC REFERENCE LEVEL FOR RADIATION DOSE OPTIMIZATION.

The present work describes that we try to construct a system that collects dose information that performed CT examination from multiple facilities and unified management. The results of analysis are compared with other National diagnostic reference level (DRL), and the results are fed back to each facility and the cause of the abnormal value is investigated for dose optimization. Medical information collected 139 144 tests from 33 CT devices in 13 facilities. Although the DRL of this study is lower than that of Japan DRL, it was higher than the DRL of each country. When collecting all the examination, it is thought that the variation of the dose due to the error other than the intended imaging site is large. In future, we should continue to collect information in order to DRL renewal and we also think that it is desirable to collect information on physique and detailed scan region as well.

Development and practice of ISMS at a Radiotherapy Hospital by using IHE Integration profiles.

Our hospital is specialized for radiation therapy and has many information devices. Various job categories are working. When we implemented an EMR, we aimed to enforce ISMS by using IHE profiles. To solve the already existed system-related problems, we selected and use some profiles (EUA, PSA, ATNA and PAM). After implementation, we audited and then some findings were pointed out. These findings are being settled by the PDCA cycle. We also found that appropriate IHE profiles were effective in the building of ISMS.

Development of Clinical Database System Specialized for Heavy Particle Therapy.

We have developed a data archiving system for study of charged particle therapy. We required a data-relation mechanism between electronic medical record system (EMR) and database system, because it needs to ensure the information consistency. This paper presents the investigation results of these techniques. The standards in the medical informatics field that we focus on are Integrating the Healthcare Enterprise (IHE) and 2) Health Level-7 (HL7) to archive the data. As a main cooperation function, we adapt 2 integration profiles of IHE as follows, 1) Patient Administration Management (PAM) Profile of IHE-ITI domain for patient demographic information reconciliation, 2) Enterprise Schedule Integration(ESI) profile of IHE-Radiation Oncology domain for order management between EMR and treatment management system(TMS). We also use HL7 Ver2.5 messages for exchanging the follow-up data and result of laboratory test. In the future, by implementation of this system cooperation, we will be able to ensure interoperability in the event of the EMR update.

Geographical distribution of radiotherapy resources in Japan: investigating the inequitable distribution of human resources by using the Gini coefficient.

This is a pilot study that aims to elucidate regional disparities in the distribution of medical resources in Japan. For this purpose, we employed the Gini coefficient (GC) in order to analyze the distribution of radiotherapy resources, which are allocated to each prefecture in Japan depending on the size of its population or physical area. Our study used data obtained from the 2005 and 2007 national surveys on the structure of radiation oncology in Japan, conducted by the Japanese Society for Therapeutic Radiology and Oncology (JASTRO). Our analysis showed that the regional disparities regarding the radiation oncologists and radiotherapy technologists were small, and concluded that such resources were almost equitably distributed. However, medical physicists are inequitably distributed. Thus, policymakers should create and implement measures to train and retain medical physicists in areas with limited radiotherapy resources. Further, almost 26% of the secondary medical service areas lacked radiotherapy institutions. We attribute this observation to the existence of tertiary medical service areas, and almost all of prefectures face a shortage of such resources. Therefore, patients' accessibility to these resources in such areas should be improved.

[Survey on medical information education for radiologic technologists working at hospitals].

Recently, the importance of medical information for radiologic technologists has increased. The purpose of this questionnaire survey was to clarify the method of acquiring skill in medical information for radiologic technologists from the point of view of the managers of radiology departments. The questionnaire was sent to 260 hospitals that had introduced picture archiving and communication systems (PACSs) for the person responsible for medical information in the radiology department. The response rate was 35.4% (92 hospitals). The results of this survey clarified that few hospital have staff for medical information in the radiology department. Nevertheless, the excellent staff who have the skills to troubleshoot and develop systems are earnestly needed in radiology departments. To solve this problem, many technologists should understand the content, work load, and necessity of medical information. In addition, cooperation between radiologic technologist schools and hospitals is important in the field of medical information education.

[Investigation of practical method for quality assurance and control of medical displays].

Quality assurance (QA) guidelines for medical display systems in Japan, JESRA X-0093, were published in August 2005 and have been used in many medical fields to maintain image quality on medical displays. This report offers detailed explanations of terms and testing methodologies in the guidelines, taking into account users with little knowledge of display technology. The management grade classifications, luminance meters, test patterns, and evaluation methods for executing the QA are supplementally described based on the technical background of related things. In addition, the validity of the evaluation methods and judgment criteria for uniformity and contrast response tests were examined in some experiments. The experimental results of the contrast response indicated that some cases presented inadequate display contrast even if the contrast responses were set within ± 15% of the standard acceptable range for grade 1. The luminance responses of displays used in two computed tomography systems (CTs) and one magnetic resonance imaging system (MRI) were also measured, and the results indicated that their responses with conventional gamma responses were problematic for comparing images with those of medical displays.