Optimisation in interventional radiology by BIR Publishing

10 OCTOBER 2014

OPTIMISATION IN INTERVENTIONAL RADIOLOGY IET Birmingham: Austin Court CPD: 5 CREDITS

BIR Annual Congress 2014: 22-23 October, London

Welcome and thank you for coming to the â&#x20AC;&#x2DC;Optimisation in interventional radiologyâ&#x20AC;&#x2122; event organised by the British Institute of Radiology. This booklet contains the abstracts and biographies for each speaker. This meeting has been awarded 5 RCR category I CPD credits. CPD certificates will be distributed by email within two weeks of the meeting once the online delegate survey has been completed. Please complete the online delegate survey using the below link. We will use your valuable feedback to improve future conferences. https://www.surveymonkey.com/s/optimisationIR We hope you find the day interesting and enjoyable.

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Programme 09:30 Registration and refreshments 10:00 Welcome and introduction Chair: Mr Jonathan Cole, Principal Physicist, Royal Free London NHS Foundation Trust 10:15 Clinical context – a radiographer’s point of view Mrs Elaine Holt, Cardiac Radiographer, University Hospital of South Manchester 10:30 Clinical context – a radiologist’s point of view Dr Jonathan Hopkins, Consultant Interventional Radiologist, University Hospitals Birmingham NHS Foundation Trust 10:55 Refreshments 11:15 Technology for IR Dr Greg Stevens, Clinical Scientist, Plymouth Hospitals NHS Trust 11:35 Image quality assessment – part 1 Mr Jonathan Cole, Principal Physicist, Royal Free London NHS Foundation Trust 11:55 Image quality assessment – part 2 Dr Greg Stevens, Clinical Scientist, Plymouth Hospitals NHS Trust 12:15 Dose metrics Dr Lorna Sweetman, Principal Clinical Scientist, The Christie NHS Foundation Trust 12:45 Lunch 13:30 Dose audit Dr Lorna Sweetman, Principal Clinical Scientist, The Christie NHS Foundation Trust 14:00 What can we change? – part 1 Mr Jonathan Cole, Principal Physicist, Royal Free London NHS Foundation Trust 14:20 What can we change? – part 2 Mr Andy Rogers, Head of Radiation Physics, Nottingham University Hospitals NHS Trust 14:40 Refreshments 15:00 Clinical experience of optimisation Mrs Elaine Holt, Cardiac Radiographer, University Hospital of South Manchester

15:15 Case study 1 â&#x20AC;&#x201C; dose audit Dr Lorna Sweetman, Principal Clinical Scientist, The Christie NHS Foundation Trust 15:30 Big and small Mr Andy Rogers, Head of Radiation Physics, Nottingham University Hospitals NHS Trust 15:45 Case study 2 â&#x20AC;&#x201C; paediatrics Mr Jonathan Cole, Principal Physicist, Royal Free London NHS Foundation Trust 16:00 Future directions Mr Andy Rogers, Head of Radiation Physics, Nottingham University Hospitals NHS Trust 16:15 Discussion 16:30 Close of meeting _______________________________________________________________________

Please remember to complete the online delegate survey using the below link: https://www.surveymonkey.com/s/optimisationIR Your certificate of attendance will be emailed to you within the next two weeks once these have been completed.

BIR Annual Congress 2014: 22-23 October, London

Speaker profiles Mr Jonathan Cole Principal Physicist, Royal Free London NHS Foundation Trust Jonathan is a Principal Physicist at the Royal Free Hospital in North London. He provides medical physics expert support to a range of diagnostic radiology modalities with a particular focus on interventional radiology, cardiology and regional NHS Breast Screening Services. Prior to joining the Royal Free Jonathan trained at Kingâ&#x20AC;&#x2122;s College Hospital where he subsequently worked as a technical evaluator in KCARE and then a Clinical Scientist in the Radiation Protection Service supporting cardiology and angiography. Mrs Elaine Holt Cardiac Radiographer, University Hospital of South Manchester Trained at Lincolnshire School of Radiography, DCR(R) obtained in 1991. In 1992 employed as radiographer in General X-ray at Wythenshawe Hospital, South Manchester before commencing as a Cardiac Radiographer in the Cardiology X-ray department until 2002. During this time, she attended Salford University and obtained an MSc in Advanced Radiography Practice. Following a year working in New Zealand, she took up the position of MR radiographer with Lodestone until 2005. She then returned to University Hospital of South Manchester as a Senior Cardiac Radiographer and Radiation Protection Supervisor where she helped to formulate the North West Skin Dose Group and developed the Skin Dose Clinic at UHSM. Dr Jonathan Hopkins Consultant Interventional Radiologist, University Hospitals Birmingham NHS Foundation Trust Dr Jonathan Hopkins is a Consultant Interventional Radiologist having been appointed at Queen Elizabeth Hospital, Birmingham in 2004. Jonathan is a member of the BIR Radiation Protection Committee and a Physics Examiner for the RCR. Mr Andy Rogers Head of Radiation Physics, Nottingham University Hospitals NHS Trust I am Head of Radiation Physics at Nottingham University Hospitals NHS Trust and also the retiring Chair of the British Institute of Radiologyâ&#x20AC;&#x2122;s [BIR] Radiation Protection Committee and BIR Vice-President External Affairs. I represent BIR on the working group that will advise the DH on the EU Basic Safety Standards revision as well as the National Research Ethics Service. I have recently joined the international standards organisation IEC to represent the UK in a project looking at the use of dose data held in digital imaging modalities along with being a member of an ICRP working group drafting a report on Diagnostic Reference

Levels. My current research interests are observer studies, skin dose assessment and optimisation in interventional cardiology. Dr Greg Stevens Clinical Scientist, Plymouth Hospitals NHS Trust Dr Greg Stevens is a registered clinical scientist working at Plymouth Hospitals NHS Trust. Greg completed his PhD in physics in 2002 and went on to complete a number of post-doctoral appointments before moving into medical physics and working for the NHS. His medical physics masters was completed at Exeter university. He currently is the editor to the working party that is updating the fluoroscopy sections of report 32 and is a corresponding member of DRSIG. Dr Lorna Sweetman Principal Clinical Scientist, The Christie NHS Foundation Trust Lorna is the Lead Physicist for Radiation Protection in the Diagnostic Radiology Group of Christie Medical Physics and Engineering. She is a Radiation Protection Adviser and Medical Physics Expert for a number of NHS and private healthcare organisations in North West England. She is a member of the NW SOS (North West Save Our Skins) group, which brings together specialists from interventional cardiology facilities across the region to develop and share best practice. The group has developed a widely used protocol for the minimisation and management of radiation-induced skin injuries.

Abstracts Clinical context – a radiographer’s point of view Mrs Elaine Holt This presentation reflects on the key practical and technical considerations for achieving optimisation in the cardiac catheter labs at the University Hospital of South Manchester. This is taken from a cardiac radiographer’s perspective and will include procedure types and image requirements for diagnosis and treatment. External factors associated with patient groups will also be discussed, for example the treatment of emergency patients. Clinical context – a radiologist’s point of view Dr Jonathan Hopkins The talk will reflect upon image optimisation from an operators point of view. The aim of any interventional imaging system imaging system is to provide useful images to guide an appropriate therapeutic procedure. This means that sometime images may need to be of very high-quality but this comes at the cost of a radiation burden. Often relatively low-quality and therefore low-radiation images may be all that is needed. The talk will explore how this trade-off is made often in real time, and when high-quality images are required. Technology for IR Dr Greg Stevens Learning outcomes: to provide very basic information on current state of technology used in fluoroscopy equipment. This talk will provide a very basic run down on how fluoroscopy equipment performs and highlight the differences and similarities between traditional intensifiers based systems and newer flat panel detector systems. Image quality assessment – part 1 Mr Jonathan Cole Learning outcomes: Acquire knowledge of specific measures of static image quality as applied to interventional radiology and cardiology with an awareness of their uses and limitations. This talk discusses methods for measurement of objective image quality applied to static images. The concepts of signal, noise, contrast, SNR, CNR, resolution, MTF and NPS will be reviewed and their use and limitations within fluoroscopic imaging will be explored. The effect of changing imaging parameters on these measurements will also be considered.

Image quality assessment â&#x20AC;&#x201C; part 2 Dr Greg Stevens Learning outcomes: to provide delegates with a basic understanding of dynamic image quality and two of the more important parameters that affects image quality. This talk will discuss an area that is of fundamental importance for clinical image quality but has generally been ignored by medical physicists because of the difficulty in obtaining reproducible measurements; namely image quality away from static equilibrium. Most of the mathematics has been removed to provide delegates with practical methods to measure persistence and pulse width in a clinical setting. Dose metrics Dr Lorna Sweetman Learning outcomes: Acquire an understanding of the available dose metrics in order to be able to select the most suitable for a given optimisation exercise. There are many quantities that can be used as indicators of patient dose; each has advantages and disadvantages. This talk will review the available dose metrics and discuss the characteristics that make them more useful in different circumstances. The talk will also consider the availability and usefulness of national and international reference datasets for the comparison of local doses. Dose audit Dr Lorna Sweetman Learning outcomes: Acquire a general knowledge of approaches to dose audit and an appreciation of some of the common difficulties as well as some more unexpected findings. This talk will address the various aspects of dose audit from data collection through data analysis to recommendations and action plans. Manual and automated methods will be considered as well as the many variables (procedural, technical, patient and staff related) that can influence the distribution of patient doses. The talk will also highlight the typical problems associated with data quality and interpretation and how they might be overcome. What can we change? â&#x20AC;&#x201C; part 1 Mr Jonathan Cole Learning outcomes: Acquire a working knowledge of the impact of practical changes to technique on image quality and dose. Patient doses and image quality are affected by both machine parameters and the techniques used by the operators. This talk focusses on the latter and

explores the consequences of using different positioning, protocols and imaging modes. Examples will be discussed including tube and detector positioning and angulation, magnification, collimation and 3D imaging. What can we change? – part 2 Mr Andy Rogers Learning Outcomes: Acquire an understanding of how technical parameters affect image quality and dose and how to bring influence upon those factors. This talk will discuss how the x-ray unit set-up affects the balance between dose and image quality and what potential options one has to influence these factors. Factors discussed will be kV, mA, pulse width, filtration, frame rate, detector dose and image processing factors. Clinical experience of optimisation Mrs Elaine Holt This presentation considers the clinical experience of optimisation in the cardiology catheter labs of the University Hospital of South Manchester. The department’s “Save Our Skins” (skin dose policy) framework is central to the optimisation process. It will include the introduction of new equipment and technologies and how these have influenced working practice . The requirements for specific procedures will also be considered. Big and small Mr Andy Rogers Learning Outcomes: Acquire an understanding of how large and small patients impact on standard set-up and what strategies may be employed to minimise the effect on image quality of such patients. This talk will discuss the fundamental issues with attempting to image very small and large patients in terms of imager quality and dose. Practical and technical adjustments to minimise deleterious effects on image quality will be discussed. Case study 2 – paediatrics Mr Jonathan Cole Learning outcomes: Acquire a general knowledge of some methods of paediatric optimisation together with an awareness of potential problems and pitfalls. Paediatric imaging represents a special case for optimisation, having patients who are more sensitive to the detrimental effects of radiation

whilst presenting unique challenges to image quality. This talk will present the practical experiences of the initial stages of optimising two paediatric protocols for interventional procedures. The methods used, results obtained and limitations to measurements will be discussed. Future directions Mr Andy Rogers Learning Outcomes: Acquire a knowledge of the areas where manufacturers are innovating in Interventional imaging to improve the state-of-the-art. This talk will present technical features that are currently moving the whole field forward. The improvements to be discussed will focus on tube design, detector design and image processing improvements and possibilities.

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BIR Annual Congress 2014: 22-23 October, London

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FORTHCOMING EVENTS

BIR Annual Congress 2014 22-23 October, London BIR UK MRI COURSE 4-7 NOVEMBER 2014 LONDON WELSH BRANCH MEETING: TO REPORT OR NOT TO REPORT....WHAT IS THE ANSWER? 11 NOVEMBER 2014 SOUTH WALES THE JOURNEY FROM RESEARCH TO PUBLICATION 20 NOVEMBER 2014 LONDON THE FUTURE OF RADIOLOGY IN THE NHS: TOP TOPICS FOR INTERVIEWS 21 NOVEMBER 2014 LONDON DIAGNOSTIC RADIOLOGY FOR ADVANCED HEAD AND NECK CANCER PLANNING 26 NOVEMBER 2014 LONDON STATE OF THE ART RADIOTHERAPY EDUCATION DAY 10 DECEMBER 2014 LONDON WESSEX BRANCH EVENT 10 DECEMBER 2014 SOUTHAMPTON ADVANCES IN RADIOTHERAPY FOR PROSTATE CANCER: FROM THEORY TO PRACTICE 12 DECEMBER 2014 CARDIFF THE SPINE IN HEALTH AND DISEASE 21 JANUARY 2015 LONDON CONTRAST STUDY DAY AND ESSENTIAL PHYSICS FOR FRCR 29 - 30 JANUARY 2015 SHEFFIELD RADIOLOGY ERRORS 6 FEBRUARY 2015 LONDON EMERGENCY INTERVENTIONAL RADIOLOGY 13 FEBRUARY 2015 LONDON 4TH ANNUAL SPECT/CT SYMPOSIUM: CURRENT STATUS AND FUTURE DIRECTIONS OF SPECT/CT IMAGING 23 FEBRUARY 2015 LONDON VISIT: WWW.BIR.ORG.UK FOR MORE INFORMATION AND TO REGISTER!

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