Clinical Practice (Guidelines and Statements)

Contents

  1. Joint position statement on medical imaging exposure and radiation safety for patients
  2. IR BLEEDING RISK GUIDANCE
  3. IR Statement - POIRS
  4. Medtronic Valiant Navion™ Thoracic Stent Graft System Recall
  5. Transjugular Intrahepatic Portosystemic Stent-Shunt (TIPSS)
  6. Guidance management of gas embolism
  7. Provision of interventional radiology services, Second edition Sept 2019
  8. Global Vascular Guidelines
  9. NICE Guidance for Prostate Artery Embolisation (PAE)
  10. BIAS Report - Fourth Iliac Angioplasty Study Report 2018
  11. BIAS Registry
  12. Mechanical Thrombectory for Ischaemic Stroke
  13. BSIR statement - Obtaining informed consent after the Montgomery ruling
  14. Training of Existing Consultants in Interventional Radiology
  15. NHS Reference Cost Collection 2016/17
  16. BSIR Statement on UFE
  17. NICE Guidance CG147 update
  18. Updates on national tariff related publications from NHS Improvement
  19. Letter to members and medical directors re IR data submission to NVR 2016
  20. Benchmarking Consent in Nephrostomy
  21. Duty of Candour
  22. FSSA Position Statement - Appointment to Heads of School

Joint position statement on medical imaging exposure and radiation safety for patients

The UK Health Security Agency (UKHSA) and the British Institute of Radiology (BIR) support the view that the decision to perform a medical imaging exposure should be based on clinical need rather than the dose from previous exposures.

Background

In May 2021, the International Atomic Energy Agency (IAEA) published a joint position statement with a range of international organisations and professional bodies and call for action to strengthen radiation protection of patients undergoing recurrent radiological imaging procedures. 

The IAEA highlighted the potential for automatic exposure monitoring systems to monitor cumulative dose at an individual patient level. The joint position statement proposed actions to address concerns over high cumulative doses from recurrent medical imaging including, identification of clinical conditions that require recurrent imaging and developing strategies in terms of the type of imaging and frequency. It also recommended the need for customised imaging protocols for these patients and use of the latest technology to help reduce patient dose. Further actions include strengthening radiation protection education and training of healthcare professionals and strengthening communication.  

Notably, the joint position statement recommended that dose monitoring systems should be used to monitor the exposure history of individual patients using type of radiological procedure, estimated effective dose or patient-specific organ dose estimates. The joint position statement recommended where possible, clinical and radiation dose information from the patient’s previous imaging procedures needs to be made available to help strengthen the decision-making process when justifying a series of radiological procedures for a patient.

AAPM response

In response to the joint position statement, the American Association of Physicists in Medicine (AAPM), the American College of Radiology (ACR), and the Health Physics Society (HPS) published a policy on the use of dose metric tracking for medical exposures. The AAPM consider that the decision to perform a medical imaging exam should be based on clinical grounds, including the information available from prior imaging results, and not on the dose from prior imaging-related radiation exposures.

The AAPM advise that justification of the potential patient benefit and optimisation of medical imaging exposures are the most appropriate actions to take to protect patients from unnecessary medical exposures.

The AAPM recommends against using dose values, including effective dose, from a patient’s prior imaging exams for the purposes of medical decision making, as the use of cumulative effective dose may have a negative impact on patient care.

The UK Health Security Agency (UKHSA) and the British Institute of Radiology (BIR) recognise the benefits of exposure monitoring systems in the optimisation process, while noting that there is no IEC standard governing the estimation of effective dose. UKHSA and BIR support the views outlined by the AAPM that the decision to perform a medical imaging exposure should be based on clinical need rather than the dose from previous exposures. In exceptional cases, when planning multiple high dose interventional (or CT perfusion) procedures exposing the same area, over a short time period, and where deterministic effects are expected, previous dose information should also be considered in the justification and optimisation process.

To protect patients from unnecessary medical exposures, appropriate justification of medical imaging exposures is essential.

Optimisation of medical imaging exposures is one of the fundamental principles of the Ionising Radiation (Medical Exposure) Regulations and is required to keep doses from medical exposures as low as reasonably practicable, consistent with the intended purpose.

 

About The British Institute of Radiology

The British Institute of Radiology is an international membership organisation for everyone working in imaging, radiation oncology and the underlying sciences.

Our aims are to:

  • support the work of our members and their colleagues to achieve professional excellence.
  • provide continuing professional development for our multidisciplinary community
  • publish cutting-edge research for our authors and readers across the world
  • influence and connect with the wider professional sector.

Registered Charity No: 215869

 

About the UK Health Security Agency

The UK Health Security Agency is an executive agency, sponsored by the Department of Health and Social Care.

www.gov.uk/government/organisations/uk-health-security-agency

 

© Crown copyright 2023

Version 1.0

Prepared by: the Medical Exposures Group, UK Health Security Agency
For queries relating to this document, please contact: MedicalExposures@ukhsa.gov.uk

Published: 4 July 2023

You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v3.0. To view this licence, visit OGL. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.

Carole Cross | Director of Communications and Partnerships

The British Institute of Radiology

Audrey House, 16-20 Ely Place, London EC1N 6SN

+44 (0)20 3668 2224 (please leave message and I will get back to you) | www.bir.org.uk

Registered charity number: 215869

BIR on LinkedIn | Facebook | Twitter

 

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IR BLEEDING RISK GUIDANCE

Dear BSIR members,

Please find attached the BSIR bleeding risk guidance document.

This has been jointly produced by the BSIR Safety & Quality Committee in conjunction with the British Society of Haematology.

This is intended as an easy to use guide for IR teams.

The HEMSTOP screening questionnaire is designed to act as a pre-procedural screening tool rather than simply performing routine clotting screens on all patients, and has been widely supported by the British Society of Haematology. This is used by other surgical specialties and pre-operative assessment teams and we hope that this will guide future radiological practice in the UK.

The second half of the document is designed to guide the temporary cessation and restarting of an anticoagulant or antiplatelet medication for an IR procedure.  This is a complex area to summarise and therefore intended to be used as a general guide for radiology teams, but may require engagement with referring or specialist teams when managing complex patients or for those patients who require bridging protocols.

We hope that this will be a useful guide for daily practice, streamlining processes in an attempt to avoid unnecessary tests, and we are keen to distribute this to the BSIR membership.

Many thanks

Best wishes

Dr Raj Das and Dr Clare Bent on behalf of the BSIR Safety and Quality Subcommittee

Any comments or correspondence please send to : raj.das@stgeorges.nhs.uk and Clare.Bent@uhd.nhs.uk

IR Bleeding Risk Guidance

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IR BLEEDING RISK GUIDANCE FINAL BSIR BSH 2022

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IR Statement - POIRS

The Provision of Interventional Radiology Services (POIRS) has been revised, and the second edition is due to be published this summer (2019). A statement has been released by the Royal College of Radiologists (RCR) and British Society of Interventional Radiology (BSIR), to introduce the POIRS document, identify the benchmarks for Interventional Radiology and to highlight the competencies of interventional radiologists in patient management, both in an inpatient and outpatient scenario, obtained as part of their subspecialty training.

Click HERE to view the statement.

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Transjugular Intrahepatic Portosystemic Stent-Shunt (TIPSS)

TIPSS Guidelines

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Guidance management of gas embolism

Please click HERE to view Management of Patients With Gas Embolism

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Provision of interventional radiology services, Second edition Sept 2019

Please click here to view the Provision of interventional radiology services, Second edition, Sept 2019.

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Global Vascular Guidelines

Please click HERE to view the Global Vascular Guidelines  CLTI Guideline Published in June 2019

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NICE Guidance for Prostate Artery Embolisation (PAE)

NICE Guidance for Prostate Artery Embolisation (PAE)

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BIAS Report - Fourth Iliac Angioplasty Study Report 2018

BIAS Report - Fourth Iliac Angioplasty Study Report 2018

Foreword

My thanks to the many people who have contributed to the British Iliac Angioplasty and Stenting (BIAS) registry. The BSIR is very proud to have instigated and supported this project, which is now in its fourth (and nal) report stage. BIAS has been one of the vanguard registries in the United Kingdom. This report joins its three predecessors, and is not only useful for its content, but is also a tribute to all those BSIR members who have taken the time to complete data entry. The society realises that much of this has been given freely, and often in individuals’ spare time. As President, on behalf of The Society, I thank you all for that. 

BIAS is (to the best of The Society’s knowledge) the largest iliac artery endovascular intervention registry worldwide, with over 13,000 patients entered over its 16 years of operation. It demonstrates the commitment of the British Interventional Radiology community to ensuring that this index procedure for vascular interventional radiology is delivered safely and is benchmarked for future delivery. We can see that patients experience good outcomes at follow up, which is key. BIAS also provides us with excellent longitudinal information about the way services are delivered, for example the ever-increasing use of day-case facilities.

The BSIR’s rich history in supporting and developing registries is an enviable one. Going forward, The Society encourages members to continue to contribute to the National Vascular Registry (which has taken over the role of documenting iliac intervention from BIAS, as well allowing the recording of more distal peripheral interventions). At the same time, we ask members to consider other areas where data submission by Interventional Radiologists into new registries might establish benchmarks for safe and efective practice. Anyone with enthusiasm and ideas for future registries is encouraged to contact the Registries and Audit Committee via the BSIR website (www.BSIR.org). Many congratulations and thanks to you all. Trevor Cleveland President, British Society of Interventional Radiology.

Many congratulations and thanks to you all.

Trevor Cleveland

President, British Society of Interventional Radiology

 

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BIAS Registry

8000+ cases entered since last publication (BIAS III, 2008) 13000+ cases altogether. Largest registry of iliac intervention worldwide as far as I know 50+ cases per week at peak recruitment in 2013. Substantially better recruitment so far compared with NVR. Follow up data excellent - 97% for most data points. Very low complication rates High success rates. read more..

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Mechanical Thrombectory for Ischaemic Stroke

Training to deliver mechanical thrombectomy

In order to achieve the desired delivery of a 24/7 service in MT across England, the number of operators capable of contributing to MT services needs to expand more rapidly than will be achieved by current INR trainee numbers. This means training other specialists to perform MT.

The British Society of Neuroradiologists (BSNR) has produced “Training guidance for mechanical thrombectomy” (Lenthall R, McConachie N, White P, Clifton A, Rowland-Hill C. BSNR training guidance for mechanical thrombectomy. Clin Radiol 2017; 72(2): 175.e11–175.e18.) which details the training that will be required for practitioners from different clinical backgrounds to achieve the necessary skills and experience to effectively contribute to the acute stroke service. This guidance will underpin all routes to increasing the workforce.

https://www.rcr.ac.uk/clinical-radiology/being-consultant/mechanical-thrombectomy-ischaemic-stroke

 

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Obtaining informed consent after the Montgomery ruling - please see BSIR statement attachment below, available to view and print.

 

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BSIR statement - Obtaining informed consent after the Montgomery ruling

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Training of Existing Consultants in Interventional Radiology

Training of Existing Consultants in Interventional Radiology - please see BSIR statement attachment below, available to view and print.

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Training of Existing Consultants in Interventional Radiology

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NHS Reference Cost Collection 2016/17

NHS have now published this year’s reference cost collection (2016/17 costs) all the spreadsheets and supporting documentation can be found HERE

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BSIR Statement on UFE

BSIR Statement on UFE

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NICE Guidance CG147 update

NICE Guidance CG147 update

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Enquiries and frequently asked questions

NHS Improvement now publish the queries they receive on the national tariff.  The 2016/17 enquiries log now updated with questions and FAQs up to January and this can be found here:

https://www.gov.uk/government/publications/nhs-national-tariff-payment-system-201617

NHS Improvement have also launched the 2017/19 document with a selection of FAQs, that document can be found here:

https://improvement.nhs.uk/resources/national-tariff-1719/

 

Tariff doc corrections

NHS Improvement have updated a number of documents on the 2017/19 webpage due to small errors.  The main national tariff has had a date correction made in paragraphs 271 and 272 (relating to MFF recalculation).  They have corrected a column header issue on the MFF page of the national prices spreadsheet and further to feedback have removed the non-mandatory price for adult hearing services from the non-mandatory prices spreadsheet.  The documents can all be found here:

https://improvement.nhs.uk/resources/national-tariff-1719/

 

Reference cost collection guidance.

NHS Improvement have now published the reference cost guidance for 2017, it can be accessed here:

https://improvement.nhs.uk/resources/approved-costing-guidance/

 

Whole population budget webinars.

Following NHS Improvement latest webinar on new payment approaches, a page as been set up to bring all of the webinars on the subject together.  This will be added in the next month or so with further material.

https://improvement.nhs.uk/resources/whole-population-budgets/

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Letter to members and medical directors re IR data submission to NVR 2016

Please see below a position statement from the BSIR about time allocation (in job planning) and administrative support for IR data entry into NVR. We hope that members may find this useful in negotiations with trust management over these issues.

Yours faithfully,

Chris Hammond

Chair: BSIR R&A Committee

Letter to members and medical directors re IR data submission to NVR 2016

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Please see below a survey of nephrostomy outcomes (also performed earlier in 2016), which we hope may aid you in benchmarking your practice and assisting in consent processes.

Chris Hammond

Chair: BSIR R&A Committee

Benchmarking Consent in Nephrostomy

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FSSA Position Statement - Appointment to Heads of School

FSSA position statement  - regards heads of school

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