Imaging for Saving Kids - the Inside Story about Patient Safety in Paediatric Radiology
68th World Health Assembly
Tuesday, 26th May 2015 12:30 - 14:00
Palais des Nations - UN Office in Geneva

Summary Report
The World Health Assembly (WHA) is the supreme decision-making body of the World HealthOrganisation (WHO) and is held annually in Geneva. The Assembly is attended by delegations from the194 WHO Member States, the NGOs in official relations with the WHO and representatives from otherUN agencies. On 26 May 2015, a side event entitled “Imaging for Saving Kids – the Inside Story about
Patient Safety in Pediatric Radiology” was held during the 68th WHA. This event was jointly organized by
the Governments of Kenya, Malaysia, Spain, and Uganda together with the following nine NGOs inofficial relations with the WHO: Diagnostic Imaging, Healthcare IT and Radiation Therapy TradeAssociation (DITTA), International Commission on Non-Ionizing Radiation Protection (ICNIRP),
International Commission on Radiological Protection (ICRP), International Organization for Medical
Physics (IOMP), International Society of Radiology (ISR), International Society of Radiographers andRadiological Technologists (ISRRT), RAD-AID International, World Federation for Ultrasound in Medicineand Biology (WFUMB), and World Organization of National Colleges, Academies and Academic
Associations of General Practitioners / Family Physicians (WONCA).

This event conducted at the United Nations Office at Geneva (UNOG) brought policymakers, health careproviders, professional societies, equipment manufacturers, and patient’s representatives together tojointly discuss measures that can be achieved to improve health and service delivery by maximizing thebenefits and minimizing the risks when using medical imaging in children. The main topic addressed was
the delicate balance between the pivotal role of medical imaging in the appropriate management ofmany illnesses which afflict children and children’s increased sensitivity to health risks associated withionizing radiation.

Dr. Maria Neira, Director of the Department of Public Health, Environmental and Social Determinants ofHealth at the WHO and Dr. Edward Kelley, Director of Department of Service Delivery and Safety at theWHO co-chaired the event. They delivered the opening remarks, highlighting that this Side Event was aunique opportunity that all stakeholders come together and collaborate to make a difference in thesafety and quality of children’s healthcare, to harmonize efforts, policies, and regulations.

During the first session Dr. Donald Frush of the American College of Radiology (ACR) and theInternational Society of Radiology (ISR), focused on setting the scene. As a Steering Committee member
and co-chair of the Image Gently education and communication campaign, he encouraged healthcare
practitioners to educate and provide informational material to patients, both in person and throughharnessing the power of social media. He also encouraged to instill a sense of engagement andaccountability in healthcare providers by spreading amongst them a positive and resonating message,
that of improving the imaging care of children, such as through catch words “when imaging kids, ImageGently”.

The second session addressed the policy, strategy and actions to improve patient safety in paediatricimaging. The representatives from the Ministries of Health of Kenya, Malaysia, Spain and Uganda shared
their intent in fostering partnerships amongst stakeholders and their respective countries, such as withequipment manufacturers, radiologists, and policymakers, while also strengthening policies to ensure
the active implementation of the ten priority actions to improve radiation protection in medicineidentified in the Bonn Call For Action1. These representatives were Dr. Paulyne Wairimu, Head ofMedical Devices and Diagnostics, Pharmacy and Poisons Board from Kenya; Dr Noor Hisham Abdulah,
Director General of Health, Ministry of Health of Malaysia, Dr Eliseo Vaño, Radiation Protection Advisor
to the Ministry of Health of Spain, Chair of the Committee 3 on Radiation Protection in medicine fromthe International Commission on Radiological Protection (ICRP), and Chair of the Working Party on1The Bonn Call for Action is the main outcome of an international conference on radiation protection in medicine held in Bonn, Germany, inDecember 2012, organized by the IAEA and cosponsored by WHO. The 10 priority action identified are: 1) enhancing implementation ofjustification of radiological procedures, 2) enhancing implementation of optimization of protection and safety, 3) strengthening manufacturers’
contribution to radiation safety, 4) strengthening RP education and training of health professionals, 5) shaping and promoting a strategic research
agenda for RP in medicine, 6) improving data collection on radiation exposures of patients and workers, 7) improving primary prevention ofincidents and adverse events, 8) strengthening radiation safety culture in health care, 9) fostering an improved radiation benefit-risk-dialogue,and 10) strengthening the implementation of radiation safety requirements globally.

Medical Exposures of the Euratom Art 31 Expert Group; and Dr Rosemary Byanyima Kusaba2, Advisor to
the Ministry of Health, Uganda. It was noted that there is a need to strengthen collaboration between
ministries of health and key stakeholders such as radiologists, radiographers, medical physicists, family
doctors, patients/parents, manufacturers, scientific bodies and RP regulators. Regulatory bodies should
cooperate and encourage sharing of resources. There is an issue of fragmentation in health care delivery
that calls for an integrated and people-centred approach. In addition to regulatory control of radiation
safety by national radiation safety authorities, it also has to be linked and integrated into patient safety
policies and strategies, as well as linked to policies and regulations for medical devices and healthtechnologies. Universal health coverage includes access to affordable health technology and quality andsafe services. There is a need for policies focused on children- both underuse and overuse of radiationin pediatric imaging are issues, due to lack of awareness or misperceptions among patients, lack ofunderstanding

about justification/optimization and imaging options/alternatives. There is a large

variation in the radiation doses used for the same procedures between hospitals and also between
practitioners in the same facility. We should work on optimization and foster the establishment and useof diagnostic reference levels (DRLs) for children. Radiation safety standards exists e.g. newinternational basic safety standards (BSS) and new Euratom BSS, as well as guidance andrecommendations from the ICRP and others. We can build on existing resources, encourage theadoption of standards of quality and safety that serve as benchmarks nationally/internationally.
Capacity building, education and training are essential for health professionals, service providers,patients, families, and community. Policies have to be evidence-based so, there is a need to develop astrategic research agenda on RP in medical imaging. We should employ a collaborative approach,engaging all stakeholders, civil society, professional bodies, patients, families and the community.

Then, there was one session focused on patient and family engagement to improve safety in paediatricimaging. Mrs Margaret Murphy, Chair of the WHO network of Patients for Patient Safety (PFPS), took
the floor in informing the audience that there exists a low level of understanding of radiation risks
associated with imaging amongst patients, especially when it comes to the radiation risk for children.
Encouragingly, however, patients are very interested in taking a more proactive stance within theconsulting process with their healthcare providers, which would not only raise awareness, but would
also engage them in contributing to the monitoring of their own cumulative levels of radiation.

2Due to a last minute issue Dr R.B. Kusaba could not attend the session and her presentation was delivered on her behalf by Dr. M. Kawooya,
also from Uganda.

In the following session the end-users of radiation in pediatric imaging addressed the question “Whereare we now and how can we do it better together?” The unique challenges that Latin America is facing
were presented by Dr. Gloria Soto Giordani of the Inter-American College of Radiology/InternationalSociety of Radiology (CIR/ISR). These namely include the great diversity of practice across the Latin
American countries, and the lack of information specific to pediatric imaging, itself exacerbated by theshortage of radiological professionals in the field (e.g. pediatric radiologists, medical physicists).
Together, these result in a fragmented service. She concluded that the way forward would be throughcoordinated strategies involving all stakeholders and through increasing awareness to the need of apositive change in the culture of radiological protection, since it is the responsibility of all to providechildren with safe imaging.

Dr. Guy Frija of the European Society of Radiology/International Society of Radiology (ESR/ISR) and Chairof EuroSafe Imaging campaign and alliance framed challenges of radiation protection in pediatricimaging into 3 main categories: justification, optimization, and quality of equipment. First, hehighlighted that evidence-based imaging referral guidelines must be employed for the justification ofprocedures. He noted that currently, imaging referral guidelines exist in most European countries, butare not being employed: he suggests their implementation by way of regulations and awareness. TheESR is promoting the use of clinical decision support (CDS) systems for implementing imaging referral
guidelines, to provide a platform at the point of care with evidence-based information and patienttailored CDS tools relevant to imaging decisions. Second, diagnostic reference levels (DRLs) specificallytargeted for the pediatric population are necessary in order to optimize procedures with the goal ofreaching radiation “as low as reasonably achievable (ALARA)”. Finally, with continuous technologicaladvances, he highlighted the importance of keeping up-to-date with imaging equipment, as similar
image quality can be obtained while being exposed to considerably less radiation when using the latest
technology.

Dr. Michael Kawooya of the African Society of Radiology/International Society of Radiology (ASR/ISR)
reinforced the notions of education and awareness through the coordination of strategies amongst
stakeholders and the translation of global recommendations into implementable policies. The topic ofsafe pediatric imaging is especially relevant in Africa where not only is its population largely composedof children, but it is also under resourced in human and infrastructural capacities. Most recently inFebruary 2015, ASR has successfully launched the AFROSAFE campaign – a multistakeholders campaign
to improve safety and quality in medical uses of radiation in Africa, based on action points from Bonn’sCall For Action.

Ms. Donna Newman of the International Society of Radiographers and Radiological Technologists (ISRRT)
shared the radiographer’s point of view on the collaborative responsibility in the safety of pediatricimaging, also through education and the justification and optimization of procedures, as theradiographer is the last person to interact with the patient prior to obtaining the procedure.

From the perspective of medical physicists, Dr. Madan Rehani of the International Organization for
Medical Physics (IOMP) emphasized his profession’s unique contribution as the experts of the technicalaspects in radiation dose estimation and management strategies. Thus, they play pivotal role indiscussions revolving the education of healthcare professionals and patients alike.

Dr. Frush concluded this session with a strong analogy: the delivery of a radiation dose is akin to that ofa medication dose; over or under dosing is considered a medical error. He therefore emphasized theimportance for all stakeholders – policymakers, healthcare providers, equipment manufacturers andpatients – to form partnerships. After all, transcending this common goal of each and every party
involved for safer medical imaging in children is the coordinated strategy of awareness and educationthat will permit justification and optimization of every radiological procedure to save both lives andresources.

Finally the co-chairs Dr. M. Neira and Dr. E. Kelley delivered the closing remarks. This Side Event
identified issues of underuse and overuse of medical imaging in children. We should improvejustification of procedures and optimization of diagnostic data, radiation protection and patient safety.
and promote use of imaging referral guidelines. Radiation safety is linked to several relevant WHO
activities/programmes that are all collaborating, as reflected in their participation in this side event.
National programmes should consider collaboration between health authorities andexperts/professionals, with the support from international societies. A take home message from thisSide Event was “Perform medical radiation imaging according to standards”.