The paper also includes cautions in setting the alert values and discusses the benefits of using patient dose management systems for the alerts, their registry and follow-up, and the differences between notifications, alerts, and trigger levels for individual procedures and the terms used for the collective approach, such as diagnostic reference levels. This review summarises the different uses of notifications and alerts to help in optimisation for CT and for fluoroscopy-guided interventional procedures as well as in the analysis of unintended and accidental medical exposures. Alerts in X-ray systems may be considered before procedures (as in CT), during procedures (in some interventional radiology systems), and after procedures, when the patient radiation dose results are known and processed. The main interest in using these values for high-dose procedures (CT and interventional) is to optimise imaging procedures, reducing the probability of stochastic effects and avoiding tissue reactions. Notifications and alerts may also be useful for optimisation and to avoid unintended and accidental exposures. Some interventional radiology societies as well as national authorities have also published dose notifications for fluoroscopy-guided interventional procedures. Recommendations for CT scanners have been published by the American Association of Physicists in Medicine. The terms “notifications” and “alerts” for medical exposures are used by several national and international organisations. This is a joint statement of the European Society of Radiology (ESR) and the European Federation of Radiographer Societies (EFRS), published simultaneously in Insights into Imaging and Radiography (DOI: 10.1016/j.radi.2019.01.009). ![]() This paper summarises the key categories of safety issues in the provision of radiology services, from the joint perspectives of radiographers and radiologists, and provides references for further reading in all major relevant areas. These encompass: protection from direct harm arising from the techniques and technologies we use ensuring physical and psychological well-being of patients while under our care maintaining the highest possible quality of service provision and protecting the staff to ensure they can deliver safe services. There are numerous patient safety issues in radiology which must be considered. The fundamental professional roles of radiographers and radiologists are focused on providing benefit to patients with our skills, while maintaining their safety at all times. In addition, this paper provides practical advice on how to implement alert and trigger levels in daily practice of FGIs in order to increase patient safety. This paper discusses some important issues of the EU-BSS such as unintended and accidental radiation exposures of patients, the meaning of significant dose events and how to deal with patients who were exposed to a substantial radiation dose with the risk of tissue injuries. Interventionalists should play an important role in this project since implementation of the EU-BSS will affect their daily practice. Implementation of the EU-BSS requires concerted action from interventionalists, radiographers, medical physics experts and competent national authorities. The medical community responded through increased awareness for radiation protection and public authorities by recommendations and legislation, for example, the European Basic Safety Standards (EU-BSS) which were published in 2014, or the international Basic Safety Standards (BSS). In the late nineties, first reports of skin injuries appeared in the literature. Also, the number of complex interventional procedures has increased. ![]() ![]() Over recent years, an increasing number of fluoroscopically guided interventions (FGIs) have been performed by radiologists and non-radiologists.
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