Clinical audits in radiation protection

The purpose of clinical audits is to ensure an ideal use of high-dose ionising radiation in medicine. Their realisation will enable to review the justification of the expositions and to optimise the processes and resources of the providers. A steering committee consisting of the main stakeholders ensures that these audits are implemented in the form of peer reviews.

The essentials in brief

  • In Switzerland, the average dose of ionising radiation used for the purpose of medical diagnosis has increased by 40% over the past 20 years.
  • Several European studies (1, 2, 3) have shown that some of the examinations and treatments that employ ionising radiation are not justified.
  • Clinical audits are not controls carried out by the authority, but reviews conducted by colleagues, also known as peer reviews.
  • The Federal Office of Public Health (FOPH) launched the project of "Clinical audits" in 2011, in close collaboration with professional associations in medicine, medical physics and medical technology. Since 2018, their representatives have formed the steering committee for clinical audits in Switzerland.
  • The Radiological Protection Ordinance (RPO) is the legal basis for clinical audits. Its revised version entered into force on 1.1.2018.
  • The pilot clinical audits in the audited areas have proven to be useful in terms of protecting patients and organising processes. In addition, minimal overlaps with other audits or quality controls have been observed.

Organisation of clinical audits in Switzerland

A steering committee was set up and began work in 2018. Its members are representatives of the Swiss Societies of Radiology (SSR), Radiation Oncology (SSRO), Nuclear Medicine (SSMN), Cardiology (SSC), Radiobiology and Medical Physics (SSRPM), the Swiss Association of Medical Radiology Technicians (ASTRM), the Swiss Medical Association (FMH) and the FOPH. Together they define the strategy and implementation of clinical audits based on the experience acquired during the pilot clinical audits.

Committees of experts have been formed for each of the specialties audited. As part of their remit, they are responsible for defining the content of audits and advising the steering committee.

A pool of auditors has been specially trained to carry out clinical audits, for which the audit teams will be interdisciplinary.

The scientific secretariat, integrated within the FOPH, coordinates clinical audits.

Description of a clinical audit

As illustrated in the figure below and the video (also in French or Italian), a team of auditors usually includes a doctor, a medical physicist and a radiographer. Together, they visit the provider to be audited and evaluate their working practices. Each auditor focuses on their area of expertise and compares the practices of their peers against recognised standards.

Clinical audits

At the end of the audit, which usually takes a day, the team of auditors presents its initial recommendations for improving clinical practice and discusses these with the team of the audited unit. Finally, the auditors prepare their report and send it directly to the provider, which is invited to implement the recommendations.

Documents

Further information

1. National Survey on Justification of CT-examinations in Sweden (PDF, 748 kB, 09.11.2016)Almén A, Leitz W, Richter S; National Survey on Justification of CT-Examinations in Sweden. Swedish Radiation Safety Authority, 2009:03.

2. Unjustified CT examinations in young patients (PDF, 86 kB, 09.11.2016)Oikarinen H, Meriläinen S, Pääkkö E, Karttunen A, Nieminen M, Tervonen O; Unjustified CT examinations in young patients; Eur Radiol (2009) 19: 1161-1165

3. Audit de la conformité aux bonnes pratiques (PDF, 1 MB, 25.09.2018)Audit de la conformité des prescriptions d'examens d'imagerie médicale: Volet B, Ministère de la santé, Luxembourg, 2017

Last modification 09.09.2021

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Federal Office of Public Health FOPH
Radiation Protectiono Division
Radiotherapy and Medical Diagnostics Section
Schwarzenburgstrasse 157
3003 Berne
Switzerland
Tel. +41 58 462 96 14
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