40th Liverpool Course – is this a record?

The 40th Liverpool course on radiation protection and quality assurance (QA) in diagnostic radiology is due to take place on 06 – 07th April 2022 and, as a sign of the modern times, will take place as an on-line event. The course is possibly the longest running of its kind in the world, having been established by Trevor Henshaw and Mike Moores over three decades ago. We are proud to say that it has been endorsed by the College of Radiographers for approximately that same time.

The first course was held on 26/27th October 1984 at the Postgraduate Centre at Whiston Hospital for radiographic staff employed in the Mersey Region. It was then repeated for staff in the North West Region and thence twice yearly in 1985/86 before settling down to become an annual event.

Initially, one of the main aims of the course was to raise the profile of quality assurance and radiation protection in diagnostic radiology and to promote the test protocols that had recently been produced by the Diagnostic Radiology Topic Group of the Hospital Physicist’s Association. For the first time the protocols described standard test methods for all the main items of x-ray equipment as well as providing information and guidance on expected results. The original protocols have since undergone a number of iterations but the original concepts are alive and well and still serve as the basis for standard test methods for all x-ray equipment including mammography and CT.

During the intervening period, more than 1500 persons have participated in the course from all over the UK, Europe and the World. For example, in 1989 approximately 70 persons attended from the UK, Holland, Sweden, Denmark, Norway, Belgium, Germany and France. Overall, representatives from over 20 different countries have participated including those from the home nations. This included radiographers, physicists, government and university scientists, as well as industrial representatives.

With the emergence of the European Communities Council Directive on patient protection in 1984, the course was taken as the basis for training in quality assurance and radiation protection in Europe by the European Radiation Protection Education and Training (ERPET) Programme. Under this programme, courses were run in conjunction with local hosts in France (Paris twice), Spain (Madrid), Italy (Udine) and Germany (Passau) aimed at transferring knowledge and experience between Member States. It is rumoured that President Mitterand had indicated that he would not support a training course on radiation protection being held in France that was given in English. He needn’t have worried since wherever possible (definitely in France) lectures including associated slide material were presented in the host language thanks to an excellent translation service available through the University of Liverpool!

In the late 1980’s the course was also run in Dundee for several years in order to meet demand from colleagues in Scotland and Northern Ireland who normally had to travel considerable distances for UK based training.

In the early days of the course test equipment for x-ray equipment was rudimentary. Some test methods still involved the use of an oscilloscope and a large biscuit tin for waveform analysis with the Ardran-Crookes penetrameter as the primary means of measuring kV. CT scanner technology was still at a very basic stage of development compared with today’s systems with relatively few installed units in the UK as a whole.

In the 1980’s it was well reported that the State of California had more installed scanners than the whole of the UK. Radiography was very much film based and test methods for film/screens and automatic processors were an integral component of routine QA.

An integral part of the early course involved manufacturers and suppliers of test equipment making presentations to course participants on their latest products. Also, in order to provide practical training in QA early evening practical sessions in a local hospital (Broadgreen in Liverpool and Dundee Royal Infirmary in Dundee) were included in the course programme and made for very long days. But an evening in the bar afterwards created a very relaxing and friendly environment for useful discussion and exchange of experiences. This formed an important and integral part of the learning process.

An important aim of the Liverpool Course has been to provide the most up to date information on methods and techniques for assessing the performance of diagnostic x-ray equipment and their potential impact on radiation protection of both staff and patients, including optimisation. This has involved keeping abreast of the ongoing technological revolution in medical imaging that has occurred over the past 40 years; not only in terms of the evolving methods for imaging data capture and the move towards totally digital systems, but also the growth of an IT and web-based infrastructure that enables the deployment of integrated QA and radiation protection support processes. Equally, since the impact of the covid-19 pandemic, the course has moved on-line. This means participants do not have to travel to Liverpool and can participate in the comfort of their own locale.

Over the years the course has been ably supported by guest lecturers who could give their own unique and practical experiences in the field of radiation protection and QA in diagnostic radiology. Past speakers have included Wynford de la Haye, Richard Price, Jean Harvey, Stewart Whitley from the radiographic profession, Barry Wall (NRPB), Ian Hendra (DHSS), Mike Nettleton (HSE), Hans Julius (ICRP), Brian Mansfield (Philips Medical Systems), Derek Roberts (Agfa Gevaert), Arnold Cowen, Dick Mould, David Sutton (Medical Physics), Graham Whitehouse, James Carmichael, Ove Mattsson and David Sinclair (Radiology) to name a few.

Course attendees have also spanned all nations and professional boundaries, such as Professors Trevor Shelley (Southampton) and  Soren Mattsson (ICRP, Sweden), H. Schibilla (Commission of European Communities, Brussels), Pedro Ortiz (IAEA, Madrid), Ole Hjardemaal (National Institute of Radiation Hygiene, Denmark),  Richard Evans (CEO College of Radiographers), Pam Black (Vice President College of Radiographers) have made unique contributions.

When the first Course was held, many people who attended were struck by the warmth and friendliness of Liverpool. Many vowed to return at the earliest opportunity to see the sites of a city on the rise. In the years since 1984, Liverpool has undergone a major transformation economically, architecturally and culturally and is beginning to move forward with vigour into the 21st Century. Hopefully the scientific background and associated training in radiation protection and QA in diagnostic radiology will continue to do the same. With developments such as Artificial Intelligence (AI) and Machine Learning (ML) on the horizon, an interesting future awaits.

Dr Mike Moores, Director

Participants on the 1988 Liverpool course