principles of radiation protection justification

Once justified, the radiological procedure should be optimized and performed such that the exposure of the patient is managed in order to achieve the medical objective. J Radiol Prot. The three fundamental principles of radiation protection of patients are justification, optimisation, and the application of doses As Low As Reasonably Achievable (ALARA) (ICRP103) . Radiologists however remain central in establishing and agreeing policies and procedures relating to justification, including assigning of responsibilities and delegation privileges to other medically and non-medically qualified staff for radiology medical exposures. Concise, full-color coverage discusses the safe use of ionizing radiation in all imaging . Keywords: In unregulated cases (such as with exposure to UV radiation from the sun) authorities can only inform the public about the risks and how to reduce them. ICNIRP gratefully acknowledges Emilie van Deventer (World Health Organization), Sigurur Magns Magnsson (International Radiation Protection Association), Jacques Lochard (International Commission on Radiological Protection), Shengli Niu (International Labour Organization) and Ferid Shannoun (United Nations Scientific Committee on the Effects of Atomic Radiation) for their participation in preparatory seminar(s) and feedbacks on several drafts. This represents the mechanism by which society defines the accepted standards that must be applied for acceptance of a practice. Both approaches are valid and tend to use the same evidence base in their generation but reflect different approaches to responsibility for justification. 0000123026 00000 n Too low radiation dose could be as bad as too high radiation dose. When discussing roles and responsibilities, it is impossible to ignore the need for regulatory compliance. Justification for radiological procedures to be performed as part of a health screening programme for asymptomatic populations shall be carried out by the health authority in conjunction with appropriate professional bodies. after determining the justification of x-ray examination of procedure the referring physician must accept basic responsibility for protecting the patient from radiation exposure, the physician may exercise this responsibility by employing competent technical personnel. In particular, higher levels of inappropriate imaging are evident where the practice of self-referral is prevalent [8, 9]. 0000089311 00000 n It should be noted, however, that the exposure guidelines are not meant to be protective for people with certain clinically substantiated diseases or conditions that may make them more susceptible to harm from non-ionizing radiation, e.g., patients with Xeroderma pigmentosa, or individuals taking photosensitizing medications. J Am CollRadiol 12(2):158165. Has the clinical problem been explained to the radiological medical practitioner? Repacholi MH. https://ec.europa.eu/energy/sites/ener/files/ec-01-08-_d_-_2018-07-30_-_final_report_for_publication.pdf, 1990 NRPB-RCR Patient dose reduction in diagnostic radiology: a report of the Royal College of Radiologists and the National Radiological Protection Board. It may be more realistic to justify a series of exposures on the basis of an expected care pathway and then reassess justification of some or all of subsequent procedures within the care pathway as the patients condition develops and care is subsequently modified. These early successes all highlight the need for a supportive environment, and this support is essential from health policy makers at national and local level, both for initial introduction and on-going change management. A well-constructed regulatory approach may allow for local arrangements to reflect needs and practice for different scenarios or healthcare settings. When the exposure restrictions set by ICNIRP are well below threshold levels for adverse health effects, further reduction in the limit values does not result in additional health benefits, and therefore optimization is not necessary. The Physical Principles of Medical Imaging SPRAWLS May 1st, 2018 - The web based edition of The Physical Principles of Medical Imaging 2nd Ed Perry Sprawls Ph D This is a . The ICNIRP guidelines are not intended to protect against biological effects as such, unless there is also an associated adverse health effect. Mechanisms should be put in place to encourage staff to be able challenge practice which does not seem in the best interest of patients, staff or the department as a whole. Introduction. In many cases, delegation of tasks only applied to the justification of simple procedures and did not include CT. Who decides which medical procedure is appropriate and whether it is justified? Similarly, a precise border between visible and infrared radiation cannot be defined because visual sensation at wavelengths greater than 780 nm is noted for very bright sources (ICNIRP 2013). International Commission on Non-Ionizing Radiation Protection (ICNIRP)1. Principles of radiation protection Ionising radiation can trigger both deterministic and stochastic effects. The justification of reasons for justifying activities that form part of a practice has largely been ignored within the framework of radiation protection. In this statement, the International Commission on Non-Ionizing Radiation Protection (ICNIRP) presents its principles for protection against adverse health effects from exposure to non-ionizing radiation. Justification The first of these principles is that no human should be exposed to doses of radiation - in the workplace or otherwise - unless it is going to do more harm than good. 0000001416 00000 n There are three basic principles of radiation protection: justification, optimization, and dose limitation. Other articles address justification, most notably Article 57 which outlines responsibilities and states that the referrer and the practitioner are involved in the justification process, as specified by Member States. There is added complexity when considering sub-types of IHA. Although Article 57 allows for the involvement (as specified by the Member State) of the referrer and the practitioner in the justification process, it also reaffirms that the clinical responsibility for the medical exposure rests with the practitioner. Fully integrated CDS systems are expected also to facilitate retrospective review and audit of requests, thus improving the requesting and justification process and informing the development and amendment of CDS recommendations as practice changes and is agreed. Further detail regarding the survey is summarised in the Additional file 1. This includes: Any time a new source of radiation is discovered, used, or implemented In such cases, adoption of CDS systems enhances the referrers knowledge of appropriate medical exposures and does not challenge existing legal responsibility. This would require radiologist input or agreement and would mark a significant difference in the way justification processes are seen today. 0000077784 00000 n Radiat Prot Dosimetry. The environment and disease: association or causation? ICNIRP sets its exposure guidelines only on the basis of scientifically substantiated effects. 65 0 obj <> endobj The work cannot be changed in any way or used commercially without permission from the journal. There is clearly a disconnect. Radiation. ICRP . These may differ for different types of imaging, taking into account modality and complexity. In the past five years, the importance of safety culture in radiological services has come to the fore. Bookshelf HWnF}Wh., 9H"(,qQDE_"iEQ3g/`jXvG2j~=1~UnRwsm(UFRZYj__,5t7h82G5m_e:YrJ [hei^W|{b"G `SNStJ17q-j1)S5_Ph=ZOZf`5U7#He-{Z Key findings: In most cases, roles and responsibilities in justification can be made clear and acceptable to all clinical professionals involved with the healthcare pathway of any individual patient. The Royal College of Radiologists, London, Implementing External Clinical Audits in Radiological Practices: The Experience in Finland Volume 9Issue 4, 2009Cover Story: Clinical Audit in the European Union, HealthManagement.org, The Royal College of Radiologists. Challenges to appropriateness in such cases should be made through the agreed mechanisms and should be addressed by the practitioner involved. Cite this article. A general formulation of limitation for non-ionizing radiation is the exposure level or dose to any individual in situations other than exposures for medical purposes and exposures of volunteers, as described below, should not exceed the appropriate recommended restrictions. Most general referrers will be reluctant to undertake such training and while good CDS systems may increase the percentage of appropriate requests, they will not address this need for additional training for the practitioner, as required by the BSSD and national legislation. PubMed In Europe, a survey undertaken in 2020 by EuroSafe Imaging through the Heads of the European Radiation protection Competent Authorities (HERCA) channel (see Additional file 1) of 19 European Union Member States revealed that 22% of competent authorities responsible for radiation protection for medical exposures are part of the Ministry of Health or other Ministry, 38% are linked to the Health Ministry (e.g., as an Agency of the Health Ministry) while 38% are independent of the national Health Ministry. Data is temporarily unavailable. Through this initiative, the FDA strives to promote patient safety through two principles of radiation protection developed by the International Commission on Radiological Protection :. Copyright 2020 The College of Radiographers. As previously mentioned, most human exposures to IR are due to diagnostic imaging modalities. Health Phys 105:7496; 2013. International Commission on Radiological Protection. Would you like email updates of new search results? Ebdon-Jackson, S., Frija, G. & European Society of Radiology. Who has the primary responsibility for ensuring overall radiological protection of patients? Health Phys. 0000005003 00000 n The analysis of data should be performed using appropriate statistical procedures. https://doi.org/10.1594/esi2018/ESI-0089, European Commission. For epidemiological studies an adequate description of the investigated population group, well-defined exposure contrasts and adequate identification and control of confounding factors and minimization of bias are essential. For instance they may occur from an electric discharge arising from metallic objects charged by exposure to some types of non-ionizing radiation; these types of indirect effects are considered by ICNIRP. Before exploring the practical implications and solutions for justification, it is useful to consider in some detail the requirements and associated responsibilities relating to the justification process, as stated in the BSSD. The objectives of the review were to investigate the legal and sociological basis of justification in society in order to fully assess its relevance to radiation protection. Its aims are to identify important aspects relating to justification, highlight key requirements and consider approaches and developments which are intended to improve justification of these exposures. Appropriate justification remains one of the most important challenges for radiological services and staff, whether considered from the perspective of patient safety and radiation protection or the efficient use of radiological resources, be they equipment and facilities or workforce. Time, distance, and shielding measures minimize your exposure to radiation in much the same way as they would to protect you against overexposure to . Br J Radiol 85:523538. The severity of deterministic effects increases with dose. A-1400 Vienna, Austria Justification of procedures and optimization of protection are the two pillars of radiological protection in health care, and they are embedded in the notion of good medical practice. 0000001977 00000 n As a result, it can be assumed that under most exposure scenarios, if the reference levels are not exceeded, the basic restrictions also would not be exceeded. Up to now, audits of appropriate justification have required manual processes which are time consuming. Oxford: Pergamon Press; ICRP Publication 138, Ann ICRP 47(1); 2018. The EuroSafe Imaging/HERCA survey referred to above has provided additional information regarding roles and responsibilities for justification in imaging. Implications for practice: The employment of justification of practices as a fundamental principle of radiation protection should be eliminated since it is already enshrined within the legal framework applicable to applications of ionising radiation. The hospital management has responsibility to ensure that all practicable measures are taken to prevent such exposures, and, if such an exposure does occur, that it is properly investigated and corrective actions are taken. Council Directive 97/43/Euratom of 30 June 1997 on health protection of individuals against the dangers of ionizing radiation in relation to medical exposure, and repealing Directive 84/466/Euratom Off J Eur Commun No L180 (1997), 30 June 1997. https://op.europa.eu/en/publication-detail/-/publication/aa7564fa-fd07-4872-943c-66df8f4f1099/language-en, European Commission. The regulatory requirements around justification support this, but it must be acknowledged that saying no is not easy for a healthcare professional when in direct contact with a concerned patient, as it can lead to a breakdown of trust on the part of the patient. This paper was endorsed by the ESR Executive Council in October 2020. In some cases, the education and training of the inspector may be sufficient to discuss or challenge justification of procedures for individual patients. 0000089768 00000 n The support received by the German Federal Ministry for the Environment (BMU), the European Union Programme for Employment and Social Innovation "EaSI" (20142020), the International Radiation Protection Association (IRPA), the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA), and the New Zealand Ministry of Health is gratefully acknowledged. Education and training of the inspector may be sufficient to discuss or challenge justification of for! 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