The ESR has developed a practical audit tool-Esperanto [27]-and there is a long history of clinical audit in radiology in both UK and Finland [28,29,30]. How optimization of medical exposure is ensured and who is responsible? 8600 Rockville Pike It is reasonable to assume therefore that the primary responsibility for justification rests with the practitioner. The introduction may follow the same pathway as the introduction and adoption of picture archiving and communication systems (PACS) in the 1990s, and of course PACS is now ubiquitous and its value is accepted. At present, there are limited publications on the use of imaging in these circumstances [14] but it presents a significant issue for many healthcare economies. If the capacity of these compensatory mechanisms is overwhelmed or exhausted, this may result in adverse health effects. 1. The latter electromagnetic interference effects are of a technical nature and do not fall within the remit of ICNIRP. These are submitted to the Main Commission for further consideration and finalization. This has been known for some time. 0000021959 00000 n This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. This discussion paper has been produced within the context of the European Society of Radiology EuroSafe Imaging initiative and considers primarily the issues and challenges associated with justification of medical exposures using ionising radiation for individual patient diagnostic imaging procedures. Most family doctors and many hospital doctors, however, are unlikely to have up to date knowledge of imaging or radiation protection and they should not take on the role and responsibilities of the practitioner, without undergoing considerable further training, including detailed radiation protection training. The International Commission on Non-Ionizing Radiation Protection (ICNIRP) collaborators are listed in the Acknowledgement section. Radiation Protection in Medical Radiography, 9th Edition makes it easy to understand both basic and complex concepts in radiation protection, radiobiology, and radiation physics. While safety culture is important, it should not be used to bypass existing responsibilities laid out in policies and procedures. Health Phys 105:7496; 2013. International Commission on Radiological Protection. Any of the following unintended or accidental medical exposures shall be promptly investigated and corrective actions implemented: Written records shall be kept of all unintended and accidental medical exposures. do more good than harm. In particular, it is less specific when addressing the responsibilities for justification, requiring a consultative approach involving the radiological medical practitioner and the referring medical practitioner as appropriate. 0000004385 00000 n The analysis of data should be performed using appropriate statistical procedures. 3 " Doses should all be kept as low as reasonably achievable, taking into account . CENTRE FOR RADIATION, CHEMICAL AND ENVIRONMENTAL HAZARDS, . Optimization is a prospective and iterative process that requires judgements to be made using both qualitative and quantitative information. This directive includes medical exposure for the first time, such exposures having been addressed previously in a separate Directive-97/43/Euratom, where justification was already addressed. Regulatory requirements serve to formalise good practice and should not impact negatively on service provision as long as it is robust and of high quality. In healthcare however, imaging is often applied as part of a pre-defined healthcare pathway including initial assessment and periodic follow up to assess either disease progression or efficacy of treatment. The guiding principle of radiation safety is "ALARA". Ethical foundations of the system of radiological protection. 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. 0000006013 00000 n Ionizing radiation Result- Knowledge about principle of radiation from medical use and applications leads to protection was very disappointing, because majority of the radiation doses from 30.60% of the participants know the basic principle of radiation protection (Justification, artificial or manmade sources to which the Optimization, and Dose . 0000001416 00000 n Telephone: +43 (1) 2600-0, Facsimile +43 (1) 2600-7, 19982023 IAEA, All rights reserved. 0000009237 00000 n Nuclear. Similarly, mechanisms must be introduced to enable conflict review and resolution. 3. Introduction. Radiation protection publication no 118. 0000077897 00000 n The process of determining appropriateness of a medical procedure is an evidence based approach to choosing the best test for a given clinical scenario, with account taken of the diagnostic efficacy of the proposed radiological procedure as well as of alternative procedures that do not use ionizing radiation, for example, ultrasound, magnetic resonance imaging (MRI) or endoscopy. This justification is the responsibility of physicians who are diagnosing or treating the patient, and who have been properly trained to make such judgements. ICRP issued lots . Yet at the same time, these services are considered expensive because of high equipment costs and funding is seldom sufficient to expand services so that they can address increased demand for greater numbers and more complex imaging. 0000039680 00000 n 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. -EHO CHZ|c+C#YGW70GW:/z.6..>Cy}!EI)]fZi2~X?=>l_}uFzk_"v}S6y]2v>U]kCY1v8vkz,EjT]y-f&=T\dN/K3Dp/1X0k5llgZ5Z,,,--,}-:YAVd_5Ya-\j yf]g$8#+jtFGOOGOOGOOGOOG77GG w,^Bw_wSK(2xKInO In regard to the EU funds, for further information please consult: http://ec.europa.eu/social/easi. 0000009154 00000 n J Am Coll Radiol 1:169172, Article This should be accepted within the healthcare institution but could be considered also as a key performance indicator in any external accreditation programme or quality assessment of a radiology department. All co-authors contributed equally to this paper. In most cases, changes to initial justification of individual exposures within a pre-agreed series would require medical knowledge and could be performed and documented when considering individual imaging requests or preferably as part of multi-disciplinary meetings attended by a range of medical specialists involved in the care of a specific patient. Where the task of justifying was permitted, this needed to be documented, restricted to certain staff groups or individuals within these groups (e.g. Patients expectations can be influenced by public health campaigns and coordinated approaches with family doctors. Processes should allow for responsibility for justification to be transferred from one professional to another where it is clear that the first professional does not have the competence to make an appropriate decision. Imaging referral guidelines have been in place for many years in Europe. Another distinction that can be made is between intentional and unintentional exposures. 2022 Oct;28 Suppl 1:S50-S58. The more significant events are required to be reported to the regulatory body, according to the national requirements. %PDF-1.7 % While there are advantages of independence, clear separation can lead to a lack of appreciation of each organisations priorities, which are not always consistent. 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. There are no competing interests to declare. Justification in clinical radiological practice: a survey among staff of five London hospitals. The mention of commercial products, their sources, or their use in connection with material reported herein is not to be construed as either an actual or implied endorsement of such products by ICNIRP or any of the organizations with which the collaborators are affiliated. Get new journal Tables of Contents sent right to your email inbox, http://www.icnirp.org/en/about-icnirp/support-icnirp/index.html, Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), http://www.icnirp.org/en/about-icnirp/aim-status-history/index.html, Principles for Non-Ionizing Radiation Protection, Articles in PubMed by International Commission on Non-Ionizing Radiation Protection (ICNIRP)1, Articles in Google Scholar by International Commission on Non-Ionizing Radiation Protection (ICNIRP)1, Other articles in this journal by International Commission on Non-Ionizing Radiation Protection (ICNIRP)1, Guidelines for Limiting Exposure to Electromagnetic Fields (100 kHz to 300 GHz), Dose Estimation for Exposure to Radioactive Fallout from Nuclear Detonations, Radiological HEPA Filter 10-year Lifetime Evaluation in Research Facilities, Analysis of ICNIRP 2020 Basic Restrictions for Localized Radiofrequency Exposure in the Frequency Range above 6 GHz, Gaps in Knowledge Relevant to the Guidelines for Limiting Exposure to Time-Varying Electric and Magnetic Fields (1 Hz100 kHz), Privacy Policy (Updated December 15, 2022). Justification: No practice or source within a practice should be authorized unless the practice produces sufficient benefit to the exposed individuals or to society to offset the radiation harm that it might cause; that is: unless the practice is justified, taking into account social, economic and other relevant factors Optimisation (ALARA): Further detail regarding the survey is summarised in the Additional file 1. The process of radiation protection includes making informed decisions even if full knowledge about the risks associated with exposure is not available. In the past five years, the importance of safety culture in radiological services has come to the fore. Turning these functions into roles within a clear regulatory framework can then be transparent and responsibilities can be assigned to the person best placed to carry them out, based on their training and their role in the patients healthcare pathway. 0000089694 00000 n The medical physicist has responsibilities in the optimization of radiation protection and safety in medical exposures, including source calibration, clinical dosimetry, image quality and patient dose assessment, and physical aspects of the quality assurance programme, including medical radiological equipment acceptance and commissioning. In Documents of the NRPB. xref doi: 10.1016/j.radi.2022.07.009. While there is evidence of improvement in European countries, it is essential that complacency does not reverse this trend. Further comments explained that in some Member States a range of medical practitioners were allowed to be practitioners for specified fields and that in one case the undertaking itself could be considered as the practitioner, with the activities undertaken by authorised health professionals. For electromagnetic fields with frequencies below 300 GHz, the actual exposure limits in the guidelines are called basic restrictions. ICRP aims to provide protection against adverse effects of ionizing radiation without unduly limiting the benefits associated with their use. A core concept in ionizing radiation protection is risk tolerability, or the question of how much risk is acceptable. In the USA, appropriateness criteria have been developed, which might be considered as standards against which a proposed radiological investigation can be assessed. The process of justification allows determining whether the medical exposure will take place or not. 3 Major Principles of ALARA for Radiation Protection Time: Minimize your time exposed to the radiation source, to receive the lowest achievable dose. The .gov means its official. It is grouped into different frequency or wavelength bands, namely ultraviolet (UV) radiation (wavelengths 100400 nm), visible light (wavelengths 400780 nm),3 infrared radiation (wavelengths 780 nm1 mm), radiofrequency electromagnetic fields (frequencies 100 kHz300 GHz), low frequency (frequencies 1 Hz100 kHz) and static electric and magnetic fields (0 Hz). These guidelines are established using a conservative approach, which means that compliance with the recommended exposure limits will provide a very high level of protection from substantiated adverse health effects due to the exposure. Protection. While the regulatory approach and requirements described above need to be understood and complied with, there are other issues and competing priorities which need to be recognised and addressed. ICNIRP thanks the ICNIRP Scientific Expert Members who participated in the early draft development: Jukka Juutilainen, Rdiger Matthes, Mats-Olof Mattsson, Chiyoji Ohkubo, Ren de Sze, Rianne Stam, and Andrew Wood. Part of A review of the scientific basis for radiation protection of the patient. Please enable it to take advantage of the complete set of features! Appropriate use of imaging has benefits both for individual patients and for the efficient use of any radiology service, whether within a radiology department or across the wider institution where imaging takes place at multiple locations. To do this, you can use three basic protective measures in radiation safety: time, distance, and shielding. 0000004237 00000 n The International Commission on Radiological Protection (ICRP) is responsible for the development of these principles. Patients under medical care are another special category. BMJ 306(6870):110111. 180 focused on the management of exposure to ionizing radiation and expressed radiation protection principles as justification . Time, distance, and shielding measures minimize your exposure to radiation in much the same way as they would to protect you against overexposure to . 2023 BioMed Central Ltd unless otherwise stated. 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 . https://www.myesr.org/media/4735, Godwin R, de Lacey G, Manhire A (eds) (1996) Clinical audit in radiology: 100+ recipes. Appropriate design of medical radiological equipment and software; Operational considerations specific to the modality and application; Quality assurance program implemented and independent audits made of this program; Dosimetry of patients to determine typical doses to patients for common diagnostic and image guided interventional procedures, and absorbed doses to the planning target volume and relevant organs for each patient in radiotherapy; Diagnostic reference levels established and used for most common diagnostic procedures (see more. Accessibility However, it is not a general policy to report back to all individuals or organizations regarding ICNIRPs response to their comments. A healthy safety culture must be promoted and supported by management and should be evident in public and private practice imaging departments, allowing staff to openly and professionally question the actions of others. 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