Radiological Protection of Patients

Optimizing radiological protection of patients in diagnostic and interventional procedures using X rays

Rationale - The use of X rays is increasing year by year and is deemed to increase further, as a large part of the world has little access to X ray diagnosis. Surveys in conventional radiology show differences in patient doses of up to a factor of 20, or even higher, among hospitals of the same country, for the same radiological examination and for average sized patients. Thus the potential for reduction of unnecessary exposure has been clearly demonstrated. First steps on guidance levels have been undertaken in a number of countries in 2006-7 and this is going to bring patient exposure reduction. Exposure of paediatric patients and pregnant women are receiving special attention because of higher implied risks of exposure. The types and number of interventional radiological procedures are rapidly increasing, as the benefits for the patient can be dramatic, in some countries their number doubles every 3-4 years. In such procedures often, doses received are high, and in some cases, radiation injuries can occur and have been reported in some cardiac and also in non-cardiac procedures such as angioplasty, radio frequency ablation and stent implantations. Often, these procedures have to be repeated for the same patient. In addition, more and more physicians (non-radiologists and non-cardiologists) with no education in radiation protection are involved in these procedures. Digital radiology has the potential for reducing patient exposure, but ironically, has often led to substantially increased exposure. Efforts are therefore underway towards optimization of protection and to training, particularly of those transitioning from conventional to digital radiology. In mammography, optimization of protection is essential to achieve the benefit (early detection, reduction in false positive and false negative diagnosis and with great impact on reducing mortality) with the lowest radiation exposure. Computed tomography is extremely powerful in diagnosis, and, at the same time, the relative magnitude of some of the exposures from its use poses special problems, and guidance on effective approaches in dose reduction needs to be developed, especially for paediatric patients. In recent years the Agency has achieved a substantial momentum, up to the level of enthusiasm, among cardiologists, who have developed a number of actions to optimize protection and disseminated the information through regional and national societies of interventional cardiology. This momentum needs to be maintained and other physicians need to be approached. The dedicated Website for Patient Protection and the cooperation with professional bodies are the major tools. In addition, developing a system for interventionalists to report the cases of radiation induced injuries is required

Objective

To achieve global acceptance of strategies and guidance to optimize diagnostic/treatment quality and dose to patients.

Major Tasks for 2008-2009

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Optimizing radiological protection of patients in nuclear medicine and avoiding accidental exposure in radiotherapy

Rationale - This project covers the optimization of patient protection in nuclear medicine and the prevention of accidental exposures of patients undergoing radiotherapy. Experience has shown that accidental exposures can occur for a number of reasons, including lack of adequate training of various groups – nuclear medicine physicians, radiation oncologists, physicists, technologists, maintenance engineers and regulators on radiation safety. It is possible to make radiotherapy programmes more robust against accidental exposure, by making use of the lessons learned from the past, as included in Agency’s guidance and training packages. Multidisciplinary groups of participants working in radiotherapy have been trained to do so. There is an inherent difficulty in obtaining documented evidence of the work done, as participants are reluctant to report in writing or publish about their vulnerabilities found. A new approach, based on anonymous reporting is being explored. Here also, the Website will provide for dissemination the information and anonymous results as widely as possible. Further a mechanism to estimate the effectiveness of training in prevention shall be developed.

Objective

To achieve global acceptance of guidance reduce unnecessary exposure of patient, family members/ care givers and public in nuclear medicine procedures.

Major Tasks for 2008-2009

 

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