Vienna (ABC Live): Radiation Protection in Medicine :Nothing is as easy as one-two-three, but prescribing radiological examinations is increasingly coming close. With machines, particularly CT-s, becoming more sophisticated and offering fast and easy multislice scanning, patients could get exposed to more radiation than medically justified.
The IAEA’s International Conference on Radiation Protection in Medicine next week will review best practices and progress made so far under the Bonn Call for Action – a list of 10 actions proposed at the previous IAEA conference on the topic to limit unnecessary and unintended exposure to radiation in medicine. These include the implementation of the principle of justification – the use of radiological examinations and procedures only when benefits outweigh risks from radiation.
Having the appropriate guidelines is a step towards reducing the number of inappropriate or unnecessary diagnostic imaging procedures, which could make up as many as 20-40 per cent of all diagnostic imaging procedures, according to sources including the conclusion of a 2009 IAEA workshop on justification.
Many countries are taking action in this area based on international best practices. In Malaysia, for instance, the College of Radiology, with the support of the IAEA and the UK’s Royal College of Radiologists, has just published new Clinical Imaging Guidelines in Radiology, which describes justified procedures for different health conditions and patient groups.
“Our target was all physicians, but mostly junior doctors working at emergency departments, as that is where overutilization of radiological examinations frequently takes place,” said Shantini Arasaratnam, Head of the Radiology Department at Kuala Lumpur Hospital and Vice President of the College of Radiology. “Medical personnel need to have sufficient knowledge of radiation protection to minimize unwarranted radiation exposure to patients.”
The College of Radiology published its first set of clinical practice guidelines in 2000, but a lot has changed in the industry since, Arasaratnam said. “There are a lot more modalities available and the machines have become way more sophisticated.” With this equipment comes the risk of overutilization, she said.
Malaysian experts reviewed relevant IAEA publications and guidelines from other countries and based their document on the one issued by the UK’s Royal College of Radiologists. Following consultations with clinicians, radiologists and medical physicists from across the country, they modified the UK guidelines to Malaysia’s specific situation in terms of equipment used and differences in patients’ risk profile. “The guidelines are important but we emphasize that they do not replace communication between clinicians and radiologists,” Arasaratnam said. “This is particularly so in complex cases.”
Bonn Call for Action in Radiation Protection in Medicine
At the conference, participants will review how national and international organizations and other stakeholders can harmonize their actions for better impact. The “Bonn Call for Action Implementation Toolkit” and a newly redesigned IAEA Radiation Protection of Patients web site, created by the IAEA and launched at the Conference, will help in implementation by providing information resources for organizations and individuals working in this area.
The joint statement by the IAEA and the World Health Organization issued as part of the Call for Action states that “there is no doubt that the application of ionizing radiation and radioactive materials in diagnostic, interventional and therapeutic procedures in medicine is beneficial for hundreds of millions of people each year. However, employing radiation in medicine has to involve a careful balance between the benefits of enhancing human health and welfare, and the risks related to the radiation exposure.”
“There is a need for a holistic approach which includes partnership of national governments, civil society, international agencies, researchers, educators, institutions and professional associations aiming at identifying, advocating and implementing solutions to address existing and emerging challenges; and leadership, harmonization and co-ordination of activities and procedures at an international level.”
Besides the implementation of the principle of justification, other Call for Action items include:
- implementation of the principle of optimization of protection and safety;
- strengthening of the role of manufacturers in safety;
- strengthening the radiation protection education and training of health professionals;
- promotion of a strategic research agenda for radiation protection in medicine;
- increasing the availability of improved global information on medical exposure and occupational exposure in medicine;
- improving the prevention of medical radiation incidents and accidents;
- strengthening radiation safety culture in health care;
- fostering an improved radiation benefit-risk dialogue, and
- strengthening the implementation of safety requirements.