Ionising Radiation Regulations Research Articles

HSE’s safety assessment principles for criticality safety

The Health and Safety Executive (HSE) published its revised Safety Assessment Principlesfor Nuclear Facilities (SAPs) in December 2006. The SAPs are primarily intended for useby HSE’s inspectors when judging the adequacy of safety cases for nuclear facilities.The revised SAPs relate to all aspects of safety in nuclear facilities including thetechnical discipline of criticality safety. The purpose of this paper is to set out forthe benefit of a wider audience some of the thinking behind the final publishedwords and to provide an insight into the development of UK regulatory guidance.The paper notes that it is HSE’s intention that the Safety Assessment Principlesshould be viewed as a reflection of good practice in the context of interpretingprimary legislation such as the requirements under site licence conditions forarrangements for producing an adequate safety case and for producing a suitableand sufficient risk assessment under the Ionising Radiations Regulations 1999(SI1999/3232 www.opsi.gov.uk/si/si1999/uksi_19993232_en.pdf).

Applying the ionising radiation regulations to radon in the UK workplace

As a response to the identification of a health risk from workplace radon in the UK, the Ionising Radiations Regulations include the protection of workers from excessive levels of radon. Employers are required to make risk assessments, and the interpretation of the Health and Safety Executive is that the regulations apply to workplace premises in locations already designated as Radon Affected Areas for domestic purposes, with the difference that in workplaces, it is the maximum winter radon concentration rather than the annual average which is the parameter of interest. This paper discusses the rationale behind the current regulatory environment, outlines the role and duties of Accredited Radiation Protection Advisers and summarises the strategies necessary to conform to the regulations.

Safe systems of work are needed for the diagnosis of occupational mental illness

Occupational mental illness is now the most commonly reported illness to the national surveillance scheme, Occupational Physician Reporting Activity, of work related illness [1]. Its diagnosis is problematic as it involves recognizing a pattern of subjective symptoms in a patient that can be causally attributed to work rather than to personal vulnerabilities. As with most psychiatric illness there is no objective test to confirm the diagnosis. The difficulty of verifying the existence of a stressful working environment and of associating it with a particular occupation or job have been given as reasons for not making occupational mental illness a Prescribed Industrial Injury [2]. Neither is it recognized by the Health and Safety Executive in the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations. This contrasts with personal injury litigation or injury awards for certain pension schemes that recognize occupational mental illness as an injury and require doctors to give an opinion about causality. Characteristics of workplaces that are hazardous for mental health have been identified from a variety of observational studies and include those where there are high demands on employees, a lack of control over the way the work is done, a lack of social support, an imbalance between effort and reward, job dissatisfaction, a hostile working environment or culture such as bullying or where there is job insecurity due to restructuring or external inspections [3–7]. Less commonly operational aspects of the job are reported as sources of stress but these tend to be in extreme circumstances where there is a risk of personal harm. The importance of obtaining information independent of the patient (known epidemiologically as triangulation) may be helpful for validation purposes. Personal factors associated with mental illness need to be assessed to include a previous personal or family history of mental illness, recent stressful life events and personality traits of neuroticism [8]. An experienced occupational physician is familiar with evaluating relevant personal and workplace factors and with diagnosing common mental illnesses such as anxiety or depression. For example, the victim of unreasonable or particularly stressful working practices with anxiety specific to work or depression, but with no other relevant trigger factor and no past medical history of mental illness or neurotic personality traits, is likely to be suffering from occupational mental illness. Such patients are usually the most vulnerable in an organization and it is one of the roles of an occupational physician to support and protect these patients while simultaneously preventing similar illnesses in other workers. Unfortunately many such patients either leave or are dismissed after a prolonged period of sickness absence on the grounds of incapability. The benefit of a correct diagnosis needs to be weighed against the harm of a false one. The occurrence of several cases of occupational mental illness from one employer reduces the likelihood of false positives, provided such diagnoses have not been made negligently or there has not been a deliberate attempt to mislead the doctor. It is regrettable that in communicating the diagnosis of occupational mental illness (with the consent of the employee) to the responsible employer it may be met with an angry response to include the threat of loss of contract, a vindictive complaint or attempts to discredit the doctor’s diagnostic skills [9]. By contrast, the communication of an occupational physical illness is unlikely to be met with such a response and in some circumstances it is a statutory requirement (e.g. the Lead, Asbestos and Ionising Radiation Regulations). The reporting of occupational mental illness to the employer’s health and safety committee, or by way of an annual report from occupational health, may be met with similar resistance thereby making the integration of certain occupational health data into management statistics and Regulatory compliance problematic [10]. Alternative strategies used by occupational physicians to handle this situation include equivocation over diagnostic aetiology or writing an additional letter to management that is not seen by the patient. However, both these methods can cause the doctor to lose credibility in the eyes of the patient and by so doing he or she will be compromising their professional independence. The Health Correspondence to: Department of Occupational Health, Dudley NHS PCT, Health Centre, Cross Street, Dudley, DY1 1RN, UK. Tel: +44 1384 366 423, fax: +44 1384 366 422; e-mail: jon.poole@dudley.nhs.uk

Radon level and radon effective dose rate determination using SSNTDs In Sannur cave, Eastern desert of Egypt

For the assessment of inhalation doses due to radon and its progeny to cavern workers and visitors, it is necessary to have information on the time integrated gas concentrations and equilibrium factors. Passive single cup dosimeters using solid state nuclear track detectors (SSNTD) is the best suited for this purpose in wadi Sannur cave, Beni Suef, Egypt. The average radon concentration measurements for the cave are 836 +/- 150 Bq m(-3) by CR-39 detectors and for equilibrium factor an overall average of all measured values was used 0.687. The effective dose for cave workers is 3.65 mSv/year while for visitors is 23 muSv/year. Comparing these values to the Ionizing Radiation Regulations (IRR) values which indicate that the estimated effective doses for workers and visitors in this cave are less than the average overall radon dose.

Management of particles detected on the Dounreay site

Much effort is involved in finding and retrieving historic particles from the environssurrounding the Dounreay nuclear site. Historic particles are also present on the site itself,and these are dealt with as part of the ongoing contaminated land management regime.UKAEA operates systems of routine monitoring on outside surface areas in order to limitexposure to the workforce under the Ionising Radiation Regulations 1999. Contaminatedmaterial is removed when found, and this material undergoes separation andanalysis routinely and where suspected to contain a particle. Information regardingon-site particles has been built up as a result of this. The distribution of on-siteparticles provides details of the likely dispersion pathways, and it is apparentthat some interaction occurs between the on-site and off-site particle transportmechanisms.The strategy for dealing with contaminated land at Dounreay is to manage contaminationin situ during the decommissioning phase, where the risk of doing so is acceptable. Particlespresent a very low risk to Dounreay site workers but it is considered ALARP (as low asreasonably practicable) to detect and remove these particles. The particles are a legacyissue arising from historic practices, which would not meet today’s safety standards. Acontinuing programme to detect, remove and record their presence will be required duringthe site closure process. This will be necessary to meet current regulations and the likelycriteria for releasing the site for future re-use. The final solution for the particles will not beknown until the Best Practicable Environmental Options study is completed and furtherdevelopment of the site end-point work has been reported. It is unlikely that there willbe a full removal of particles from the total environment, so some form of longterm monitoring programme may be required plus a high standard of recordkeeping.

Use of the mini C-arm for wrist fractures--establishing a diagnostic reference level

The establishment of diagnostic reference levels (DRLs) for all typical radiological examinations became mandatory following the implementation of the Ionising Radiations (Medical Exposure) Regulations Act 2000. At present, there are no national dosage guidelines in the UK regarding use of fluoroscopy in orthopaedic trauma. The increasing popularity of the mini C-arm image intensifier amongst surgeons has led to concerns regarding use of ionizing radiation by personnel who have not been trained in radiation protection. It is therefore essential to have formal protocols for use of the mini C-arm to comply with the law and to maintain safe clinical practice. It is attempted to provide dose data for wrist fracture manipulations that may be used as a basis for setting a DRL for this procedure. Screening times were recorded for 80 wrist manipulations in a fracture clinic setting using a mini C-arm image intensifier. A DRL was set using the third quartile value for screening time. The median screening time for wrist fractures was 20 s with a range from 1 to 177 s. The third quartile value for screening time was 34 s. This value can be used as a provisional DRL for wrist fracture manipulations. The DRL is a quantitative guide for the optimisation of radiological protection. IR(ME)R 2000 states that if it is consistently exceeded by an individual operator or a piece of equipment, investigation and remedial action must be taken. We recommend that trauma units establish their own local DRLs for common procedures as made mandatory by legislation.

Improving patient safety in radiotherapy by learning from near misses, incidents and errors

Radiotherapy incidents involving a major overdose such as that which affected a patient in Glasgow in 2006 are rare. The publicity surrounding this patient's treatment and the subsequent publication of the enquiry by the Scottish Executive have led to a re-evaluation of procedures in many departments. However, other incidents and near misses that might also generate learning are often surrounded by obsessive secrecy. With the passage of time, even those incidents that have been subject to a public enquiry are lost from view. Indeed, the report on the incident in Glasgow draws attention to strong parallels with that in North Staffordshire, the report of which is not freely available despite being in the public domain. A web-based system to archive and make available previously published reports should be relatively simple to establish. A greater challenge is to achieve open reporting of near misses, incidents and errors. The key elements would be the effective use of keywords, a system of classification and a searchable anonymized database with free access. There should be a well designed system for analysis, response and feedback. This would ensure the dissemination of learning. The development of a more open culture for reports under the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) is essential: at the very least, their main findings and recommendations should be routinely published. These changes should help us to achieve greater safety for our patients.

How to use ‘Total-QALYs’ to Make the Treatment Justifications Required by IRMER

Background: The requirements of the Ionising Radiation (Medical Exposure) Regulations (IRMER) include a duty on the doctor prescribing radiotherapy to justify the treatment by ‘showing a sufficient net benefit giving appropriate weight’ to the therapeutic benefits and ‘the individual detriment that the exposure may cause’. No guidance is given, either in the regulations or elsewhere, on how to decide this balance between benefit and detriment. No prosecutions were brought by the Department of Health under this regulation for unjustifiable damage to normal tissue as a side effect of treatment, but, with the transfer of the enforcement powers to the Healthcare Commission, there is a need to agree on a common approach for demonstrating justifications of treatments.

Design and construction of a facility for neutron activation analysis using the 14 MeV neutron generator at HMS Sultan

The potential for using a small, sealed tube, DT neutron generator for neutron activation analysis has been well documented but not well demonstrated, except for 14 MeV activation analysis. This paper describes the design, construction and characterization of a neutron irradiation facility incorporating a small sealed tube DT neutron generator producing 14 MeV neutrons with fluence rates of 2·108 s−1 in 4π (steady state) and 1011 s−1 in 4π (pulsed). Monte Carlo modeling using MCNP4c and McBend9 has been used to optimize the design of this facility, including the location of a thermal irradiation facility for conventional neutron activation analysis. A significant factor in designing the facility has been the requirement to conform with Ionising Radiation Regulations and the design has been optimized to keep potential radiation doses to less that 1 μSv/h at the external walls of the facility. Activation of gold foils has been used for flux characterization and the experimental results agree well with the modeling.

Experience of radiation passbooks in the UK NRPB dose record keeping service

The National Radiological Protection Board (NRPB)--now part of the new UK Health Protection Agency (HPA)--has operated an automated Dose Record Keeping (DRK) Service for over 30 y, and currently maintains records for some 10,000 workers. A proportion of these are designated as Outside Workers, and are issued with Radiation Passbooks, under the Ionising Radiations Regulations 1999 (IRR99). The present study reports the operational experience of NRPB's DRK Service in issuing passbooks, providing advice to users and issuing tailored reports. Indication is given on some problems commonly encountered by employers and dosimetry services.

Design and practices at four European synchrotron radiation facilities

The European Directive 96/29/Euratom of 13/05/1996, based on the ICRP 60 Recommendations, defines basic safety standards for the protection of the health of workers and the general public against the dangers arising from ionising radiation. Member states of the European Union have had to integrate these basic standards in their national legislation. Synchrotron radiation facilities are affected by this new radiation protection legislation. In the UK, the Daresbury Synchrotron Radiation Source (SRS) operates under the Ionising Radiations Regulations 1999, and the third generation Diamond Light Source (DLS) project is largely benefiting from their experience. In France, the ESRF case is presently being used to define detailed prescriptions, that will also apply to future sources in this country, for example the third generation light source Synchrotron Soleil, presently under construction. This paper summarises general policies and practices of these four SR facilities: SRS, European Synchrotron Radiation Facility (ESRF), DLS and Synchrotron Soleil.

The Consistent Image – How to Improve the Quality of Dental Radiographs: 2. The Image Receptor, Processing and Darkroom/Film Handling

The two papers in this series aim to discuss quality assurance as applied to dental radiography. 'The lonising Radiation Regulations' emphasize the need for quality assurance programmes wherever radiography is being undertaken. A written quality assurance programme is good practice. This second paper deals with the image receptor, processing and darkroom/film handling. Utilization of digital imaging will eliminate processing and darkroom errors but may introduce new categories of error.

The Consistent Image – How to Improve the Quality of Dental Radiographs: 1. Quality Scale, Operator Technique, X-ray Set

There are two papers in this series aiming to put into context quality assurance as applied to dental radiography. 'The Ionising Radiation Regulations' emphasize the need for quality assurance programmes wherever radiography is being undertaken. A quality assurance programme should aim to be written down common sense. This first paper deals with assessment of image quality, faults arising from poor operator technique and exposure factors. The object of a quality assurance programme is to minimize the dose to the patient whilst maximizing diagnostic utility.

Radiation safety management in health care – The application of Quality Function Deployment

The paper presents a study of the potential for applying the Quality Function Deployment (QFD) method to the analysis of the framework for safety management contained in the Ionising Radiation (Medical Exposure) Regulations (IRMER) of 2000. The QFD method has been successfully applied to many industrial and manufacturing processes in order to ensure that quality is built into products at the outset rather than tested for after their production. In this context, the term quality is used to describe the degree to which the needs and requirements of the customer are fulfilled. More frequently, now, the QFD approach is being applied to health care in order to engineer clinical processes that can best fulfil the needs of the patient. In the case of diagnostic radiology, safety management must not only be concerned with radiation protection but, more importantly, with the accuracy and consistency of any diagnostic outcome. Both are important patient needs. A first stage analysis of IRMER 2000 is presented that assesses how patients' needs are expressed by the individual IRMER components of justification, optimisation, clinical audit, expert advice, equipment and training. The analysis involved a QFD assessment by four radiation protection experts with over 100 man-years of experience. A second stage analysis assesses how the individual IRMER components have been engineered into a safety management framework through specific requirements embodied in IRMER 2000. The results of this assessment are discussed in terms of clinical, human, operational management and equipment related aspects of the radiological process. This study highlights how the QFD approach may be applied to engineer specific aspects of radiological practice that play a key role in ensuring that patients' needs are fully met. As an example, clinical audit requirements are analysed by means of the QFD method to indicate the design requirements of information and knowledge based systems that can provide the necessary information for this type of key management activity.

Radiation dose measurement and optimization

CorrespondenceRadiation dose measurement and optimizationB M MooresB M MooresCo-ordinator, RADIUS Group, EC Radiation Protection Research ProgrammeSearch for more papers by this authorPublished Online:5 Mar 2014https://doi.org/10.1259/bjr/18002911SectionsPDF/EPUBFull Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail About References 1 Paisley EM, Eatough JP, Mountford PJ, Frain G, Pickerill J. Patient radiation doses during invasive cardiac procedures categorised by clinical code. Br J Radiol 2004;77:1022–6. Link ISI, Google Scholar2 George G, Eatough JP, Mountford PJ, Koller CJ, Oxtoby J, Frain G. Patient dose optimization in plain radiography based on standard exposure factors. Br J Radiol 2004;77:858–63. Link ISI, Google Scholar3 Shrimpton PC, Wall BF, Jones DG, Fisher ES, Hillier MC, Kendall GM. A national survey of doses to patients undergoing a selection of routine x-ray examinations in English hospitals. NRPB-R200. Chilton, UK: National Radiological Protection Board, 1986. Google Scholar4 EC Directive 97/43 EURATOM, 1997. Google Scholar5 Rosenstein M. Diagnostic reference levels in medical imaging. Proceedings of an international conference held in Malaga, Spain, 26–30 March 2001; 241–263. International Atomic Energy Agency, 2001. Google Scholar6 Ionising Radiations (Medical Exposure) Regulations [IR(ME)R], 2000. Google Scholar7 Shiralkar S, Rennie A, Snow M, Gallard RB, Lewis MH, Gower-Thomas K. Doctors' knowledge of radiation exposure-questionnaire study. Br Med J 2003;327:371–2. Crossref Medline, Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited bySTATUS OF RADIATION DOSE LEVELS IN PAEDIATRIC CHEST RADIOGRAPHY IN A TERTIARY HOSPITAL IN GHANA2 August 2021 | Radiation Protection Dosimetry, Vol. 195, No. 2An overview of measuring and modelling dose and risk from ionising radiation for medical exposuresRadiography, Vol. 20, No. 4Optimization of patient radiation protection in pelvic X-ray examination in Ghana5 July 2012 | Journal of Applied Clinical Medical Physics, Vol. 13, No. 4Image quality in the anteroposterior cervical spine radiograph: Comparison between moving, stationary and non-grid techniques in a lamb neckRadiography, Vol. 17, No. 2Patient dose measurements in radiological practices9 May 2006 | Physics in Medicine and Biology, Vol. 51, No. 11Response to “Radiation dose measurement and optimization”B F Wall5 March 2014 | The British Journal of Radiology, Vol. 79, No. 940Authors' replyB M Moores13 February 2014 | The British Journal of Radiology, Vol. 79, No. 940 Volume 78, Issue 933September 2005Pages: 777-871 © The British Institute of Radiology History RevisedApril 06,2005ReceivedJanuary 12,2005AcceptedApril 20,2005Published onlineMarch 05,2014 Metrics Download PDF

RADIATION EXPOSURE AND THE UROLOGIST: WHAT ARE THE RISKS?

Endourology is established in urology practice with routine use of fluoroscopic guidance. Medical personnel are rarely exposed to direct radiation exposure but secondary exposure occurs via radiation scatter. There are few reports on scatter radiation exposure and the subsequent risk to medical personnel involved in urological fluoroscopic procedures. We review the risks of scatter radiation exposure to medical personnel with reference to the routine use of fluoroscopic imaging in urological practice. We measured staff radiation exposure during a series of ureteral endourological procedures using LiF:Mg,Ti thermoluminescent dosimeters placed at the extremities of the operating surgeon, the assistant and the scrub nurse. Doses for percutaneous nephrolithotomy (PCNL) procedures were calculated by extrapolating from the ureteral procedure thermoluminescent dosimeter data. Theoretical scattered radiation dose rates were also calculated. The average ureteral procedure fluoroscopy time was 78 seconds with an exposure rate of 71 kV, 2.4 mA. The surgeon received the highest radiation exposure with the lower leg (11.6 +/- 2.7 microGy) and foot (6.4 +/- 1.8 microGy) receiving more radiation than the eyes (1.9 +/- 0.5 microGy) and hands (2.7 +/- 0.7 microGy). For a predicted annual caseload of 50 ureteral cases, the dose received does not exceed 0.12% of the Ionising Radiations Regulations 1999 annual dose limit for adult workers. Radiation exposure during PCNLs is higher but does not exceed 2% of the annual dose limits even if 50 PCNLs are performed annually. Fluoroscopic screening results in radiation exposure of medical personnel. The estimate of maximum scatter radiation exposure to the surgeon for 50 PCNL procedures a year did not exceed 10 mGy. This amount is less than 2% of permissible annual limits of equivalent dose to the extremities. Medical personnel should be aware of scatter radiation risks and minimize radiation exposure when involved in fluoroscopic screening procedures.

Principles and precautions of conventional radiography

The production of X-rays and the different techniques available to image them are described. The types and applications of contrast agents are discussed, along with side-effects and how to avoid/minimize them. Standard radiographic projections are detailed and the methods used to improve image quality mentioned. The radiation dose for a number of radiographic procedures is listed, along with regulations governing their administration; methods of reducing the radiation dose are discussed. X-rays are high-energy electromagnetic photons produced by bombarding an anode with electrons. X-rays are used in diagnostic imaging, in conventional radiography and CT. Tissues absorb X-rays according to their density. Conventional radiographs allow the resolution of four densities (air, fat, soft tissue, calcification). Imaging can also be performed fluoroscopically or digitally. If there is no natural contrast, exogeneous contrast agents may be used to artificially enhance visualization of tissue and have a wide spectrum of applications. Contrast agents may be classified as ‘positive’ (e.g. barium) or ‘negative’ (e.g. air) according to whether they are of high or low radiodensity. X-ray exposure should be performed only when it produces a net benefit to the patient and should be kept as low as reasonably achievable (the ALARA principle). The UK Ionising Radiation (Medical Exposure) Regulations require by law that all medical exposure to ionizing radiation is clinically justified and authorized.

Second cancer risk, concomitant exposures and IRMER(2000)

In this issue we publish a Commentary by Dr Roger Harrison [1] on second cancer risk following radiotherapy. Harrison looks at the evidence from various sources, including an NRPB summary, and the complexity of comparing risk in the radiotherapy patient population with that in the normal population. He also addresses the particular problem of ‘‘concomitant dose’’ in radiotherapy planning and verification that has been highlighted by other authors in articles in BJR, particularly Waddington and Mackenzie [2] and Munro [3]. The Ionising Radiation (Medical Exposures) Regulations (IRMER(2000)) [4] require justification of all medical exposures [Reg:6(1)]. Under the optimization regulation [Reg:7], the Practitioner is also required to ‘‘ensure that exposures of target volumes are individually planned, taking into account that doses to non-target volumes and tissues shall be as low as reasonably practicable (ALARP) and consistent with the intended radiotherapeutic purposes of the exposure’’. Neither of these regulations distinguishes between the radiotherapeutic dose and the ‘‘planning and verification doses’’ required by the total process. Also, ALARP has such a different meaning for radiotherapy exposures from that for diagnostic exposures that it is almost inappropriate as a concept. (We may need to develop our own language specifically for protection in radiotherapy, but more of that later.) A specific interpretation is put on these regulations in the Medical and Dental Guidance Notes [5]. In situations where the clinician is required to consider the extra dose from planning and verification exposures independently, ‘‘The IRMER Practitioner responsible for the treatment exposure (the Clinical Oncologist) can justify the concomitant exposures at the outset or during the radiotherapy course, but in doing so must be aware of the likely exposures and the resulting dose so that the benefit and detriment can be assessed. This can be achieved by including likely concomitant (extra-target) exposures within site-specific protocols with a total effective dose agreed’’. Waddington and McKenzie [2] chose to follow the Guidance Notes to demonstrate the possibility of expressing concomitant exposures using ‘‘effective dose’’, and have presented an excellent paper analysing that part of the ‘‘dose’’ from verification images; and at the same time justifying the need to record these doses by looking at the potential for cancer induction. Harrison [1] has taken this a stage further to analyse in more depth the radiation induced cancer issue for radiotherapy patients. One of his conclusions is that to specify and document individual concomitant exposures separately would seem to be unnecessary. This Editorial aims to stimulate further debate on these subjects, which are partly about the need for radiotherapy departments to comply with IRMER(2000) [4], but also about the need for all staff to gain a better understanding on cost-benefits of radiotherapy. It is extremely important that the radiotherapy community addresses this subject and arrives at a consensus that will benefit the patient. In the summary of the current position, which follows, absorbed dose (shortened to ‘‘dose’’) has been used throughout. The use of ‘‘effective dose’’ is questionable in radiotherapy for several reasons: the radiotherapy patient population is a highly selected subgroup of the general population with different longevity; also tissue weighting factors will be different because dose gradients and doses are much greater in radiotherapy than in diagnostic radiography. Therefore it is avoided here.

‘X-ray dose training: are we exposed to enough?’

Readers will not be surprised at the level of ignorance about radiation doses displayed by clinicians in the paper by Jacob et al., but they may be more concerned to find that radiologists did not fare all that much better, at least in their junior years. The authors’ findings have implications for the way in which radiologists and other clinicians discharge their responsibilities under the Ionising Radiation (Medical Exposures) Regulations [IR(ME)R], but they also have a wider significance in the field of radiation protection. The roles and responsibilities of referrer and practitioner under IR(ME)R are, in theory, quite different and easily separated. The referrer needs to know enough about medicine and his or her patient to give the practitioner the clinical information necessary to carry out the justification process. The practitioner is the repository of knowledge concerning radiation hazards, and will balance these when deciding whether the examination should go ahead. You could therefore argue that, although it would be a good thing for referrers to understand something about the risks associated with ionizing radiation, detailed knowledge is not a necessary prerequisite as far as their IR(ME)R duties are concerned. However, it is not quite as simple as that. The authors make the valid point that the referrer controls the wording of the request and can be selective concerning the clinical details divulged to the practitioner, and we all recognize that one of the less welcome results of implementing imaging guidelines is that referrers learn what to write on request cards in order to get the examination they want. Jacob et al. suggest that this ability to “spin” the clinical information effectively transfers part of the justification process into the hands of the referrer, and that this is a reason to ensure that they know more about the risks of radiation than is currently the case. I accept the logic of this argument, but I do wonder whether referrers who are prepared to be economical with the truth in order to obtain the practitioner’s signature on the request card would allow a short course in radiation protection to influence their behaviour very much, or for very long. Also relevant to any discussion of the justification process is the question of who is to be regarded as a practitioner. The authors include in their definition any clinician who carries out fluoroscopic procedures, and many hospitals take this position. That means that you are committed to giving radiation protection training to a large group of clinical staff on a recurring basis, training that will involve considerably more than the old unlamented half-day “POPUMET course”. Alternatively, the training could be included in the postgraduate courses of the relevant specialities, and this has recently been achieved for cardiologists. Following an approach from the Radiation Protection Committee of the British Institute of Radiology (BIR), the Royal College of Physicians (RCP) agreed to include radiation protection training in the cardiology specialist registrar syllabus, and a number of training courses, jointly validated by the BIR and RCP, have been set up around the country. The reason for targeting cardiologists was the fact that many of them spend a large proportion of their time carrying out complex interventional procedures involving radiation doses that can approach levels where deterministic effects become a possibility. There is thus good reason to educate them in the principles of radiation protection, whether or not we believe they are acting as IR(ME)R practitioners or operators. This type of training, given during the Clinical Radiology (2004) 59, 926–927

Is there a benefit in promoting the concept of radiation risk?

Is there a benefit in promoting the concept of radiation risk?