Radiation Protection Culture Research Articles

Radiation risk during thoracic CT scan for diagnostic and radiotherapy planning procedures in Hassan II, Hospital, Agadir Morocco

Objective: This study aims to establish diagnostic reference levels and radiation-induced risk for the diagnostic CT-scans and the radiotherapy planning CT-scans of the thorax in the regional hospital of Agadir, Morocco. Materials and methods: Data from two groups of patients undergoing thoracic CT-scans with either diagnostic CT-scans (G1, n = 120) or radiotherapy planning CT-scans (G2, n = 120) are collected. All acquisitions were helical. DRLs is calculated for each type of thoracic CT-scan by estimating the 75% percentile of the CTDIvol and the DLP. The total cancer risk RC was calculated according to the ICRP publication 103. The data are statistically analyzed by SPSS Statistics V21.0. The student’s t-test was used to establish the relationship between gender, clinical indication, and effective dose. The Spearman test was used to establish the relationship between age, BMI, and effective dose. Results: DRLs in terms of CTDIvol and DLP for radiotherapy planning of thorax were 19.37 mGy and 851.9 mGy cm, respectively. In diagnostic CT-scans, DRLs in terms of CTDIvol for pulmonary embolism, infectious lung disease, Chronic Obstructive Pulmonary Disease (COPD) were 11.13 mGy, 10.26 mGy, and 7.37 mGy respectively, and DRLs in terms of DLP were 417.73 mGy cm, 451.9 mGy cm and 317.78 mGy cm respectively. The cancer risk for radiotherapy planning CT-scans is ranged between 209 and 1564 with a mean value of 715 per 1 million of CT-scan. For diagnostic CT-scans, the cancer risk is ranged between 199 and 626 with a mean value of 357 per 1 million for pulmonary embolism, between 238 and 668 with a mean value of 369 per 1 million for infectious lung disease, and between 130 and 393 with a mean value of 244 per 1 million for COPD. Conclusion: Optimizing the doses received by patients in medical imaging, particularly CT, has become an obligation. Reviewing practices and procedures and promoting a radiation protection culture can help to better manage the radiation doses received by the patient.

Radiation Protection among South African Diagnostic Radiographers-A Mixed Method Study.

Worldwide, radiographers' radiation protection practices vary. In South Africa, evidence of diagnostic radiographers' suboptimal radiation protection practices has been reported, but the reasons for these practices and suggestions to improve practices were lacking. Therefore, this study explored radiation protection among South African diagnostic radiographers. This study used an explanatory, sequential, mixed-method approach. Data were collected in three phases. Phase I, the quantitative phase, used an online questionnaire and respondents from Phase I interested in participating in Phase II, the qualitative phase, were interviewed, yielding 13 in-depth semi-structured telephone interviews. In Phase III, eight radiography managers co-constructed change strategies to optimize radiation protection in South Africa in two focus group interviews. Radiation protection was suboptimal despite diagnostic radiographers having a good attitude, subjective norm and perceived behavioral control toward radiation protection and optimal radiation protection knowledge. Varying attitudes to radiation protection, lack of resources, and support from radiography management and healthcare teams contributed to suboptimal radiation protection practices. Radiography managers suggested increasing radiation protection awareness, ameliorating the diminished stature of the radiographer in the healthcare team, and increasing the availability of optimal quality resources. South African diagnostic radiographers' radiation protection knowledge was optimal, but the implementation of radiation protection varied and was influenced by multiple factors. A radiation protection culture supported by management is advocated to optimize radiation protection. However, ultimately radiation protection practices are incumbent on the individual radiographers' choice to practice radiation protection.

Integration of Ethics into Radiation Protection Practice Through Islamic Personality Approach

Established guidelines in radiation protection practice still could not guarantee compliance from radiographers' part. Since non-compliance is unethical, radiographers should be better versed in biomedical ethics principles. The objective of this paper is to review the integration of ethics into radiation protection practice through an integrated Islamic personality approach. The review involves literature related to the topic studied. Content analysis of reading materials is performed. Results found that integrating ethics in the radiation protection framework could be accomplished by combining the essence of culture and belief. Personalizing Islamic Personality in radiation protection practice could help uphold ethics in practice. Keywords: Ethics; Radiation Protection Culture; Islamic Personality; Muslim radiographers eISSN: 2398-4287 © 2022. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians/Africans/Arabians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v7i22.4163

Impact of a radiological protection campaign in emergency paediatric radiology: a multicentric observational study in Brazil

PurposeTo evaluate the impact of a paediatric radiological protection campaign, implemented in the emergency units of a healthcare provider network in Brazil. This campaign aimed to promote awareness among emergency department physicians, regarding justification of paediatric X-ray referrals for paranasal sinus, chest and CT exams, as a strategy to reduce exposure to ionising radiation.MethodFrequency analysis of common paediatric imaging referrals from 19 emergency departments was performed for a 3-year period (2015–2018) to coincide with before, during and after the implementation of the radiation protection campaign. The campaign was multifaceted and involved dissemination of educational materials and imaging referral guidelines along with quarterly meetings with participating centres' leaderships. Additionally, patient dose cards were distributed to patients/carers. The Chi-Square test was used to examine the association between the type of examination and the patient's age group. Exact-Fisher test was performed to check for an association between participant engagement and the existence of the radiation protection committee.ResultsReferrals reduced by 25% following the campaign with no reports of misdiagnosis. Many referrals in the youngest age groups. In 15 units, a radiological protection committee was created to raise awareness and to create a multi professional team to communicate the risks and benefits of radiological procedure in children.ConclusionThe campaign resulted in a substantial reduction in radiological referrals while promoting a radiation protection culture. Simple education initiatives can contribute to savings in both finances and radiation doses, particularly important in radiosensitive cohorts.

South African radiographers’ radiation protection practices, a qualitative study

IntroductionRadiation protection is multifarious, and consequently, a radiographers' application of radiation protection is multifaceted. Studies have shown varying radiation protection practices among radiographers. The first quantitative phase of this explanatory, sequential mixed-method study used the theory of planned behaviour to explore South African radiographers' radiation protection behaviour. Overall, South African radiographers' attitudes to radiation protection, subjective norm, perceived behavioural control, and radiation protection intention was high. This second phase of the study aimed to explore the reasons for South African radiographers' radiation protection practices. MethodsThis study used an exploratory and descriptive qualitative approach. Data was collected through 13 in-depth semi-structured telephone interviews. Thematic analysis was used in order to uncover original phenomena. Data saturation was achieved and the study adhered to trustworthiness and ethical measures. ResultsThematic analysis identified two themes. The participants had the appropriate radiation protection knowledge, but radiation protection compliance remained a personal choice. Impediments such as feeling rushed during imaging of trauma and challenging patients, patients knowledge of radiation protection, resources, imaging referrals, inadequate training when transitioning from analogue to digital radiography and managerial support contributed to radiation protection compliance. Strategies such as further education, research and a change in mindset were suggested to further foster radiation protection compliance. ConclusionEven though participants' knowledge of radiation protection aligned with the legislated guidelines, limited internalising of the knowledge resulted in compliance being a personal choice. Participants reflected on their insouciant attitude and observed a similar attitude in their radiographer colleagues. Patient and work-related impediments were identified to contribute to radiation protection compliance. Strategies to further foster compliance were suggested. Implications for practiceUnderstanding the reasons for radiographers’ choice in radiation protection will allow the development of strategies that foster optimum application of radiation protection practises. Developing a radiation protection culture that enhances personal compliance supported by education and evidence should be considered.

Assessment of Level of Awareness Towards Radiation Protection Among the Staff Working at Angiography Suite at Public Hospitals

Introduction Several challenges with radiation protection and safety culture in radiology departments needs to be addressed as few studies done in this aspect in our country. Especially with regard to the awareness about radiation protection, hazards, dosimetry usage and measurement. Objective The objective of this study is to find knowledge about radiation exposure hazard and practices among various auxiliary staff working in radiation units. Material and Methods Cross-sectional study done by using stratified random sampling method. A questionnaire made to check the awareness level of the radiological staff regarding radiation protection working in angiography suite. The questionnaire had two parts with various questions about radiation protection measures and safety related knowledge for staff and patient. Data collected from angiography suite of three public sector hospitals of Lahore, Pakistan. All the data entered in statistical package for the social science (SSPS) version 16 and analyzed for statistically significant outcomes. Results Total of 67 staff members were included in this study from three different public sector hospitals, 55.2% were males 44.77% were females. Twenty-nine (29) persons belonged to the age group of 20-30-years. Twenty (20) doctors, 21 nurses, 12 radiographers and 14 paramedical staff were included. 89.55% staff members were aware of radiation hazard. 55.22% had training on radiation protection and 44.77%. 56.71% were aware of dosimeter. Only 16% were aware of as low as reasonably achievable (ALARA). Conclusion The radiological staff members were partially aware about radiation hazards and radiation safety. They were lacking from training and workshops. Essential steps required to develop nationwide strategies for improving the situation and maintaining a safe working environment.

Key outcome summaries of the scientific programme of the IRPA15 congress

This special issue of JRP includes a selection of research papers and review articles presented at the 15th Congress of the International Radiation Protection Association (IRPA15) as chosen by the scientific committee. All invited journal contributions are suitably expanded beyond the initial conference presentations to meet the criteria for a full journal article and include (a) presentation within a comprehensive radiological protection context and (b) additional data/interpretation. Published contributions address a wide spectrum of scientific topics and concepts to further develop the radiation protection (RP) system. They are based on scientific evidence and available experience in a wide spectrum of applications of the protection system. The IRPA is the international voice of the RP profession. It promotes excellence in RP by providing benchmarks of good practice, enhancing professional competence, and encourages the application of the highest standards of professional conduct, skills and knowledge for the benefit of individuals and society. Within the overarching theme of the conference ‘Bridging RP Culture and Science—Widening Public Empathy’ IRPA15 provided an invaluable opportunity to discuss and strengthen the relations between RP culture and science, and share developing scientific knowledge and related experience in RP among members of the scientific community, between representatives of key international organizations, including ICRP, IAEA, WHO, and NEA but also with the public. Some discussions focused on the rationale of available RP programmes and priorities, with an opportunity to identify and further develop key scientific issues of the current RP system as well as key processes for the interaction between members of the scientific community and society. The scientific programme of IRPA15 included eight topics and four thematic areas. The topical areas were: Underpinning Science; Dosimetry and Measurement; the System of Protection; Standards and Regulation; Practical Implementation—Medical Sector, as well as Industry and Research; Emergency Preparedness and Response; Existing Exposures and Non-ionizing Radiation. The thematic areas addressed were: Ethics; Communication and Public Understanding; RP Culture; Human Capital and Competency.

IRPA practical guidance for engagement with the public on radiation and risk

The International Radiation Protection Association, IRPA, promotes the worldwide enhancement of professional competence, radiation protection (RP) culture and practice by providing benchmarks of good practice, as well as encouraging the application of the highest standards of professional conduct, skills and knowledge for the benefit of individuals and society. Enhancing public understanding of radiation and risk is highlighted by experiences from past emergencies, including the accident at Tokyo Electric Power Company’s (TEPCO) Fukushima Daiichi Nuclear Power Plant in 2011 and the following post-disaster recovery, as one of the most important challenges, and this challenge is common across almost all public interfaces regarding radiation and risk. To this end IRPA has been continuing a Task Group activity for Public Understanding since 2013. After a series of workshops in various regions of the world, the IRPA draft guidance was developed and issued for consultation of the Associate Societies in 2019. Through these processes, IRPA received a lot of helpful comments and suggestions. IRPA finally published ‘Practical Guidance for Engagement with the Public on Radiation and Risk’ on the IRPA website in October 2020. The objective of the guidance is two-fold. Firstly, it is to enthuse all of us in our profession to become more active public advocates for RP. Secondly, it is to provide information, experiences and techniques to help us to become more effective and comfortable in this challenging task. This paper provides a key summary of the published IRPA guidance.

Medical physicists in radiology – present status in AFOMP region

The wide use of ionization radiation in healthcare and increasing high radiation procedures like computed tomography [CT] and interventional radiology [IR] procedures have raised serious safety and health concerns for both patients and health professionals necessitating establishment of a radiation protection culture. Responsibilities for radiation protection in the imaging team lies on the radiologists, radiation technologists and medical physicists. However the role of the medical physicist [MP] in radiology imaging is not as well established as it is in radiation oncology. In radiation oncology, clinical medical physicists are mandatory by law but many radiology departments currently operate without MP, though international standards and requirements mandates the role of the MP in radiation protection in radiology. The Asia Oceania Federation of Organizations for Medical Physics [AFOMP] has 19 National Member Organizations [NMO] as members and 2 NMO’s as affiliate members from Asia–Pacific region covering about 4.5 billion population with majority of countries are less-developed countries with lack of appropriate infrastructure and funding, lack of regulations regarding requirement of MPand, awareness of radiation protection. We have carried out survey by sending a questionnaire to AFOMP member countries to get the information about number of MP in radiotherapy, radiology and related details. We have received response from 21 countries, the data collected is analyzed and found that 16/21 counties have MP in radiology and number of MP vary from 0.94% to 69.9% as compared 21/21 countries having MP in radiotherapy varies from 16.7% to 94.4%.

Inventory of Radiation Protection in Hospitals of Level III in Senegal

The aim of this study was to evaluate the level of protection of employees who are exposed to radiation in a level III hospital establishment. It was a descriptive cross-sectional survey of six months’ duration, involving eight level III Hospitals (Aristide Le Dantec, Fann, Hoggy, Hear, Abass Ndao, Pikine, Touba, and Thies) in Senegal. Sixty-one of the one hundred questionnaires were recovered (overall response rate of 61%). The population of the study was mainly female (54.1%). The average age was 38.57 with extremes ranging from 23 to 65 years old. In the places where ionizing radiation sources are handled, only at the Aristide Le Dantec Hospital did we find a “competent person in radiation protection”. This explained the lack of a classification of employees and work areas. Forty out of sixty-one (73.77%) had no knowledge of the basic principles of radiation protection (justification, optimisation, dose limitation) and had not ever taken radiation holidays. For radiovigilance, exposure time limits to ionizing radiation concerned only 29/61 or 47.54% of the study population. The inverse square law of distance was known by only 40 workers, of whom 15 had no compliance. We found the presence of dosifilms in only 7/61 or 11.47% of the workers. On the other hand, the use of lead aprons was well established and concerned 57/61 workers, i.e., 93.44%. In sum, ionizing radiation causes adverse health effects. The absence of a good radiation protection culture in Senegal requires the presence of at least 4 to 5 competent persons in radiation protection for quality training of workers in radiobiology, radiopathology and radiation protection.

LOW BMI PATIENT DOSE IN DIGITAL RADIOGRAPHY.

In this study, the radiation dose received by 364 low body mass index (BMI) adult patients undergoing chest, abdomen, lumbar spine, kidneys and urinary bladder (KUB) and pelvis X-ray examinations in an X-ray room with a digital radiography system was evaluated. The patients' kerma area product (KAP) values were recorded, and the entrance surface air kerma (ESAK) was calculated based on the X-ray tube output, exposure parameters and technical data. The 75th percentiles of the distribution of ESAK and KAP values were also estimated. The dose values were compared with the corresponding values for normal patients obtained from a previous survey in our hospital, as well as with the national and UK diagnostic reference levels (DRLs). The correlation of dose values with patient size metrics (mass, height, BMI) was also investigated. A statistically significant difference was found in KAP and the ESAK values between low BMI and normal patients (Mann-Whitney test, p<0.05), for all examinations studied. The percentage difference for chest PA, chest LAT, abdomen PA, lumbar spine AP, lumbar spine LAT, pelvis AP and KUB AP examinations was 40, 36, 48, 68, 57, 46 and 67% for median KAP and 26, 43, 52, 48, 19, 44 and 51% for median ESAK, respectively. The corresponding 75th percentiles for low BMI patients were 0.065, 0.349, 0.683, 1.54, 3.92, 1.11, 0.67mGy and 0.042, 0.218, 0.450, 0.280, 0.598, 0.597, 0.267 Gycm2 in terms of ESAK and KAP values, respectively. They were 74-90% lower compared to the national diagnostic reference levels (DRLs), 35-84% and 58-82% compared to the UK DRLs, for ESAK and KAP values, respectively. Regarding the gender of the patients, no statistically significant difference was found in the dose values between female and male patients (Mann-Whitney test, p>0.05), for all examinations studied. A statistically significant correlation was found between ESAK and KAP values with BMI for KUB AP, pelvis AP, lumbar spine AP, lumbar spine LAT and chest PA, while for chest LAT examinations, only the ESAK were significantly correlated with BMI. They also significantly correlated with the mass for KUB AP, lumbar spine LAT, abdomen PA and chest PA examinations, while no significant correlation was found between the dose values and patients' height. It can be concluded that the low BMI patients received a significantly reduced radiation dose compared to normal patients. Additional studies need to be conducted for these patient groups, which could contribute to the further development of a radiation protection culture in diagnostic radiography.

Occupational radiation exposure of health professionals and cancer risk assessment for Lithuanian nuclear medicine workers

BackgroundReconstruction and analysis of low doses received by the occupationally exposed medical radiation workers, especially nuclear medicine staff dealing with radioisotopes may significantly contribute to the understanding of radiation impact on individuals, assess and predict radiation related risks for the development of cancer or other specific diseases. MethodsA pool of 2059 annual effective doses corresponding to 272 job's positions occupied by nuclear medicine and radiology workers for a certain time period over 26 years in five Lithuanian hospitals was investigated in order to analyze the occupational exposure tendencies to medical staff. Requested data, measured in terms of whole body dose, personal dose equivalent Hp(10), was obtained from the National Register of Sources of Ionizing Radiation and Occupational Exposure. Considering that nuclear medicine staff is dealing with open sources/radioisotopes, doses to extremities, Hp(0.07), were measured using thermoluminescent dosimeters (TLD) of LiF:Mg, Ti type. Lifetime risk estimations for the development of specific cancer (thyroid cancer and leukemia) for exposed radiation workers were performed using risk models included in BEIR VII report (BEIR VII, 2006). The conservative assessment of the thyroid exposure was performed using RadRAT 4.1.1 tool. ResultsDoses to radiology technologists and radiology nurses were found to be highest over the years. However, their annual doses never exceeded dose limit of 20 mSv and were following the same decreasing tendency as the doses of other personnel. There was no increase of doses to nuclear medicine staff observed after installation of two new PET/CT machines, indicating increased radiation protection culture and application of relevant technical and protective measures by the staff. Measured fingertip doses were 2–3 times higher than the hand doses measured with TLD ring and were dependent on the type and frequency of the nuclear medicine examination procedure and on the type and activity of isotopes used for examination. ConclusionsFor the first time, retrospective dose evaluation for the cohort of medical radiation workers was performed in the country. It enabled estimation of lifetime attributable risk for the development of two cancer types: thyroid and leukemia cancer among occupationally exposed medical radiation staff. Projected risk was low, ~10−5, however it was found that the risk of thyroid cancer for female staff was 5.7 times higher than for the males. Obtained results will be used for the predictive assessment of possible radiation induced health effects to occupationally exposed medical radiation workers.

Comments on a Thought-Provoking Article about Occupational Radiation Injury.

We are all deeply conscious of radiation safety. We manage our collimation, dose, fluoroscopy time, and our lead, and our newest angiography suites have features that track patient and operator exposure. Our radiation protection culture seeks to protect the thyroid and torso. When we discuss our occupational risk from chronic low-dose ionizing radiation (LDIR) exposure, we focus on cataracts and long-term cancer risk. This article by Zhu et al, titled “Association between Radiation Exposure and Endothelium-Dependent Vasodilation: Results from Clinical and Experimental Studies,” (1) reported an association between radiation exposure and cardiovascular disease.

Translating science into recommendations: the development of NCRP Report No. 180

The development of new recommendations for radiological protection is a complex process of translating scientific knowledge of radiation risks into a coherent system for protection, using experience and ethical values. From 2014 to 2019, the US National Council on Radiation Protection and Measurements (NCRP) engaged in the development of updated recommendations to replace those previously published in 1993. This process included considering the experiences gained with implementation of the NCRP recommendations, and the recommendations of the International Commission on Radiological Protection. The new recommendations, now published as NCRP Report No. 180, go beyond the previous recommendations of the ICRP and NCRP, providing new approaches to emergency response and protection of the environment, covering additional topics not previously addressed in medical exposure. The system of protection continues to rely on justification of actions, optimisation of protection, and use of individual dose criteria to achieve the best protection for each exposure situation. For the first time in general recommendations, ethical values are discussed, and their use in complex decision making to achieve sustainable and supportable decisions outlined. The importance of stakeholder engagement is highlighted, as is the relationship with a radiation protection and safety culture. This paper outlines some of the questions and considerations that were part of the development of NCRP Report No. 180.

OPTIMISATION OF PATIENT DOSE AND IMAGE QUALITY IN FLUOROSCOPICALLY GUIDED CERVICAL SPINE SURGERY: A PHANTOM-BASED STUDY.

The purpose of the current study was to provide useful data, which may help neurosurgeons to manage the patient dose and image quality in spinal surgery procedures, utilising a phantom and a test object. The kerma area product, cumulative dose (CD) and entrance surface dose (ESD) rate on the phantom and image intensifier were measured, for selectable fields of view (FOVs), fluoroscopy modes, two geometric magnifications and various phantom thicknesses. The images were subjectively evaluated regarding low-contrast detectability and high-contrast resolution. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), high-contrast spatial resolution (HCSR) and figure of merit (FOM) values were also estimated. The ESD rates increased with increasing phantom thickness, when using electronic or geometric magnification, continuous or high-definition fluoroscopy (HDF). The observers' evaluation showed relatively slight changes in image quality when pulsed fluoroscopy was used. SNR, CNR and HCSR values decreased with increasing phantom thicknesses, while remained almost constant when using pulsed fluoroscopy. SNR and HCSR improved in HDF, while the CNR remained almost constant only for the FOVs 23 and 17 cm. By applying electronic magnification, this resulted in improved HCSR. FOM values decreased in HDF, with increasing phantom thickness and using electronic magnification. For the 'thinnest' patients, CD may overestimate skin dose by 25% than the actual values. Geometric magnification resulted in improved FOM, especially for low-dose fluoroscopy and FOV 23 cm. The knowledge of the increments in dose values, image quality and FOM indices concerning phantom thickness may help neurosurgeons to optimise spinal surgery procedures by selecting the appropriate operational parameters, which could contribute toward the establishment of a radiation protection culture.

PATIENT DOSE IN DIGITAL RADIOGRAPHY UTILISING BMI CLASSIFICATION.

Dose audit is important towards optimisation of patients' radiation protection in diagnostic radiography. In this study, the effect of the body mass index (BMI) on radiation dose received by 1869 adult patients undergoing chest, abdomen, lumbar spine, kidneys and urinary bladder (KUB) and pelvis radiography in an X-ray room with a digital radiography system was investigated. Patients were categorised into three groups (normal, overweight and obese) based on the BMI values. The patients' entrance surface air kerma (ESAK) and the effective dose (ED) were calculated based on the X-ray tube output, exposure parameters and technical data, as well as utilising appropriate conversion coefficients of the recorded kerma area product (KAP) values. The local diagnostic reference levels (LDRLs) were established at the 75th percentile of the distribution of ESAK and KAP values. Statistically, a significant increase was found in ESAK, KAP and ED values, for all examinations, both for overweight and obese patients compared to normal patients (Mann-Whitney test, p < 0.0001). Regarding the gender of the patients, a statistically significant increase was found in the dose values for male patients compared to female patients, except for the chest LAT examinations (Mann-Whitney test, p = 0.06). The percentage increase for chest PA, chest LAT, abdomen AP, lumbar spine AP, lumbar spine LAT, pelvis AP and KUB AP in overweight patients was 75%, 100%, 136%, 130%, 70%, 66% and 174% for median ESAK, 67%, 81%, 135%, 134%, 85%, 63% and 172% for median KAP, as well as 89%, 54%, 146%, 138%, 82%, 57% and 183% for median ED values, respectively. For obese patients, the corresponding increases were 200%, 186%, 459%, 345%, 203%, 150% and 785% for median ESAK, 200%, 185%, 423%, 357%, 227%, 142% and 597% for median KAP, as well as 222%, 156%, 446%, 363%, 218%, 136% and 625% for median ED. The corresponding LDRLs for overweight patients were 0.17 mGy, 1.21 mGy, 3.74 mGy, 7.70 mGy, 7.99 mGy, 4.07mGy, 5.03 mGy and 0.13 Gy cm2, 0.69 Gy cm2, 2.35 Gy cm2, 2.10 Gy cm2, 2.59 Gy cm2, 2.13 Gy cm2, 2.49 Gy cm2 in terms of ESAK and KAP values, respectively, while in the case of obese patients were 0.28 mGy, 1.82 mGy, 7.26 mGy, 15.10 mGy, 13.86 mGy, 6.89 mGy, 13.40 mGy and 0.21 Gy cm2, 1.10 Gy cm2, 4.68 Gy cm2, 4.01 Gy cm2, 4.80 Gy cm2, 3.27 Gy cm2, 6.02 Gy cm2, respectively. It can be concluded that overweight and obese patients received a significantly increased radiation dose. Careful adjustment of imaging protocols is needed for these patients to reduce patient dose, while keeping the image quality at an acceptable level. Additional studies need to be conducted for these patient groups, that could further contribute to the development of radiation protection culture in diagnostic radiography.

IRPA GUIDANCE-THE ROLE OF STAKEHOLDERS, RADIATION PROTECTION CULTURE AND ETHICS IN EMERGENCY PREPAREDNESS.

The International Radiation Protection Association, IRPA, promotes the excellence in radiation protection by providing benchmarks of good practice, as well as enhancing professional competence and networking. In relation to emergency situations, including post-accident and recovery phases, a key issue is the ability of the system of protection to take a broader view of societal values, along with the need to develop processes which support and respect the dignity and well-being of the affected populations. Regarding the various situations of radiation exposure, IRPA's activities include aspects which can contribute to medical preparedness in radiation emergencies, focusing particularly on stakeholder engagement, radiation protection culture, the ethical dimensions of radiation protection and public understanding of risks. As it is a combination of science, experience, ethical and social values, radiation protection culture promotes radiation risk awareness in the different exposure situations, including the implementation of countermeasures in radiation and nuclear emergencies and post-accident situations, with attention also on medical countermeasures.

Prevention of Contrast and Radiation Injury During Coronary Angiography and Percutaneous Coronary Intervention

In this review, we provide a summary of the recently published literature on various methods of preventing contrast-induced acute kidney injury (CI-AKI) and radiation-related injuries associated with cardiac catheterization and percutaneous coronary intervention (PCI). The overall reported incidence of CI-AKI is declining, primarily due to adaptation of a standardized definition for CI-AKI as well as implementation of pre-procedural protocols to prevent or decrease the risk of CI-AKI. The implementation of increasing awareness and establishing radiation protection culture has been shown to be effective measures in reducing radiation exposure. Coronary angiography and PCI are valuable diagnostic and therapeutic tools in cardiovascular medicine. Accurate imaging of the coronary arteries in cardiac catheterization is dependent on the use of intravascular injection of iodinated contrast media and fluoroscopic imaging. Patients undergoing diagnostic and interventional cardiac catheterization may be exposed to a substantial amount of contrast media and ionizing radiation. Administration of contrast media is correlated with increased risk of CI-AKI, and exposure to radiation is known to be associated with a spectrum of acute and chronic tissue injuries.

Radiation levels and image quality in patients undergoing chest X-ray examinations

Patient dose monitoring for different radiographic procedures has been used as a parameter to evaluate the performance of radiology services; skin entrance absorbed dose values for each type of examination were internationally established and recommended aiming patient protection. In this work, a methodology for dose evaluation was applied to three diagnostic services: one with a conventional film and two with digital computerized radiography processing techniques. The x-ray beam parameters were selected and “doses” (specifically the entrance surface and incident air kerma) were evaluated based on images approved in European criteria during postero-anterior (PA) and lateral (LAT) incidences. Data were collected from 200 patients related to 200 PA and 100 LAT incidences. Results showed that doses distributions in the three diagnostic services were very different; the best relation between dose and image quality was found in the institution with the chemical film processing. This work contributed for disseminating the radiation protection culture by emphasizing the need of a continuous dose reduction without losing the quality of the diagnostic image.

NUCLEAR NEW BUILD-INTEGRATING CULTURAL DIFFERENCES IN RADIATION PROTECTION.

Across the world, we are seeing a resurgence in Nuclear New Build. In the UK alone, plans are under way for the construction of 10 new reactors, using 4 different reactor designs all of which are to be provided by foreign vendors, and operated by 3 newly formed licensees within the UK. As these new licensees embark on the task of establishing themselves and progressing the design and build of these reactors, there are challenges faced in integrating the Radiation Protection Requirements and Culture from the various Foreign Investors and Vendors into the UK 'Context'. The following paper identifies the origin of the Radiation Protection Requirements within the UK and foreign investor/vendor countries, in an attempt to integrate them into the UK licensing and approval process. Thus, allowing due credit to be taken for the regulatory regime of the foreign countries where these reactors originate.