Radiological Protection In Medicine Research Articles

Why is radiological protection different in medicine? Sievert Memorial Lecture

There are many aspects of radiological protection in medicine that are different from other areas of activity using ionising radiation. In this paper, the author presents and justify some of these differences and highlight the reasons for and benefits of this consideration for the medical field. It is important to understand the differences as we are all likely to be patients at some point in our lives and be exposed to ionising radiation for imaging procedures several times and, in some cases, for therapeutic indications. The work done by the International Commission on Radiological Protection and other international organisations to produce and recommend a consistent system of radiological protection in medicine for the safe use of ionising radiation in medical practices must be highlighted. We should understand why we do not apply dose limits and dose constraints to patients, as well as why we have three levels of justification when considering the use of ionising radiation for patients. We highlight the relevance of personalised radiation protection in parallel to personalised medical practice, and the importance of an integrated approach for occupational and patient protection, especially for interventional procedures. We also cover the differences between patients and volunteers in biomedical research, the importance of radiation safety in quality assurance programmes (including the consideration of unintended and accidental exposures) for some clinical practices, and the relevance of education and training in radiological protection for medical and health professionals and information on radiation risks for patients. Finally, the ethical issues with regard to the safe use of ionising radiation in medicine and the impact of new technology will be addressed.

The mandate and work of ICRP Committee 3 on radiological protection in medicine.

The mandate of Committee 3 of the International Commission on Radiological Protection (ICRP) is concerned with the protection of persons and unborn children when ionising radiation is used in medical diagnosis, therapy, and biomedical research. Protection in veterinary medicine has been newly added to the mandate. Committee 3 develops recommendations and guidance in these areas. The most recent documents published by ICRP that relate to radiological protection in medicine are 'Radiological protection in cone beam computed tomography' (ICRP Publication 129) and 'Radiological protection in ion beam radiotherapy' (ICRP Publication 127). A report in cooperation with ICRP Committee 2 entitled 'Radiation dose to patients from radiopharmaceuticals: a compendium of current information related to frequently used substances' (ICRP Publication 128) has also been published. 'Diagnostic reference levels in medical imaging' (ICRP Publication 135), published in 2017, provides specific advice on the setting and use of diagnostic reference levels for diagnostic and interventional radiology, digital imaging, computed tomography, nuclear medicine, paediatrics, and multi-modality procedures. 'Occupational radiological protection in interventional procedures' was published in March 2018 as ICRP Publication 139. A document on radiological protection in therapy with radiopharmaceuticals is likely to be published in 2018. Work is in progress on several other topics, including appropriate use of effective dose in collaboration with the other ICRP committees, guidance for occupational radiological protection in brachytherapy, justification in medical imaging, and radiation doses to patients from radiopharmaceuticals (an update to ICRP Publication 128). Committee 3 is also considering the development of guidance on radiological protection in medicine related to individual radiosusceptibility, in collaboration with ICRP Committee 1.

Concept of Dose Index Used in Medicine

The characteristic of radiation exposure in medicine is to irradiate a human body directly. Therefore, the benefits of radiological practice in medicine have to largely exceed its risks. The risks need to be considered not only for the use of radiation but also the case of not having an examination. Moreover, those risks have to be reviewed in terms of both medical workers and patients. Also, radiation exposure in medicine is generally not uniform but ununiform for both sides. Although it is difficult to measure doses, in recent years, simulation software using computers has begun to be widely used. There are also unique radiation units in medicine based on quality control, such as CTDIvol, Ka,e, PKA and others. On the other hand, exposure in medicine can be also characterized by no upper limit having been specified, such as dose limits or dose constraints. Instead, some efforts have been made in the establishment of diagnostic reference levels to narrow a gap between facilities. We should apply and take “justification” and “optimization” for radiological protection in medicine, “dose limits” for medical workers and “diagnostic reference levels” for patients into account.

ICRP and Radiological Protection in Medicine.

Standards in relation to radiological protection in medicine are well-documented, particularly with the recent update of the Basic Safety Standards. The principles of justification and optimisation remain key, as dose limitation is not applicable in medical practice. Appropriate justification relies on the knowledge, experience and discretion of the relevant medical practitioners and this may be overlooked in the race for diagnosis and treatment. One argument would be further regulation of medical exposures, although it is difficult to see how this could be imposed without denying patients essential investigations and treatments. Another contentious issue is individual patient dose management with the possible creation of a 'radiation passport'. Individual radiation susceptibility is a topic that has attracted much attention, but how to manage such persons, if identified, raises further questions. Communicating radiation risks and benefits to patients appropriately needs to be addressed, including who should be responsible for this, given accurate knowledge is a prerequisite. Ethics in radiological protection is also being widely discussed and this in relation to medical practice, which already involves numerous ethical issues, is likely to be open to debate in the near future.

Overview of ICRP Committee 3: protection in medicine.

Committee 3 of the International Commission on Radiological Protection (ICRP) develops recommendations and guidance for protection of patients, staff, and the public against radiation exposure when ionising radiation is used for medical diagnosis, therapy, or biomedical research. This paper presents a summary of the work that Committee 3 has accomplished over the past few years, and also describes its current work. The most recent reports published by the Commission that relate to radiological protection in medicine are 'Radiological protection in cone beam computed tomography' (Publication 129), 'Radiation dose to patients from radiopharmaceuticals: a compendium of current information related to frequently used substances' (Publication 128, in cooperation with Committee 2), 'Radiological protection in ion beam radiotherapy' (Publication 127), 'Radiological protection in paediatric diagnostic and interventional radiology' (Publication 121), 'Radiological protection in cardiology' (Publication 120), and 'Radiological protection in fluoroscopically guided procedures outside the imaging department' (Publication 117). A new report on diagnostic reference levels in medical imaging will provide specific advice for interventional radiology, digital imaging, computed tomography, nuclear medicine, paediatrics, and hybrid (multi-modality) imaging procedures, and is expected to be published in 2016. Committee 3 is also working on guidance for occupational radiological protection in brachytherapy, and on guidance on occupational protection issues in interventional procedures, paying particular attention to the 2011 Commission's recommendations on the occupational dose limit for the lens of the eye (Publication 118). Other reports in preparation deal with justification, radiological protection in therapy with radiopharmaceuticals, radiological protection in medicine as related to individual radiosusceptibility, appropriate use of effective dose (in cooperation with other Committees), and guidance for healthcare practitioners on radiological and patient protection. Committee 3 has also suggested specific priorities for research on radiological protection in medicine to the Commission.

Overview of ICRP Committee 3 'Protection in Medicine'.

According to the 2011-2017 strategic plan, Committee 3 develops recommendations and guidance for protection of patients, staff, and the public against radiation exposure when ionising radiation is used for medical diagnosis, therapy, or biomedical research. This paper presents an overview of the work that Committee 3 has accomplished in recent years and describes its current work. The International Commission on Radiological Protection reports dealing with radiological protection in medicine from 2000 to the present cover topics on education and training in radiological protection; preventing accidental exposures in radiation therapy; doses to patients from radiopharmaceuticals; radiation safety aspects of brachytherapy; release of patients after therapy with unsealed radionuclides; and managing radiation dose in interventional radiology, digital radiology, computed tomography, paediatrics, cardiology, and other medical specialties. Current work deals with radiological protection in ion beam therapy, occupational protection in brachytherapy, justification in imaging, radiological protection in cone-beam computed tomography, occupational protection in interventional procedures, diagnostic reference levels for diagnostic and interventional imaging, and an update of an earlier publication on doses to patients and staff from radiopharmaceuticals. Committee 3 is also involved in preparation of a document on effective dose and its use in medicine.

Radiological protection in medicine: work of ommittee 3

Committee 3 of the International Commission on Radiological Protection (ICRP) is concerned with protection in medicine, and develops recommendations and guidance on the protection of patients, staff, and the public against radiation exposure in medicine. This paper presents an overview of the work of Committee 3 over recent years, and the work in progress agreed at the last annual meeting in Bethesda, MD in October 2011. The reports published by ICRP dealing with radiological protection in medicine in the last 10years cover topics on: education and training in radiological protection; preventing accidental exposures in radiation therapy; dose to patients from radiopharmaceuticals; radiation safety aspects of brachytherapy; release of patients after therapy with unsealed radionuclides; managing patient dose in digital radiology and computed tomography; avoidance of radiation injuries from medical interventional procedures; pregnancy and medical radiation; and diagnostic reference levels in medical imaging. Three new reports will be published in the coming months dealing with aspects of radiological protection in fluoroscopically guided procedures outside imaging departments; cardiology; and paediatric radiology. The work in progress agreed by Committee 3 is also described.

EU normative framework and standards of radiological protection in medicine

This paper examines the normative framework of the European Union (EU) and member states in the field of radioprotection of individuals undergoing medical exposure, in the light of harmonisation on the basis of the European Atomic Energy Community (EAEC or EURATOM) directives and enforcement at the national level. It discusses to what extent medical standards in radioprotection vary in member states, and analyses the factors determining differences in national laws and regulations adopted in this area. Bearing in mind the emerging challenges for medical practices in radiology and nuclear medicine, on the one hand, and the implicit limitations of the direct regulation, on the other hand, we will argue that the law can stimulate self-organisation within the healthcare environment and induce the operators on the floor to self-reflective performance, in order to enhance the quality of services and to minimise radiological risks.

Ｔｒａｎｓｃａｔｈｅｔｅｒ Ａｒｔｅｒｉａｌ Ｅｍｂｏｌｉｚａｔｉｏｎ（ＴＡＥ）における被検者皮膚表面線量の算出

The usefulness of interventional radiology (IVR) in clinical practice is well known. However, patient dose in IVR has recently been increased as a result of the prolongation of fluoroscopic time and the increased number of radiographies. We studied a simple method of calculating skin surface dose in patients who underwent transcatheter arterial embolization (TAE) for the treatment of hepatocellular carcinoma by obtaining the value of a dose area product meter attached to the digital subtraction angiography system. In 20 subjects (15 men and 5 women, aged an average of 68.2+/-7.3 years, respectively) who underwent TAE, exposure conditions (tube voltage, tube current, time, and size of image intensifier) in a time series and last value indicated on the dose area product meter were recorded. A dosimetric phantom was placed at a position the same as that of the patient for TAE, the surface dose (SD) of the phantom was measured under various exposure conditions, and SD per unit mAs (SD/mAs) was obtained. Then the skin surface dose in each subject was estimated from the values of the exposure condition and SD/mAs. A high correlation was observed between the last value (x) on the dose area product meter and the estimated skin surface dose (y) (r=0.933), and the following regression equation was derived: y=0.005x-0.589. The skin surface dose calculated using the regression equation was compared with that obtained by the method recommended by the Japan Association on Radiological Protection in Medicine (JARPM), considering the value estimated from the value of exposure conditions with SD/mAs as the gold standard. The results indicated that the error in the method using the regression equation was significantly lower than that of the JARPM method (18.3+/-14.0% and 75.5+/-66.0%, respectively, p<0.01). In conclusion, the skin surface dose in TAE could be monitored with high precision using the value of the dose area product meter by obtaining the regression formula between the value of the dose area product meter and the skin surface dose estimated with the phantom values.

Practical Impact of the Evolution and Changes of ICRP Recommendations on Radiological Protection in Medicine

Practical Impact of the Evolution and Changes of ICRP Recommendations on Radiological Protection in Medicine

Practical Impact of the Evolution and Changes of ICRP Recommendations on Radiological Protection in Medicine

Practical Impact of the Evolution and Changes of ICRP Recommendations on Radiological Protection in Medicine