Training In Radiological Protection Research Articles

Online teaching of radiation protection to health professionals: Lessons learned

The study examines the online teaching of radiation protection to health professionals. Training in Radiological Protection is considered a basic requirement for radiology professionals and students in Health Sciences. Over the past 22 years, various educational materials, including videos and teaching resources, have been produced following the Guidelines on education and training in radiological protection for medical exposures of the European Commission. These materials have been utilized in various online learning modalities. The objective of this work is to assess the impact of this study on student training. To achieve this, different data collection processes have been carried out, according to the period, and have been analyzed. The results of this training have been analyzed through diverse methods, demonstrating adequate acquisition of basic theoretical contents and a positive acceptance of this methodology by the 6,518 students examined. However, the need to create original specialized materials and resources, the increase in the teacher's workload, and the lack of institutional recognition of the teacher's effort limit its development. On the other hand, it can also be concluded that the acquisition of practical skills by the student is a weakness of the online learning system that requires the incorporation of the teacher in a face-to-face or traditional manner in the delivery of these specialized practical contents. This study allows for a better utilization of the available tools in the training of students in this subject.

Gestão do cuidado em enfermagem na proteção radiológica em radiologia intervencionista

To reflect on the elements of nursing care management in radiological protection in interventional radiology. A reflection paper based on national and international articles and laws addressing the nursing care management issue and radiological protection in interventional radiology. From the conceptions of nursing care management and professional practice, the following elements were perceived in this management: expertise and applicability of the radiological protection principles, biological effects of ionizing radiation, occupational dose monitoring, personal and collective protective equipment, patient safety, training in radiological protection, quality assurance program. The management of nursing care in radiological protection in interventional radiology is implemented in an elementary way regarding care aimed at dose reduction, either for workers or patients. There is a need to recognize, understand and characterize the management of nursing care in this scenario.

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.

Estado actual de la protección radiológica en procedimientos endourológicos en España

ObjectiveTo discover the extent of training in radiological protection (RP) of Spanish urologists who perform endourological procedures, and to analyse the use of on ionising radiation control and protection measures. Material and methodsA survey conducted through the Plataforma de Investigación de Estudios Multicéntricos (PIEM) (Multicentre Study Research Platform) on the 1,894 associates of the Spanish Association of Urology, between April and October 2015. The questionnaire comprised 21 questions on endourological activity undertaken, RP training, and the use of protective measures, and personal dosimetry. Seventeen percent responded, and 238 surveys were eventually validated for study. ResultsSixty-three percent of the respondents had received no type of RP training, 25% had first level accreditation, and only 12% second level. Fifty-seven percent, 27%, and 2% of the urologists used flap, wrist and crystalline dosimetry respectively. Use of radiation protection measures was insufficient. Fifty-three percent of the urologists at greatest risk of exposure had had no training in RP, 30% did not use flap dosimetry, and 40% used neither an apron or thyroid collar during the endourological procedures. ConclusionsRP training, dosis monitoring, and the use of ionising radiation protective measures are insufficient, even by practitioners most exposed to radiation. It is essential that these serious shortcomings in RP are corrected, at the level of the individual, in urology departments, scientific societies, and the health authorities.

Radiological protection in computed tomography and cone beam computed tomography.

The International Commission on Radiological Protection (ICRP) has sustained interest in radiological protection in computed tomography (CT), and ICRP Publications 87 and 102 focused on the management of patient doses in CT and multi-detector CT (MDCT) respectively. ICRP forecasted and 'sounded the alarm' on increasing patient doses in CT, and recommended actions for manufacturers and users. One of the approaches was that safety is best achieved when it is built into the machine, rather than left as a matter of choice for users. In view of upcoming challenges posed by newer systems that use cone beam geometry for CT (CBCT), and their widened usage, often by untrained users, a new ICRP task group has been working on radiological protection issues in CBCT. Some of the issues identified by the task group are: lack of standardisation of dosimetry in CBCT; the false belief within the medical and dental community that CBCT is a 'light', low-dose CT whereas mobile CBCT units and newer applications, particularly C-arm CT in interventional procedures, involve higher doses; lack of training in radiological protection among clinical users; and lack of dose information and tracking in many applications. This paper provides a summary of approaches used in CT and MDCT, and preliminary information regarding work just published for radiological protection in CBCT.

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.

Riscos da Radiação X e a Importância da Proteção Radiológica na Cardiologia Intervencionista: Uma Revisão Sistemática

Discutimos aqui aspectos vinculados ao enquadramento legal, a recomendações internacionais e a programas de formação em proteção radiológica; ao angiógrafo e à qualidade da imagem; aos efeitos biológicos e aos riscos das radiações ionizantes; às lesões em operadores e pacientes; aos níveis de referência do paciente; ao limite de dose ocupacional e a suas medidas de prevenção. O uso das radiações ionizantes acarreta riscos, que, contudo, justificam-se em procedimentos diagnósticos e terapêuticos. A consciência e o conhecimento desses riscos minimizam o dano, otimizando a qualidade da imagens e o uso seguro das radiações ionizantes. Tem-se demonstrado a ocorrência de cataratas radioinduzidas em trabalhadores de laboratórios de cateterismo. Diversos estudos sugerem que pode haver um risco significativo de opacidade do cristalino, caso não se utilizem adequadamente os dispositivos de proteção radiológica. Adicionalmente, esses tipos de procedimentos intervencionistas são realizados na América Latina, geralmente por médicos especialistas, com a colaboração de enfermeiros, tecnólogos e técnicos, que, muitas vezes, não têm formação adequada em proteção radiológica.

Symposium: European standard on medical physics services

s / Physica Medica 30 (2014) e1ee15 e13 The high penetration of cloud computing technology leads to a situation where all applications will abandon their traditional operation and move to the cloud, where they can be delivered as services. In medical physics science, as the technology continuously breaks the ethical and security barriers, sharing of medical imaging data between experts world-wide tends to become a routine task. Examples of current accomplishments of international communication via the web will be presented. ICRP COMMITTEE 3 OVERVIEW (PROTECTION IN MEDICINE) E. Va~ no , D.L. Miller , M. Rehani . ICRP Committee 3. Chairman; ICRP Committee 3. Vice-Chairman; ICRP Committee 3 Committee 3 of ICRP is concerned with protection of persons and unborn children when ionising radiation is used for medical diagnosis, therapy, or biomedical research. According to the 2011-2017 Strategic Plan, Committee 3 develops recommendations and guidance for protection of patients, staff, and the public against radiation exposure in medicine. This paper presents an overview of the work of the Committee in recent years and current work in progress. The ICRP reports dealing with radiological protection (RP) in medicine in the last 10 years cover topics on: education and training in RP; 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. Work in progress deals with RP in Ion Beam Therapy, Occupational Protection in Brachytherapy, Justification in Imaging, RP in Cone Beam CT, Doses to Patients and Staff from Radiopharmaceuticals (update), Occupational Protection in Interventional Radiology, and Diagnostic Reference Levels for Diagnostic and Interventional Imaging. The Committee is also involved in preparation of a document on effective dose (and its use medicine). SYMPOSIUM: EUROPEAN STANDARD ON MEDICAL PHYSICS SERVICES Stelios Christofides , Derek Pearson , Gerard Colenbrander , Luca Moro . Medical Physics Department, Nicosia General Hospital, Nicosia, Cyprus; Professional Adviser to the Chief Scientific Officer, NHS England. U.K.; Department of Medical Physics, Spaarnehospital, Hoofddorp, The Netherlands; Medical Physics Department, Salvatore Maugeri Foundation,

The Image Gently Pediatric Digital Radiography Safety Checklist: Tools for Improving Pediatric Radiography

Transition from film-screen to digital radiography requires changes in radiographic technique and workflow processes to ensure that the minimum radiation exposure is used while maintaining diagnostic image quality. Checklists have been demonstrated to be useful tools for decreasing errors and improving safety in several areas, including commercial aviation and surgical procedures. The Image Gently campaign, through a competitive grant from the FDA, developed a checklist for technologists to use during the performance of digital radiography in pediatric patients. The checklist outlines the critical steps in digital radiography workflow, with an emphasis on steps that affect radiation exposure and image quality. The checklist and its accompanying implementation manual and practice quality improvement project are open source and downloadable at www.imagegently.org. The authors describe the process of developing and testing the checklist and offer suggestions for using the checklist to minimize radiation exposure to children during radiography.

Abstract No. 284 - Results of european survey on radiation protection education and training and call for action for image-guided interventional societies

Purpose Image (Fluoroscopy) guided interventions require prolonged localized fluoroscopy, multiple radiographic exposures, and repeated procedures with relatively high patient and personnel exposure. MEDRAPET (MEDical RAdiation Protection Education and Training) consortium of 6 European Professional Societies including CIRSE conducted an EU-wide study to evaluate the current status of Radiation Protection (RP) education and training for medical professionals (1). Our aim was to assess the results of questionnaires sent to: Interventional Radiology (IR), Interventional Cardiology (IC) and Vascular Surgery (VS) Societies regarding the status of education and training in RP. Materials and Methods The web-based survey was available from September 13 to October 31, 2011 for all European Union member states. We used on-line comprehensive validated questionnaire to evaluate the status of medical RP education and training. We extracted relevant data and compared these 3 specialties (IR, IC and VS) based on their basic residency training and fellowship. Results The responses of targeted professional Societies IR, IC and VS were 6/23 (26.1%), 1/1, and 2/11 (18.2%) respectively. There was no report on curricula or dedicated training from any of 3 Societies. We also looked at the main specialties like Radiology for IR’s and Cardiology for IC’s. The responses were 0/23 for Cardiologists and 23/34 (67.6%) for Radiologists Societies respectively. For IR’s basic training in RP is covered in about 65% during Radiology residency, while Cardiologists and VS have not reported such training. Conclusion All three specialties IR, IC and VS lack curricula and dedicated training in RP for fluoroscopy guided endovascular interventions. IR’s require only second level training, while IC’s and VS require both basic and dedicated second level training. Reference 1. Education and Training in Radiological Protection for Diagnostic and Interventional Procedures. International Commission on Radiological Protection (ICRP) Publication 113, Ann ICRP 39(5), 2009.

ICRP PUBLICATION 121: Radiological Protection in Paediatric Diagnostic and Interventional Radiology

Paediatric patients have a higher average risk of developing cancer compared with adults receiving the same dose. The longer life expectancy in children allows more time for any harmful effects of radiation to manifest, and developing organs and tissues are more sensitive to the effects of radiation. This publication aims to provide guiding principles of radiological protection for referring clinicians and clinical staff performing diagnostic imaging and interventional procedures for paediatric patients. It begins with a brief description of the basic concepts of radiological protection, followed by the general aspects of radiological protection, including principles of justification and optimisation. Guidelines and suggestions for radiological protection in specific modalities – radiography and fluoroscopy, interventional radiology, and computed tomography – are subsequently covered in depth. The report concludes with a summary and recommendations.The importance of rigorous justification of radiological procedures is emphasised for every procedure involving ionising radiation, and the use of imaging modalities that are non-ionising should always be considered. The basic aim of optimisation of radiological protection is to adjust imaging parameters and institute protective measures such that the required image is obtained with the lowest possible dose of radiation, and that net benefit is maximised to maintain sufficient quality for diagnostic interpretation. Special consideration should be given to the availability of dose reduction measures when purchasing new imaging equipment for paediatric use. One of the unique aspects of paediatric imaging is with regards to the wide range in patient size (and weight), therefore requiring special attention to optimisation and modification of equipment, technique, and imaging parameters. Examples of good radiographic and fluoroscopic technique include attention to patient positioning, field size and adequate collimation, use of protective shielding, optimisation of exposure factors, use of pulsed fluoroscopy, limiting fluoroscopy time, etc. Major paediatric interventional procedures should be performed by experienced paediatric interventional operators, and a second, specific level of training in radiological protection is desirable (in some countries, this is mandatory). For computed tomography, dose reduction should be optimised by the adjustment of scan parameters (such as mA, kVp, and pitch) according to patient weight or age, region scanned, and study indication (e.g. images with greater noise should be accepted if they are of sufficient diagnostic quality). Other strategies include restricting multiphase examination protocols, avoiding overlapping of scan regions, and only scanning the area in question. Up-to-date dose reduction technology such as tube current modulation, organ-based dose modulation, auto kV technology, and iterative reconstruction should be utilised when appropriate.It is anticipated that this publication will assist institutions in encouraging the standardisation of procedures, and that it may help increase awareness and ultimately improve practices for the benefit of patients.

ICRP PUBLICATION 120: Radiological Protection in Cardiology

Cardiac nuclear medicine, cardiac computed tomography (CT), interventional cardiology procedures, and electrophysiology procedures are increasing in number and account for an important share of patient radiation exposure in medicine. Complex percutaneous coronary interventions and cardiac electrophysiology procedures are associated with high radiation doses. These procedures can result in patient skin doses that are high enough to cause radiation injury and an increased risk of cancer. Treatment of congenital heart disease in children is of particular concern. Additionally, staff1As indicated in the Glossary, the term ‘worker’ is defined by the Commission in Publication 103 (ICRP, 2007b) as ‘any person who is employed, whether full time, part time or temporarily, by an employer, and who has recognised rights and duties in relation to occupational radiological protection’. In a hospital, these persons are part of the staff. The term ‘staff’ is preferred in this report because the intended audience is more familiar with this term.1 in cardiac catheterisation laboratories may receive high doses of radiation if radiological protection tools are not used properly.The Commission provided recommendations for radiological protection during fluoroscopically guided interventions in Publication 85, for radiological protection in CT in Publications 87 and 102, and for training in radiological protection in Publication 113 (ICRP, 2000b,c, 2007a, 2009). This report is focused specifically on cardiology, and brings together information relevant to cardiology from the Commission’s published documents. There is emphasis on those imaging procedures and interventions specific to cardiology. The material and recommendations in the current document have been updated to reflect the most recent recommendations of the Commission.This report provides guidance to assist the cardiologist with justification procedures and optimisation of protection in cardiac CT studies, cardiac nuclear medicine studies, and fluoroscopically guided cardiac interventions. It includes discussions of the biological effects of radiation, principles of radiological protection, protection of staff during fluoroscopically guided interventions, radiological protection training, and establishment of a quality assurance programme for cardiac imaging and intervention.As tissue injury, principally skin injury, is a risk for fluoroscopically guided interventions, particular attention is devoted to clinical examples of radiation-related skin injuries from cardiac interventions, methods to reduce patient radiation dose, training recommendations, and quality assurance programmes for interventional fluoroscopy.

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.

Brain tumours among interventional cardiologists: a cause for alarm? Report of four new cases from two cities and a review of the literature

Interventional cardiologists who work in cardiac catheterisation laboratories are exposed to low doses of ionising radiation that could pose a health hazard. DNA damage is considered to be the main initiating event by which radiation damage to cells results in development of cancer. We report on four interventional cardiologists, all with brain malignancies in the left hemisphere. In a literature search, we found five additional cases and thus present data on six interventional cardiologist and three interventional radiologists who were diagnosed with brain tumours. All worked for prolonged periods with exposure to ionising radiation in the catheterisation laboratory. In interventional cardiologists and radiologists, the left side of the head is known to be more exposed to radiation than the right. A connection to occupational radiation exposure is biologically plausible, but risk assessment is difficult due to the small population of interventional cardiologists and the low incidence of these tumours. This may be a chance occurrence, but the cause may also be radiation exposure. Scientific study further delineating occupational risks is essential. Since interventional cardiologists have the highest radiation exposure among health professionals, major awareness of radiation safety and training in radiological protection are essential and imperative, and should be used in every procedure.

Abstract to ’Education and Training in Radiological Protection for Diagnostic and Interventional Procedures’

Abstract to ’Education and Training in Radiological Protection for Diagnostic and Interventional Procedures’

The importance of education and training in reducing patient doses

Education and training in radiological protection of patients is an important part of a quality assurance program and it is recognised that the knowledge in radiation protection helps prescriber to a correct indication to procedures and practitioner to design and conduct an optimised examination. In the European Union, the international recommendations have been translated in the European Directive 97/43/Euratom asking proper education and training for professionals involved in medical exposures, both for diagnosis and therapy. International and European guidelines, together with guidelines proposed by international and national bodies and associations, are helping institutions to set up education and training programs. Several experiences and research projects have demonstrated the impact on reduction of patient doses when a quality assurance and training program in radiation protection has been conducted.

Training in radiological protection for interventionalists. Initial Spanish experience.

Training in radiological protection for interventionalists. Initial Spanish experience.

Abstract: Avoidance of radiation injuries from medical interventional procedures, ICRP Publication 85

Interventional radiology (fluoroscopically-guided) techniques are being used by an increasing number of clinicians not adequately trained in radiation safety or radiobiology. Many of these interventionists are not aware of the potential for injury from these procedures or the simple methods for decreasing their incidence. Many patients are not being counselled on the radiation risks, nor followed up when radiation doses from difficult procedures may lead to injury. Some patients are suffering radiation-induced skin injuries and younger patients may face an increased risk of future cancer. Interventionists are having their practice limited or suffering injury, and are exposing their staff to high doses. In some interventional procedures, skin doses to patients approach those experienced in some cancer radiotherapy fractions. Radiation-induced skin injuries are occurring in patients due to the use of inappropriate equipment and, more often, poor operational technique. Injuries to physicians and staff performing interventional procedures have also been observed. Acute radiation doses (to patients) may cause erythema at 2 Gy, cataract at 2 Gy, permanent epilation at 7 Gy, and delayed skin necrosis at 12 Gy. Protracted (occupational) exposures to the eye may cause cataract at 4 Gy if the dose is received in less than 3 months, at 5.5 Gy if received over a period exceeding 3 months. Practical actions to control dose to the patient and to the staff are listed. The absorbed dose to the patient in the area of skin that receives the maximum dose is of priority concern. Each local clinical protocol should include, for each type of interventional procedure, a statement on the cumulative skin doses and skin sites associated with the various parts of the procedure. Interventionists should be trained to use information on skin dose and on practical techniques to control dose. Maximum cumulative absorbed doses that appear to approach or exceed 1 Gy (for procedures that may be repeated) or 3 Gy (for any procedure) should be recorded in the patient record, and there should be a patient follow-up procedure for such cases. Patients should be counselled if there is a significant risk of radiation-induced injury, and the patient's personal physician should be informed of the possibility of radiation effects. Training in radiological protection for patients and staff should be an integral part of the education for those using interventional techniques. All interventionists should audit and review the outcomes of their procedures for radiation injury. Risks and benefits, including radiation risks, should be taken into account when new interventional techniques are introduced. A concluding list of recommendations is given. Annexes list procedures, patient and staff doses, a sample local clinical protocol, dose quantities used, and a procurement checklist.

Training in radiological protection: a pool of practical exercises. Part 4. Dose rate measurements in narrow beams of radiation

It is pointed out that a gulf separates the dose equivalent concepts used in risk analysis and those employed in exposure measurement and control. Some of the issues underlying these concepts are discussed, which are such that further modification and development of the concepts must be expected. In particular it is pointed out that when there are no significant gains in terms of protection the objective of equality of risk may need to be abandoned to take account of the need for stable administrative arrangements and the avoidance of costly changes in instrumentation.

Training in Radiological Protection - A Pool of Practical Exercises. Part V - Operation and Survey of a Level Gauge

In this, the fifth in the series of short papers, the use of a working model of a level gauge is described. It is primarily used to provide experience of using dose rate monitors under realistic conditions, to assess the adequacy of shielding provided. The model includes a variety of safety features and a means of controlling the beam size, which in turn affects the adequacy of the shielding.