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IAEA International Atomic Energy Agency
Regional Workshop on the
International Basic Safety Standards
Session 3a: Responsibilities in
Medical Exposures
17-20 April 2012, Kuala Lumpur, Malaysia
John Le Heron
Radiation Protection of Patients Unit
Division for Radiation, Transport and Waste Safety
IAEA
Medical exposures – current usage
Every year, throughout the world, ionizing radiation is used in*:
• 4.000.000.000 diagnostic procedures
• 35.000.000 nuclear medicine procedures
• 8.000.000 radiotherapy treatment courses
* An expanding activity worldwide
Diagnostic procedure Nuclear medicine procedure Radiotherapy procedure
These bring huge
benefit to healthcare
*UNSCEAR 2008
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Increasing use of radiation in medicine
• More machines, etc
• New technologies and techniques
• New roles
• Increasing complexity in the planning & delivery of the radiation
Single slice CT → Multi-Detector CT
Film → Computed & Digital Radiography
Hybrid imaging, PET-CT
Image-guided interventional procedures
Virtual procedures
E.g. Changes in the role of imaging:
First “port of call”
A move towards “screening”, in all its guises
E.g. IMRT, IGRT, etc.
More can be done with radiation in medicine
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• The BSS & Medical exposures
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Scope of Medical Exposures section
• Planned exposure situations (ICRP)
• Medical exposures • As intended, but also
• Unintended and accidental exposures
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Definition of medical exposure
• Slight change from BSS 115
• Includes health screening programmes, implicitly • Explicit in requirements
• Does not include medico-legal, etc • Covered elsewhere in the new BSS
Medical exposure: Exposure incurred:
•by patients for the purpose of medical or dental diagnosis or treatment;
•by carers and comforters;
•by volunteers in a programme of biomedical research involving their
exposure.
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Responsibilities
• An area identified in the review of the BSS as needing improvement
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Responsibilities
Government (in addition to Section 2):
to ensure, as a result of consultation between
Health Authorities, professional bodies and the
Regulatory Body, that:
• DRLs are established
• Dose constraints are established for
• Carers and comforters
• Volunteers in biomedical research
• Criteria and guidelines are established for the release of patients after radionuclide therapy
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Responsibilities
• Regulatory Body • Authorization allows persons to take on the
responsibilities of the Standards as a:
• Radiological medical practitioner
• Medical physicist
• Medical radiation technologist
• Other health professionals with specific duties in patient radiation protection
• Only if: • Specialized in the appropriate area
• Meet the respective education, training and competence requirements in radiation protection
• Named in an up-to-date list maintained by the licensee
IAEA
Education, training and competence
• Crucial to radiation protection in medical exposure • Radiological medical practitioner
• Medical physicist
• Medical radiation technologist
• Radiopharmacist
• All definitions have a similar format: • A health professional, with specialist education and training in …….,
competent to …… .
• Explanatory note to each definition: • Competence of persons is normally assessed by the Member State
by having a formal mechanism for registration, accreditation or certification of ….
• Member States that have yet to develop such a mechanism need to assess …. based either on international accreditation standards or standards from another country ….
IAEA
Responsibilities
• Licensees to ensure that there is no medical exposure unless: Patient Volunteer in biomedical
research
Carer or comforter
Appropriate referral Programme approved by
ethics committee
Carer or comforter has
received, and
understood, information
on radiation protection
and on risks
Justified
Radiological medical
practitioner has assumed
responsibility for
protection & safety
Radiological medical
practitioner has assumed
responsibility for
protection & safety, and
dose constraints are
applied
Dose constraints are
applied
Patient informed of
expected benefits & risks
IAEA
The new BSS & the medical physicist
• The MP has a mandated role in: • Therapeutic uses of radiation:
• The requirements for calibration, dosimetry and QA, including the acceptance and commissioning of medical radiological equipment
• Are fulfilled by or under the supervision of a medical physicist
• Diagnostic uses & image-guided interventional procedures • The requirements for imaging, calibration, dosimetry and QA,
including the acceptance and commissioning of medical
radiological equipment
• Are fulfilled by or under the oversight of or with the documented advice of a medical physicist
• Whose degree of involvement is determined by the complexity of the radiological procedures and the associated radiation
risks
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Responsibilities – issues for Government
• Establishing DRLs
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Responsibilities – issues for the RB
• Key persons • Crucial roles for radiation protection
• Need to be able to assess whether a given person is acceptable or not for their intended role
• Specialization
• Radiation protection training
The doctors: • Radiologists, Nuclear Medicine
Physicians, Radiation Oncologists
• OK??
• Cardiologists and other specialists?
Medical physicists • Radiotherapy
• Diagnostic radiology
• Image-guided interventional procedures
• Nuclear medicine??
Medical radiation technologists • Radiotherapy
• Diagnostic radiology
• Image-guided interventional procedures
• Nuclear medicine??
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Responsibilities - issues
• Ensuring appropriate persons for the roles:
• Are there parallel strategies that can be used to bring about change?
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IAEA
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Parallel strategies?
• Administrative pressure
• Avoiding risk (litigation)
• Financial pressure
• Re-imbursement only if performed by appropriate persons
• Quality pressure
• ISO accreditation
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