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Strengthening justification of medical exposure in diagnostic imaging

Strengthening justification of medical exposure in diagnostic imaging. IRPA13, 13-18 May 2012, Glasgow, Scotland. John Le Heron 1 , Jim Malone 2 , Ola Holmberg 1 , Madan Rehani 1 , Renate Czarwinski 1 1 Division for Radiation, Transport and Waste Safety, IAEA, Vienna, Austria

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Strengthening justification of medical exposure in diagnostic imaging

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  1. Strengthening justification of medical exposure in diagnostic imaging IRPA13, 13-18 May 2012, Glasgow, Scotland John Le Heron1, Jim Malone2, Ola Holmberg1, Madan Rehani1, Renate Czarwinski1 1 Division for Radiation, Transport and Waste Safety, IAEA, Vienna, Austria 2 Trinity College, St James’s Hospital, Dublin, Ireland

  2. Radiation protection in medical exposure • Two radiation protection principles apply • Justification • Optimization of protection • Hence, the relative importance of justification • But its level of implementation is poor • In this presentation: • Justification & the new International BSS • IAEA initiatives to strengthen justification

  3. Justification of medical exposures - Evolution of ICRP recommendations • 1990 – ICRP 60 Should be dealt with in the same way as justification of any other practice But adds that each procedure is subject to a separate decision Based on ICRP 60 1996 – BSS 115 • A more complex approach - 3 levels • Justification of a practice • Generic justification of a defined procedure • Justification of a procedure for an individual patient 1996 – ICRP 73 2007 – ICRP 103 – ICRP 105 ICRP 73 approach is maintained – medical exposure of patients calls for a different and more detailed approach to the process of justification 2011 – New BSS Based on ICRP 103

  4. Putting theory into practice • Justification Level 3 – individual patients • Who is responsible? • How can implementation be improved? Especially in Diagnostic Imaging

  5. Who? – Respective roles and issues Referring medical practitioner Radiological medical practitioner Knowledge about procedure – benefits, risks, limitations Financial conflict of interest • Clinical context, medical history • Defensive medicine • “Request for consultation” versus “instruction to perform” ..shall be carried out through consultation between the radiological medical practitioner and the referring medical practitioner, …. • Referral guidelines / criteria of appropriateness

  6. Strategies for strengthening the implementation of justification (1) • Promoting Awareness • Devising means for effective communication about radiation risks and hence the actual need for justification • Patients, physicians, public Radiation protection of patients website rpop.iaea.org Worldwide need for promoting awareness

  7. Strategies for strengthening the implementation of justification (2) • Appropriateness • Joint responsibility • Development and use of referral guidelines or appropriateness criteria • Professional bodies • Software for referral • Availability of relevant information from the patient’s previous radiological procedures • International collaboration in developing guidelines • Shared review of the literature • Uniform methodology • Exploring joint approaches to improve their use IAEA Smart Card/SmartRadTrack project Making the radiological procedure history available

  8. Strategies for strengthening the implementation of justification (3) • Audit • Reviewing the effectiveness of the referral and related processes • New BSS – Radiological review Critical review of the current practical application of justification (& optimization) for the radiological procedures being performed in the facility

  9. Summary • Strengthening justification of medical exposure in diagnostic imaging • New BSS • Improved framework • The 3 A’s • Awareness • Appropriateness • Audit Bonn Conference 3-7 Dec 2012 J.Le.Heron@iaea.org

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