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Meet your Regulator Workshop with FANR licensees October 2011. Optimisation of Medical Exposure Radiological Protection of Patients. Average annual frequency of diagnostic medical and dental examinations, by health-care level, 1997 - 2007. FREQUENCY (per 1000 population). HEALTH-CARE LEVEL.
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Meet your RegulatorWorkshop with FANR licenseesOctober 2011 Optimisation of Medical Exposure Radiological Protection of Patients
Average annual frequency of diagnostic medical and dental examinations, by health-care level, 1997 - 2007 FREQUENCY (per 1000 population) HEALTH-CARE LEVEL
Annual average per caput effective dose of ionizing radiation due to diagnostic medical and dental X-ray examinations, by health-care level, 1997 - 2007 PER CAPUT DOSE (mSv) HEALTH-CARE LEVEL
Annual frequency of diagnostic nuclear medicine examinations, by health-care level, 1997 - 2007 FREQUENCY (per 1000 population)
Estimated number of diagnostic nuclear medicine examinations conducted annually, 1985 – 1990, 1991 – 1996 and 1997 - 2007 EXAMINATIONS (millions) SURVEY PERIOD
Estimated annual data on radiotherapy treatments aworldwide, 1997 – 2007 Source: Committee survey on medical radiation usage and exposures, 1997 – 2007. aComplete course of treatment. bExcluding treatments with radiopharmaceuticals. cAssumed value in the absence of data. dGlobal data include several countries not represented by levels I-IV.
Estimated annual collective dose of ionizing radiation due to medical exposures, 1997 – 2007 (Totals may not add precisely because of rounding)
Total annual collective effective dose of radiation due to medical exposures (excluding radiotherapy) COLLECTIVE EFFECTIVE DOSE (man Sv)
THE CHALLENGE • How to do we – regulators, health authorities, radiological professionals – ensure that the increasing radiation dose is improving patient care? • First, is the exposure justified? • Second, is the exposure optimised? • Third, how does the exposure compare with ‘best practice’?
RE-VISITING JUSTIFICATION • Medical exposures are generically justified • Medical guidelines and professional standards should generically justify certain exposures - a certain indication justifies a spinal plain X-ray; in what circumstances might a CT scan be appropriate for this indication • Justification for the individual patient REGUALTORS CAN REQUIRE A PROCESS, BUT HAVE NO OTHER ROLE. IT IS FOR THE HEALTH PROFESSIONALS.
OPTIMISATION • Calibration and quality assurance • The machine delivers the right dose or the correct amount of the correct radionuclide is injected • Deciding the dose • Taking account of the particular patient, what is the dose to be delivered to get a good result • Or take what the machine delivers • Paediatric patients • Limiting the radiotherapy dose to the healthy tissue • Equipment that provides information on patient dose
MEASUREMENT – THE ROLE OF DRLs (ICRP 103) • ‘Diagnostic reference levels are used in medical imaging to indicate whether, in routine conditions, the levels of patient dose from, or administered activity (amount of radioactive material) for, a specified imaging procedure are unusually high or low for that procedure.’ • The DRLs ‘are selected on the basis of a percentile point on the observed distribution of doses to patients or to a reference patient. The values should be selected by professional bodies in conjunction with national health and radiological protection authorities and reviewed at intervals that represent a compromise between the necessary stability and the long-term changes in the observed dose distribution’. • UAE national diagnostic reference levels?
ACCIDENT PREVENTION IN RADIOTHERAPY • Integral part of design of equipment and premises; • and of working procedures • Application of ‘defence in depth’ • Multiple defences against the consequences of failure.