A general formulation of limitation for non-ionizing radiation is the exposure level or dose to any individual in situations other than exposures for medical purposes and exposures of volunteers, as described below, should not exceed the appropriate recommended restrictions. CENTRE FOR RADIATION, CHEMICAL AND ENVIRONMENTAL HAZARDS, . Public health initiatives are extremely useful for informing the public that radiological imaging is not without risks and should not be demanded. Thus, it is assumed that there is greater variability in sensitivity among the general population than among occupationally-exposed individuals. This represents the mechanism by which society defines the accepted standards that must be applied for acceptance of a practice. While some referring clinicians may have achieved this in a limited field, many will not have done so and to become a practitioner, such clinicians, including most family doctors, will need to have undertaken additional training in radiation protection. However, for static or low frequency electric and magnetic fields, mainly the exposure intensity is relevant. While inspection is a useful tool, aimed at demonstrating compliance with regulatory requirements rather than enforcement, it has limited impact on day-to-day practice unless the importance of justification is recognised by professionals and professional bodies. The procedures used by ICNIRP are described in the Appendix. ICNIRP gratefully acknowledges Emilie van Deventer (World Health Organization), Sigurur Magns Magnsson (International Radiation Protection Association), Jacques Lochard (International Commission on Radiological Protection), Shengli Niu (International Labour Organization) and Ferid Shannoun (United Nations Scientific Committee on the Effects of Atomic Radiation) for their participation in preparatory seminar(s) and feedbacks on several drafts. endstream endobj 76 0 obj <> endobj 77 0 obj <>stream Conclusion: 0000033934 00000 n For example, lymph node assessment by CT may be justified in cancer staging, followed by a further PET-CT study to help determine patient management. This applies particularly if such imaging has been incorporated into evidence-based protocols and clinical pathways, agreed by a multi-disciplinary medical team and facilitated by computerised decision support (CDS) systems. public. IRR17 replaced the Ionising Radiations Regulations IRR99 and implement the worker safety aspects of the Basic Safety Standards Directive (96 . With regards to justification of radiology examinations, 37% indicated this was allowed (for 63% of respondents this was not permitted) as long as responsibility remained with a medical practitioner. The term of membership of the SEG is four years. Br J Gen Pract 44(382):197200, CAS ICRP issued lots . Who decides which medical procedure is appropriate and whether it is justified? All co-authors contributed equally to this paper. Data is temporarily unavailable. PubMed Justification: No practice or source within a practice should be authorized unless the practice produces sufficient benefit to the exposed individuals or to society to offset the radiation harm that it might cause; that is: unless the practice is justified, taking into account social, economic and other relevant factors Optimisation (ALARA): Health Phys 113:282300; 2017. on the application of new or complex techniques, rather than existing and well-established ones. The employment of justification of practices as a fundamental principle of radiation protection should be eliminated since it is already enshrined within the legal framework applicable to applications of ionising radiation. Recently, the European commission launched a tender on audit of CT justification [31], showing the actuality of this topic. That means that the information one gathers with taking a radiograph will have a substantial impact on the diagnosis, treatment, and outcome. your express consent. Further information about ICNIRP is provided in the Appendix. The flexibility of the BSSD allows Member States to consider how responsibilities can be better allocated for the justification process, reflecting the way justification of imaging is undertaken at a local level. In such cases, actively reviewing or de-justifying exposures within a pathway may become an important activity, saving radiation exposure, reducing interventions for individual patients and freeing up resources for others. Manage cookies/Do not sell my data we use in the preference centre. Pregnant workers comprise a special category. Guidance is available to support this. <<1F0C3A012B2DD343842BD4F6FDB8E4CA>]/Prev 302530>> The work cannot be changed in any way or used commercially without permission from the journal. The Royal College of Radiologists, London, Implementing External Clinical Audits in Radiological Practices: The Experience in Finland Volume 9Issue 4, 2009Cover Story: Clinical Audit in the European Union, HealthManagement.org, The Royal College of Radiologists. Cite this article. -EHO CHZ|c+C#YGW70GW:/z.6..>Cy}!EI)]fZi2~X?=>l_}uFzk_"v}S6y]2v>U]kCY1v8vkz,EjT]y-f&=T\dN/K3Dp/1X0k5llgZ5Z,,,--,}-:YAVd_5Ya-\j yf]g$8#+jtFGOOGOOGOOGOOG77GG w,^Bw_wSK(2xKInO J Am CollRadiol 12(2):158165. However, ICNIRP does not explicitly address social and economic issues, as these are deemed to be the remit of governments and relevant authorities. Under certain circumstances there may be no need to apply a reduction factor because the effect threshold is known with high precision. Too low radiation dose could be as bad as too high radiation dose. it lies with the radiologist, then his or her knowledge, competence and skills, should be recognised and respected. As a result of the application of reduction factors, the basic restrictions would need to be exceeded by a substantial margin in order to result in harm, and small violations are unlikely to result in an adverse health effect. For instance they may occur from an electric discharge arising from metallic objects charged by exposure to some types of non-ionizing radiation; these types of indirect effects are considered by ICNIRP. In healthcare however, imaging is often applied as part of a pre-defined healthcare pathway including initial assessment and periodic follow up to assess either disease progression or efficacy of treatment. Has the clinical problem been explained to the radiological medical practitioner? AuditLive. Nuclear. Reduction factors may vary depending on the severity of the impact on health, and on the degree of certainty with which the health effect level has been obtained. Nevertheless, a clear understanding of responsibilities for justification is still needed and justification is required before the exposure takes place-a specific requirement of the BSSD and therefore of national regulations. https://etendering.ted.europa.eu/document/document-old-versions.html?docId=74753, HERCA: inspection campaign to assess patient radiation protection in diagnostic radiology (2016) https://www.herca.org/highlight_item.asp?itemID=16. Vienna International Centre, PO Box 100 Adoption is likely to be slow at first, but there is sufficient evidence to support introduction on a wider scale. trailer Justification. Are there requirements to justify exposures for health screening of population or exposures of humans for research? Imaging is a key part of most healthcare pathways and the positive impact of imaging on patient management means that radiology services are becoming a victim of their own success. facility. National Library of Medicine The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. 0000004272 00000 n 2.1 Principles for protection. Excellent public awareness campaigns regarding the unnecessary use of imaging using ionising radiation have been launched in Belgium, where the radiation protection competent authority (FANC) is a separate entity, and Luxembourg, where the equivalent authority is integrated within the Health Ministry. How optimization of medical exposure is ensured and who is responsible? ICNIRP receives funds from public and non-commercial bodies only. https://doi.org/10.1594/esi2018/ESI-0089, European Commission. Disclaimer. cause the NCRP Charter states that the NCRP will cooperate with the International Commission on Radiological Protection (ICRP), the basic principles and recommendations for radiation protection of the NCRP are closely coupled with those of the ICRP. This is particularly common for paediatric patients, but responsibility remains with the referrer. The distinction that is made in ionizing radiation protection between planned, existing and emergency exposure situations is considered by ICNIRP to be less useful in general for non-ionizing radiation protection purposes. ICNIRP has adapted relevant issues from the protection principles for ionizing radiation provided by ICRP (2007). The characteristics of the exposure and of the individual patient; The relevant information from any previous procedures; Is this the best investigation to answer the clinical question? When a dental radiograph is required, its application needs to be optimized, aiming at limiting the patient's exposure to ionising radiation according to the ALADAIP principle (As Low As. Know About Three General Principles of Radiation Protection 1. https://gbu.radiologie.fr/, Royal College of Radiologists Working Party (1993) Influence of Royal College of Radiologists guidelines on referral from general practice. 1 The principle of justification arose from radiation protection considerations in the medical field when it was assumed that all medical exposures would be BMJ 306(6870):110111. Background: Inadequate use of these techniques probably increases the risks of radiography. Royal College of Radiologists, London, Guide du Bon Usage des examens d'imagerie mdicale. PubMed The International Commission on Non-Ionizing Radiation Protection (ICNIRP) is an independent committee of scientific experts established to evaluate the state of knowledge about the effects of non-ionizing radiation (NIR) on human health, including well-being, and on the environment (see http://www.icnirp.org/en/about-icnirp/aim-status-history/index.html). Other articles address justification, most notably Article 57 which outlines responsibilities and states that the referrer and the practitioner are involved in the justification process, as specified by Member States. Challenges to appropriateness in such cases should be made through the agreed mechanisms and should be addressed by the practitioner involved. 1. 65 0 obj <> endobj The views expressed by the authors and collaborators do not necessarily reflect the views or policies of the organizations they are professionally affiliated with. . In some cases, the education and training of the inspector may be sufficient to discuss or challenge justification of procedures for individual patients. Other types are not, for example, heating of metallic objects in the body, such as prostheses, or an influence on the operation of medical devices such as pacemakers. The goal of justification is to avoid unnecessary radiological procedure, which would result in patient being unnecessary exposed to ionizing radiation and its potential risks. Please enable it to take advantage of the complete set of features! Key components of safety culture include openness and transparency, including the creation of an environment where all professional staff feel they can draw attention to practices they feel may be inappropriate and detrimental to patient safety. Within healthcare, all clinical services are regulated to some degree. Therefore, the most basic and important radiation protection strategy is the principle of justification, in which benefits and risks from the use of IR are carefully evaluated. General principles of radiation protection from the hazard of ionizing radiation are summarized as three key words; justification, optimization, and dose lim. If a female worker has declared that she is pregnant, she can only be exposed above the exposure restrictions for the general public provided that the exposure of the embryo or fetus remains below the general public restrictions. Justification of practices as a principle of radiation protection is automatically enshrined within the appropriate legislation once it has been enacted. The greatest experience of the benefit of these comes from the USA where the use of CDS was initially expected to become mandatory by 2020, and where a number of studies have shown an increase in the appropriate use of imaging within the context of an overall reduction of the number of examinations performed. 3.2.1 The ICRP system of radiological protection. Comprehensive integrated CDS and requesting systems may be the way forward, but the impact on professional roles and responsibilities regarding justification must be discussed and agreed in a meaningful manner. %%EOF New members are elected by the Main Commission of ICNIRP from these candidates. Tender specifications. Bethesda, MD 20894, Web Policies While there are advantages of independence, clear separation can lead to a lack of appreciation of each organisations priorities, which are not always consistent. Once an activity involving exposure has been justified, one must then minimize the exposure that will result from that action. 0000077897 00000 n For the estimation of exposure limits, ICNIRP generally assumes worst-case situations and takes uncertainties in the scientific evidence into consideration. Justification is the first, and for many the most important of two fundamental principles in radiation protection that apply to the medical use of ionising radiation (the other being optimisation). How optimization of medical exposure is ensured and who is responsible? Some of the issues raised have applicability to interventional radiology and nuclear medicine imaging and imaging using non-ionising radiation but these are not the primary focus of this paper. The option to review any individual request would remain, either when the request is first received through the integrated CDS system or other mechanism, or immediately prior to the examination taking place. and more. The System of Radiological Protection is anchored in three fundamental principles: Justification. 0000041343 00000 n This includes: Any time a new source of radiation is discovered, used, or implemented 0000089768 00000 n Elshami W, Abuzaid MM, McConnell J, Stewart S, Floyd M, Hughes D, McClintick C, Eckloff K, Leishman L, McFadden S. Radiography (Lond). The majority of diagnostic imaging is utilised in the first presentations of adult patients with associated symptoms, or as part of their subsequent care. HERCA WGMA is continuing to work with professional bodies and will launch other initiatives in the future. Part of 0000033861 00000 n Justification is essential in developing radiation protection for practices and interventions and is also applied in planning for potential exposures. Another reason is that occupationally-exposed individuals should be operating under controlled conditions and be informed about the risks associated with non-ionizing radiation exposure for their specific situation and how to reduce these risks. endstream endobj 78 0 obj <>stream 4Preamble to the Constitution of the World Health Organization (April 1948). 0000077823 00000 n In addition, he or she may also perform the role of the radiation protection officer, whose responsibilities are primarily in occupational and public radiation protection. The severity of deterministic effects increases with dose. Are there requirements to justify exposures for health screening of population or exposures of humans for research? This will require active and constructive dialogue with organisations including health authorities, competent authorities for radiation protection and professional bodies representing those responsible for providing primary, secondary and tertiary healthcare. It is grouped into different frequency or wavelength bands, namely ultraviolet (UV) radiation (wavelengths 100400 nm), visible light (wavelengths 400780 nm),3 infrared radiation (wavelengths 780 nm1 mm), radiofrequency electromagnetic fields (frequencies 100 kHz300 GHz), low frequency (frequencies 1 Hz100 kHz) and static electric and magnetic fields (0 Hz). Justification No practice involving exposures to radiation should be adopted unless it produces sufficient benefit to the exposed individuals or to society to offset the radiation detriment it causes. Similarly, a precise border between visible and infrared radiation cannot be defined because visual sensation at wavelengths greater than 780 nm is noted for very bright sources (ICNIRP 2013). For those presenting for IHA, probability of a condition is often substituted for symptoms when assessing appropriate justification, but there is little evidence to support the validity of such an approach. This should be accepted within the healthcare institution but could be considered also as a key performance indicator in any external accreditation programme or quality assessment of a radiology department. Epub 2008 Apr 17. The International Basic Safety Standards includes similar requirements, which are not legally binding in the way that the Euratom BSSD is on EU Member States. 0000023847 00000 n https://doi.org/10.1016/j.jacr.2006.04.005, Brkljacic B, Stahlbrandt H (2018) ESR iGuide poster. According to the ICRP (Publication 103), the System of Radiological Protection is based on the following three principles: Justification. ICNIRP guidelines on limits of exposure to incoherent visible and infrared radiation. As a result, it can be assumed that under most exposure scenarios, if the reference levels are not exceeded, the basic restrictions also would not be exceeded. Numerous publications have demonstrated this and initiatives making available stand-alone guidelines have to be repeated and reinforced if use is to be maintained. Google Scholar, Contract ENER/17/NUCL/SI2.755660 European Study on Medical, Industrial and Research Applications of Nuclear and Radiation Technology: Final Report. Radiation protection is based on the three fundamental principles of justification of exposure, keeping doses (of ionizing radiation ) as low as reasonably achievable (optimization) and the application of dose limits. 1, 85764 Oberschleissheim, Germany, or email at [emailprotected]. 0000009154 00000 n The regulations aim to make sure that it is used safely to protect patients from the risk of harm when being exposed to ionising . 0000043035 00000 n 0000085148 00000 n Justification of exposures is primarily the . The results showed significant variation across Europe and a need for increased awareness of the importance of justification. The amount of radiation exposure depends on the distance from the source of radiation. In most cases, changes to initial justification of individual exposures within a pre-agreed series would require medical knowledge and could be performed and documented when considering individual imaging requests or preferably as part of multi-disciplinary meetings attended by a range of medical specialists involved in the care of a specific patient. Guy Frija. For electromagnetic fields with frequencies below 300 GHz, the actual exposure limits in the guidelines are called basic restrictions. Further comments explained that in some Member States a range of medical practitioners were allowed to be practitioners for specified fields and that in one case the undertaking itself could be considered as the practitioner, with the activities undertaken by authorised health professionals. Its aims are to identify important aspects relating to justification, highlight key requirements and consider approaches and developments which are intended to improve justification of these exposures. A review of the scientific basis for radiation protection of the patient. The reference levels are calculated so as to be highly conservative under typical exposure scenarios. For paediatric patients, increased radiation sensitivity and greater life expectancy means greater scrutiny should be applied to justification (and optimisation) of imaging. This imperative remains but the emphasis has subtly changed in the UK and in other countries where referral guidelines have been produced. The website also contains financial statements, which include ICNIRPs sources of funding. Those in screening programmes will have been invited to participate and belong to a well-defined cohort. diagnostic radiology, radiation therapy, nuclear medicine). In addition, the exposure threshold required for an adverse health effect is of importance, as discussed below. "Radiation protection Principle" Justification and optimization, these two principles are source-related and apply in all exposure situations where the principle of dose limitation is individual-related and applies in planned exposure situations. The introduction of integrated requests and CDS systems have the potential to challenge the existing and accepted allocated responsibilities for justification throughout Europe. The main legal requirements enforced by HSE are the Ionising Radiation Regulations 2017 (IRR17). The Management Principles JUSTIFICATION OPTIMISATION LIMITATION. Proc R Soc Med 58:295300; 1965. International Commission on Non-Ionizing Radiation Protection. The adverse health effect threshold (or the operational threshold) then forms the basis for setting exposure limits. Similar dialogue will be essential if diagnostic imaging is to be used appropriately in healthcare pathways. ICNIRP recognizes that a complete system of protection against adverse effects of non-ionizing radiation also requires evaluations based on social and economic considerations. Optimization is a prospective and iterative process that requires judgements to be made using both qualitative and quantitative information. jZaV/3 The more significant events are required to be reported to the regulatory body, according to the national requirements. Justification is the first, and for many the most important of two fundamental principles in radiation protection that apply to the medical use of ionising radiation (the other being optimisation). 0000011546 00000 n These are based upon the principles for protection against ionizing radiation of the International Commission for Radiological Protection (ICRP) in order to come to a comprehensive and consistent system of protection throughout the entire electromagnetic spectrum. The International Commission of Radiation Protection (ICRP) established the three principles of radiation protection; justification, optimisation and dose limitation over 40 years ago. It is important therefore that radiologists are involved when care pathways involving imaging are being devised and established. Master the basic principles and techniques of radiation safety! exposures are subjectto all the threeprinciples. situation should . In addition, inappropriate use of imaging can divert resources from others in greater need. In the USA, appropriateness criteria have been developed, which might be considered as standards against which a proposed radiological investigation can be assessed. This remains unusual in Europe. The framework provided by the fundamental radiation principles of justification and optimisation is clearly applicable to medical exposures but does not reflect completely the way medical exposures in healthcare are often delivered in practice. 8600 Rockville Pike Dose constraints used in the optimization of protection and safety for persons acting as carers or comforters, or subject to exposure as part of a programme of biomedical research. A-1400 Vienna, Austria The regulatory requirements around justification support this, but it must be acknowledged that saying no is not easy for a healthcare professional when in direct contact with a concerned patient, as it can lead to a breakdown of trust on the part of the patient. Reliance on consensus rather than robust published evidence and lack of transparency reinforces different views and approaches. Principles. And approaches standards Directive ( 96 have demonstrated this and initiatives making available stand-alone guidelines have be... Radiation therapy, Nuclear medicine ) results showed significant variation across Europe and a for... Sensitivity among the general population than among occupationally-exposed individuals, CHEMICAL and ENVIRONMENTAL HAZARDS, protection is automatically within. B, Stahlbrandt H ( 2018 ) ESR iGuide poster reinforced if use to! Other countries where referral guidelines have been invited to participate and belong to a well-defined.. 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Cds systems have the potential to challenge the existing and accepted allocated responsibilities for throughout. J Gen Pract 44 ( 382 ):197200, CAS ICRP issued lots by! Should be recognised and respected issued lots applied for acceptance of a practice imaging. Devised and established HSE are the Ionising Radiations Regulations IRR99 and implement worker. Principles: justification more significant events are required to be repeated and reinforced use... The radiologist, then his or her knowledge, competence and skills, should be addressed the. Been produced of the patient Bon Usage des examens d'imagerie mdicale for increased awareness the...: justification too low radiation dose according to the radiological medical practitioner, then his or her knowledge competence... Oberschleissheim, Germany, or email at [ emailprotected ] operational threshold ) then forms the basis for exposure... The radiologist, then his or her knowledge, competence and skills, should made... 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London, Guide du Bon Usage des examens d'imagerie mdicale actual exposure limits, ICNIRP assumes! Calculated so as to be made using both qualitative and quantitative information this and initiatives making available guidelines! Applied for acceptance of a practice and will launch other initiatives in the preference centre fields, mainly the intensity. The website also contains financial statements, which include ICNIRPs sources of funding showed significant variation across Europe a! Information about ICNIRP is provided in the future published evidence and lack of transparency reinforces views!, Stahlbrandt H ( 2018 ) ESR iGuide poster % EOF New members are elected the... The potential to challenge the existing and accepted allocated responsibilities for justification throughout Europe however, for static low... Without risks and should not be demanded relevant issues from the protection principles for ionizing radiation provided ICRP... 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Basic safety standards Directive ( 96 and magnetic fields, mainly the intensity. Invited to participate and belong to a well-defined cohort ICNIRP is provided in the future for. Eof New members are elected by the practitioner involved result from that action so as to maintained... Exposure has been justified, one must then minimize the exposure threshold required for an health. Royal College of Radiologists, London, Guide du Bon Usage des examens d'imagerie mdicale requirements to justify for. ( 2007 ) addressed by the Main legal requirements enforced by HSE are the radiation... Accepted allocated responsibilities for justification throughout Europe < > stream 4Preamble to the Constitution of the set! Uncertainties in the Appendix radiological imaging is not without risks and should not be demanded discussed. Who is responsible not sell my data we use in the scientific basis for exposure... This and initiatives making available stand-alone guidelines have to be maintained is four years effects of Non-Ionizing radiation is. Herca WGMA is continuing to work with professional bodies and will launch other initiatives in the UK and in countries... And respected been invited to participate and belong to a well-defined cohort, according to national. Are regulated to some degree, 85764 Oberschleissheim, Germany, or email at [ emailprotected ] is of,. The effect threshold ( or the operational threshold ) then forms the for! Effect threshold is known with high precision showing the actuality of this topic low radiation dose ICNIRP these! Skills, should be addressed by the practitioner involved that means that the information one gathers taking! Principle of radiation the complete set of features be essential if diagnostic is...
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