RPDIR-L01_Overview_WEB 2.pdf

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology Part 1: Overview of Radiation Protection in Diagnostic Radiology RADIATION PROTECTION IN DIAGNOSTIC AND INTERVENTIONA...

IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology Part 1: Overview of Radiation Protection in Diagnostic Radiology RADIATION PROTECTION IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY L 1: Overview of Radiation Protection in Diagnostic Radiology Topic 1: Definition of medical exposure IAEA IAEA International Atomic Energy Agency International Atomic Energy Agency • Mr. Sharp, I am given to understand that 2 CT examinations performed on me have given me 25 mSv whereas 20 mSv is the safe dose. I want to file legal suit against the doctor. What do you feel ?? Medical exposure versus occupational • examination if it’s justified or not. IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology 0 IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology 0 • 20 msv for one year • 100 for 5 years • In finals • 12 msv in the years is ok until we do t7geeg IAEA While holding his child in diagnostic examination Mr. Joseph got 2 mSv. As a member of the public with 1 mSv dose limit, he can not get any additional radiation dose this year. My resident doctor has got 12 mSv in her last badge report as she was wearing the badge while getting her barium study. She wants off from radiation work. ????? 1 : Overview of Radiation Protection in Diagnostic Radiology IAEA 0 ??????? 1 : Overview of Radiation Protection in Diagnostic Radiology 0 Three types of exposure Dose constraints for Comforters under a category of Medical exposure IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology 0 • Medical Exposure principally the exposure of persons as part of their diagnosis or treatment • Occupational Exposure exposure incurred at work, and practically as a result of work • Public Exposure including all other exposures IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology 0 Framework of radiological protection for medical exposure Medical exposure • • • • • • • Medical Exposure Exposure of persons as part of their diagnosis or treatment Exposures (other than occupational) incurred knowingly and willingly by individuals such as family and close friends helping either in hospital or at home in the support and comfort of patients Exposures incurred by volunteers as part of a program of biomedical research IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology • • • • IAEA International Atomic Energy Agency 1 : Overview of Radiation Protection in Diagnostic Radiology 0 The justification of a practice IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology Topic 2: Justification Dose constraints and Diagnostic Reference Levels ARE RECOMMENDED IAEA 0 Part 1: Overview of Radiation Protection in Diagnostic Radiology Justification Optimization The use of doses limits is NOT APPLICABLE The decision to adopt or continue any human activity involves a review of benefits and disadvantages of the possible options, e.g., choosing between the use of X Rays or ultrasound Often, the radiation detriment will be only a small part of the total detriment Most of the assessments needed for the justification of a practice are made on the basis of experience, professional judgement, and common sense IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology 0 Three levels of justification • • • Generic justification (I) • General level: The use of radiation in medicine is accepted as doing more good than harm Generic level: specific procedure with a specific objective: chest radiographs for patients showing relevant symptoms Third level: the application of the procedure to an individual patient IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology • • • IAEA 0 Generic justification (II) • • 1 : Overview of Radiation Protection in Diagnostic Radiology 1 : Overview of Radiation Protection in Diagnostic Radiology 0 Generic justification (III) • The resources in a country or region should be considered, e.g., fluoroscopy for chest imaging could be the procedure chosen instead of radiography for economical reasons The justification of diagnostic exposures for which the benefit to the patient is not the primary objective needs special consideration, e.g., radiography for insurance purposes IAEA It is a matter for national professional bodies, sometimes in conjunction with national regulatory authorities The exposures to staff (occupational) and to members of the public should be taken into account The possibility of accidental or unintended exposures (potential exposure) should also be considered The decisions should be reviewed from time to time as new information becomes available 0 Any radiological examination for occupational, legal or health insurance purposes undertaken without reference to clinical indications is deemed to be not justified unless it is expected to provide useful information on the health of the individual examined or unless the specific type of examination is justified by those requesting it in consultation with relevant professional bodies. IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology 0 Justification for an individual patient (third level) • • • IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology To check that the required information is not already available Once the procedure is generically justified, no additional justification is needed for simple diagnostic investigations For complex procedures (such as CT, IR, etc) an individual justification should be taken into account by medical practitioner (radiologist, referral doctor..) IAEA Part 1: Overview of Radiation Protection in Diagnostic Radiology Topic 3: Optimization IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology 0 International Atomic Energy Agency The optimization of protection (I) • Optimization is usually applied at two levels: • The design and construction of equipment and installations Day to day radiological practice (procedures) • • • The optimization of protection (II) • • Reducing the patient dose may reduce the quantity as well as the quality of the information provided by the examination or may require important extra resources Optimization means that doses should be “as low as reasonably achievable”, compatible with achieving the required image quality objectives IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology • • 0 There is a considerable scope for dose reductions in diagnostic radiology (ICRP 103) x Simple, low-cost measures are available for reducing doses without loss of diagnostic information (ICRP 103) The optimization of protection in diagnostic radiology does not necessarily mean the reduction of doses to the patient, i.e., it may be necessary to increase some doses to obtain clinical image quality Antiscatter grids improve the contrast of the image but increase the dose by a factor of 2-4 IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology 0 Diagnostic Reference Levels (DRLs) for medical exposure (as defined by the BSS) IAEA Training Material on Radiation Protection in Diagnostic and Interventional Radiology Part 1: Overview of Radiation Protection in Diagnostic Radiology • Topic 4: Diagnostic Reference Levels— practical aspects IAEA A value of dose, dose rate or activity selected by professional bodies in consultation with the Regulatory Authority to indicate a level above which there should be a review by medical practitioners and medical physicists in order to determine whether or not the value is excessive, taking into account the particular circumstances and applying sound clinical judgement IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology 0 International Atomic Energy Agency Diagnostic Reference Levels (DRLs) for medical exposure (as defined by the BSS) Diagnostic Reference Levels (DRLs) for medical exposure (as defined by the BSS) The Diagnostic Reference Levels are intended: a) b) c) The DRLs are intended: a) to be a reasonable indication of doses for average sized patients to be established by relevant professional bodies in consultation with the Regulatory Authority to provide guidance on what is achievable with current good practice rather than on what should be considered optimum performance IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology b) 0 to be applied with flexibility to allow higher exposures if these are indicated by sound clinical judgement to be revised as technology and techniques improve IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology 0 Diagnostic Reference Levels (DRLs) for medical exposure (as defined by the BSS) Dose constraints for medical exposure • • Corrective actions should be taken as necessary if doses or activities fall substantially below the DRLs and images do not provide adequate clinical image quality IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology IAEA 0 • Values of measured quantities above which some specified action or decision should be taken • • The ICRP recommends momthe use of Diagnostic Reference Levels (DRL) for patients (Report 103), as does the IAEA in its International Basic Safety Standards (IAEA Safety Series 115, 2011) • • The DRL is intended for use as a convenient test for identifying situations where the levels of patient dose are unusually high. IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology 1 : Overview of Radiation Protection in Diagnostic Radiology 0 Diagnostic Reference Levels Practical aspects (I) Diagnostic Reference Levels • For medical exposure, dose constraints should only be used in optimizing the protection of persons exposed for medical research purposes, or of persons, other than workers, who assist in the care, support or comfort of exposed patients. • 0 Diagnostic Reference Levels are not dose limits DRLs could be assimilated to investigation levels DRL are not applicable to individual patients. Comparison with DRL shall be only made using mean values of a sample of patients Quantities used for DRLs should be easily measured IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology 0 Diagnostic Reference Levels Practical aspects (II) • • • Diagnostic Reference Levels Practical aspects (III) • Quantities used for DRLs should be understood by radiologists and radiographers DRLs should always be used in parallel with image quality evaluation (enough information for diagnosis shall be obtained) DRLs can be based on several quantities (such as DAP) and parameters (such as fluoro time and number of images) IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology • • 0 DRLs should be ‘flexible’ (tolerances should be established: different patient sizes, different pathologies, etc). DRLs are not a border line between good and bad medicine Values BELOW DRLs may need optimization if the image quality is inadequate for clinical purposes. Values ABOVE DRLs require an investigation and optimization of X Ray system or protocols. The main objective of DRLs is their use in a dynamic and continuous process of optimization IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology 0