International Workshop on Justification of Medical Exposure in Diagnostic Imaging, Brussels, Belgium, 2-4 September 2009

Albert Borschette Conference Centre(CCAB)
36. rue Froissart, Brussels, Belgium

Jointly Sponsored by the
European Commission(EC) and the International Atomic Energy Agency(IAEA)

Background

Recommendations, standards and directives from the International Commission on Radiological Protection (ICRP), the IAEA, the EC, and most radiation protection legal systems position justification as a cornerstone for medical radiation protection. Both the IAEA and the European Union (EU) have active radiation protection programmes for patients, and successfully promote this area through education, training, scientific and technical projects, publications and educational/advisory materials, including those freely downloadable from the web.

Despite these initiatives, the approach to and compliance with justification is weak in diagnostic radiology and nuclear medicine. Work within the EU SENTINEL Project and a number of IAEA consultations confirm that the problem exists. It is also probable that there are significant justification problems in radiological practice in the developing world. In the West, recent studies indicate that >20% of examinations may not be appropriate; this can be as high as 45% in special cases, and up to 75% for specific techniques. This situation should be tackled promptly, particularly as tools are now available to improve it. The sense of urgency about the problem is reinforced by newer high dose activities in radiology, newly available tools for justification and clinical audit, the ongoing revision of the IAEA Basic Safety Standards (BSS), the recasting of the European Directives, and the requirement for an effective regulatory approach in a sensitive area.

These developments are happening against a background of worryingly increasing medical radiation doses, and the American College of Radiology (ACR) white paper noting “The rapid growth of CT and certain nuclear medicine studies may result in an increased incidence of radiation-related cancer in the not-too-distant future”. These concerns provide additional motivation for dealing with justification. Finally there is a need to align medical justification with contemporary ethical and social thinking.

A workshop is the next logical step and will encourage:

  • Building on the work already undertaken in the EU and by the IAEA;
  • Developing strategies for improving justification in practice, and for improving its regulation and accountability;
  • Evaluating, in a structured manner, the global literature on the knowledge of risk/dose among physicians and radiologists;
  • Examining risk communication, and the possibility of importing approaches from public health, the humanities and other areas of medicine;
  • Regional differentiation and dissemination of tools for justification, e.g. referral guidelines, including identification of needs in the developing world;
  • Ensuring that a clinical audit of radiology includes justification as an indicator;
  • Identifying key problems, including regional ones, that require further attention;
  • Engaging the individual patient with these issues through appropriate communication and consent; and
  • Disseminating the above to key global players, including professional bodies and international organizations, with a view to amplifying impact and influencing policy initiatives.

Some Topics to be Explored

  • Levels of awareness of radiation risks among physicians, radiologists and health care professionals,
  • Difficulties in communicating scales of risk/dose to health professionals and the public; the reasons for these difficulties,
  • Increasing dose associated with new technologies (particularly CT and interventional radiology),
  • Studies/audits of appropriateness of radiological examinations in practice, using referral/appropriateness guidelines as benchmarks,
  • Tools for Justification, including referral guidelines and clinical audit,
  • Importance of individual autonomy, dignity and consent in Justification rationale,
  • Related social, medico-legal and consumerist trends in healthcare delivery, and their impact on Justification
  • Self referral, self presentation, non medical exposures and their relationship with the dose limit exemption for medical exposures.

Objectives of the Workshop

  • To provide a sound contemporary philosophical, legal and socially acceptable basis for the regulation and practice of justification;
  • To encourage the development, dissemination and regional differentiation of tools for justification, such as referral/acceptability guidelines;
  • To encourage the development and dissemination of appropriate tools for regulation and for clinical audit of justification;
  • To identify strategies, an action plan and training initiatives to improve justification, including communication of dose/risk to patients and health professionals;
  • To evaluate the costs, operational problems and savings likely to be associated with a more transparent and accountable justification process.

Planned Outcome(s)

  • Improved awareness, policy, regulatory and practice developments with respect to justification in diagnostic medical procedures;
  • High quality reference material in workshop proceedings;
  • Possibility of more mature IAEA and/or EU publication(s) on medical justification and on communication of risk in medical imaging.

The Workshop will be of interest to:

Health professionals including radiologists, radiographers/technologists, and medical physicists; politicians, regulatory authorities, health authorities and managers, health economists, philosophers, clinical practitioners, social scientists, anthropologists, ethnographers, psychologists, communications experts, lawyers, academics, patients, comforters and care-givers, and the public.

 
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