Summary of the first meeting on radiation protection for referring physicians

Justification

The Technical Meeting (TM) had 19 participants from 16 countries in addition to IAEA staff members. The distribution was Algeria (1), Austria (2), Belgium (2), Brazil (1), China (1), Finland (1), Georgia (1), Hungary (1), India (1), Iran (1), Malaysia (1), Mali (1), Spain (1), The Former Yug. Rep. of Macedonia (1), United States of America (2) and World Health Organization (1). 58% were referring physicians, 26% imaging specialists and 16% others including medical specialists involved in regulations and patient dosimetry.

There was a clear feeling that significant numbers of inappropriate referrals for radiological examinations are carried out in most countries. There is limited awareness among referring physicians, including GPs and primary care physicians, about radiation exposure and dangers involved regarding different procedures.

The revised International Basic Safety Standards for Protection against Ionizing Radiation and for the Safety of Radiation Sources (BSS) states the following under Item 3.156:

The justification of medical exposure for an individual patient shall be carried out through consultation between the radiological medical practitioner and the referring medical practitioner, as appropriate, with account taken, in particular for patients who are pregnant or breast-feeding or paediatric, of:

(a) The appropriateness of the request;

(b) The urgency of the procedure;

(c) The characteristics of the medical exposure;

(d) The characteristics of the individual patient;

(e) Relevant information from the patient’s previous radiological procedures.

And in 3.157: Relevant national or international referral guidelines shall be taken into account for the justification of the medical exposure of an individual patient in a radiological procedure.

The IAEA has, in the past, successfully demonstrated provision and dissemination of guidance and training material for users of radiation (imaging and therapy specialists, interventional cardiologists and doctors who use fluoroscopy outside the field of radiology, namely: orthopedic surgeons, gastroenterologists, urologists, etc.). This experience needs to be utilized to extend coverage to referring physicians.

The meeting developed the following recommendations:

Recommendations

  1. The IAEA should make available material and promote education regarding imaging appropriateness including radiation exposure and risks;
  2. The IAEA should facilitate promotion of best practices regarding imaging appropriateness and radiation safety among member states;
  3. The IAEA should encourage and oversee ongoing audit procedures undertaken by appropriate local bodies;
  4. The IAEA and member states should find ways to improve patient education and awareness as a tool to increase imaging appropriateness and safety;
  5. The IAEA should facilitate development and dissemination of consensus regarding definitions and measurements of imaging appropriateness and safety;
  6. The IAEA should orchestrate further research and data acquisition regarding effects of low dose radiation;
  7. Governments should create legislation defining accountability and liability for improvement of imaging appropriateness and safety;
  8. National medical societies or appropriate bodies should include formal education and certification of physicians’ knowledge regarding imaging appropriateness and radiation safety;
  9. All practitioners should consider appropriateness and radiation risk when referring patients for imaging procedures, taking into account radiation exposure history of individual patients;
  10. Extra care should be taken when referring patients for imaging procedures involving radiation exposure to sensitive populations (children, pregnant women).

The group was of the strong opinion that the use of the IAEA’s Smart Card/SmartRadTrack concept to achieve radiation exposure history of the patient has the potential to improve imaging appropriateness and safety. This could eliminate many inappropriate repeat examinations.

There was considerable discussion on how much training is needed, what information to provide or to avoid, and how to deliver information. The best way to achieve training is through routine work flow (electron system with feedback and knowledge base), discussions during clinical rounds, professional meetings, workshops, round tables and seminars. Of course, this can happen only when senior professionals are equipped with knowledge and are thus able to disseminate it.

One group of participants dealt specifically with issues pertaining to less resourced countries. In particular, the group felt that the IAEA should provide radiation dose values for particular examinations in terms of equivalent number of chest X rays and/or background radiation. The information should be color coded. Further, translation of information into different languages was recommended, as well as the provision of free access to appropriateness criteria.

Smart Card project

RELID study

Poster


 
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