A landmark conference on radiation safety in health care recently concluded 30 March 2001 in Spain, with participants calling for an international action plan to enhance the radiological protection of patients.
Other recommendations for international cooperation are related to:
- supporting the distribution and appropriate use of basic medical imaging equipment in developing countries;
- emphasis on computer-based training, making use of existing educational materials;
- enhancing the infrastructure for radiological protection worldwide; and
- developing performance standards for used medical equipment so that it can be applied safely by subsequent users.
More than 720 professionals from more than 85 countries attended the conference on radiological protection of patients in Malaga, Spain. The conference was organized by the IAEA, co-sponsored by the European Commission, Pan American Health Organization (PAHO), and the World Health Organization (WHO), and hosted by the Government of Spain. More than six professional societies cooperated in its organization.
Every day thousands of people undergo medical diagnosis and treatment that use ionising radiation - an estimated 2 billion per year. But, despite concerns raised over the safety of other man made sources of radiation, most people never give a second thought to that dental x-ray or barium enema they have to have. Most assume that these are tightly controlled practices and that the doses are not harmful. For the most part, this has been the case, but modern technology is making more and more use of radiation in an ever widening array of techniques. So it is no longer as simple as asking patients when was the last time they had an x-ray to ensure that they do not exceed a certain radiation dose. There have also been different approaches taken in different countries on what dose is reasonable for a given procedure. Plus the increasing sophistication of the uses of radiation in such techniques as intravascular fluoroscopy, brachytherapy, and computerized tomography makes determining patient doses more complex than ever before.
For the first time, the Malaga Conference brought together a broad cross section of all those professionals involved in medical uses of ionising radiation at the national and international levels - doctors, nuclear medicine specialists, medical physicists, radiologists, and regulators - to share information and discuss the possible role of international collaboration in improving radiological protection of patients. It was also unique in that it included sessions that focussed on the impact on patients themselves with one session devoted to the expectations of patients and the another on issues for caregivers.
Over the five days of presentations and discussions, which included summaries from some 190 contributed scientific papers, several key issues emerged.
- In general, the radiological protection objective is to optimise, i.e. to select the best protection option under the prevailing circumstances. For members of the public and occupationally exposed workers, this objective is generally achieved by keeping doses as low as possible, but in the case of patients, too low doses may not be effective, either for getting proper image quality or for killing tumour cells.
- There is also an important difference to be made between the exposures from diagnosis and that from treatment. For the most part, doses from diagnostic procedures are low, however, for therapeutic uses, such as cancer therapy, the doses are higher and designed to kill tumour cells. One of the issues raised was how to keep track of such exposures and which type should be tracked. While there was general agreement that doses from diagnostic procedures posed low risk, new techniques, like some of the interventionist techniques used in cardiology to visualize arterial blockages so that they can be cleared, are using higher doses.
- Thus it is important that any efforts to track patient doses take such uses into account. Considering that 25% of all patients will require diagnostic procedures that use radiation, the merits of developing a permanent patient record card was discussed as a way to track high dose procedures and also to reduce unnecessary exposures due to repetitive diagnostic procedures.
As technology is advancing rapidly, keeping training up-to-date in all involved professions can be a challenge, even in developed countries. In developing countries, there is a need not only for training, but also for the infrastructure to support safe use of ionising radiation in medicine. Such an infrastructure involves not only scientifically sound standards, such as those of the International Basic Safety Standards, but also the legal and regulatory regime to put these standards of practice into effect at the patient level. Radiological protection should be seen an integral part of the health quality culture. Here international efforts, such as those by the IAEA Model Project to strengthen radiation protection at all levels and the joint initiative by PAHO and WHO to improve access and effectiveness of diagnostic x-rays in developing countries, demonstrate the concrete benefit of international collaboration.
The opportunity for information exchange and collaboration from such a broad cross section of professionals in the field from around the world is invaluable to furthering future collaboration. The outcome of this conference may point the way.