IAEA Steps up Efforts to Ensure Patient Safety during Medical Procedures Using Radiation

Estonia, which expressed interest in being the first pilot country, has been selected based on prerequisites such as an effective governmental, legal and regulatory framework for radiation safety that covers medical uses of ionizing radiation.

“This mission helps us identify issues in the implementation of the safety standards related to medical exposure and receive advice on how to improve related regulations and mechanisms for its implementation in practice,” said Ilmar Puskar, Head of the Climate and Radiation Safety Department at the Environmental Board of Estonia.

During the nine-day mission, experts from Croatia, Finland, Lithuania, Italy, Ireland, and Slovenia reviewed national regulations and other written material and conducted interviews and site visits in close cooperation with the Estonia’s regulatory body, health authority, professional bodies and end users such as hospital staff. The experts visited Estonia’s two radiotherapy and three nuclear medicine departments, and diagnostic and interventional departments in Tallinn, Tartu, Parnu and East Viru.

“The team recognized the willingness of Estonia to further strengthen the regulatory and practical arrangements for radiation protection and safety in medical exposures, and the openness and cooperation of all stakeholders involved in the mission activities,” said Ritva Bly, the mission Team leader, and Principal Advisor of the Regulatory body of Finland (STUK).

As a good practice, the team recognized that authorized health professionals can consult the information about patient medical history in the national Picture Archiving Communication System (PACS), which saves patient exposure data along with images and other patient information, when referring patients to a radiological procedure, or when deciding which procedure to perform. This helps avoiding unnecessary exposure of patients via, for instance, repeating exams without medical justification.

The team recommended improvements to national arrangements for communication with relevant professional bodies: for example, referral guidelines for strengthening justification of procedures are needed, as a practical tool for health professionals to select the most appropriate imaging method. In addition, the methodology for establishing and utilizing diagnostic reference levels, which indicate wherever doses to the patients or the amount of radiopharmaceuticals used for the same examination in different departments may be unusually high or low, should be updated.

The pilot mission in Estonia offered an opportunity to test the methodology and guidelines of this upcoming advisory service that is yet to be formalised. Based on the results, the team identified areas for amendments such as better balancing of site visits and interviews, and improvements in the preparatory work.

The updated methodology will be used to design the next pilot later this year under a new regional Technical Cooperation project aiming to continue strengthening patient safety and implementation of the justified and optimized use of ionizing radiation in medicine. Experiences from the pilots and improved guidelines will be used to design a new advisory service.

“Following these efforts, countries will be able to learn from each other thanks to exchange of experts and good practices,” said Eve-Kulli Kala, IAEA Director of Technical Cooperation Division for Europe. “Having good regulation and a framework for its implementation in medicine is a prerequisite for sustainable and efficient technical cooperation projects in this area.”