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8/17/2019 Overview Web

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IAEAInternational Atomic Energy Agency

RADIATION PROTECTION INDIAGNOSTIC AND

INTERVENTIONAL RADIOLOGY

L 1: Overview of Radiation Protection in

Diagnostic Radiology

IAEA Training Material on Radiation Protection in Diagnostic and Interentional Radiology


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IAEA

1 : Overview of Radiation Protection in Diagnostic Radiology 2

Introd!ction

• Persons are medically exposed as part of theirdiagnosis or treatment.

• ccording to !"RP and #$$% the two &asic

principles of radiation protection '(stification andoptimi)ation

• Dose limits are not applica&le% &(t DiagnosticReference Levels *DRLs+ apply to patient dose

levels• !nvestigation of doses that exceed the DRLs is

strongly recommended


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IAEA

1 : Overview of Radiation Protection in Diagnostic Radiology ,

To"ics

• Definition of medical expos(re

• -(stification

• Optimi)ation• Diagnostic Reference Levels practicalaspects

• DRls and effective doses


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IAEA

1 : Overview of Radiation Protection in Diagnostic Radiology /

Oerie#

• 0o &ecome familiar with the #$$ $afety$tandards re(irement for medical

expos(re: '(stification% optimi)ation%

diagnostic reference levels% andinvestigation of expos(re.


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Part $% Oerie# o& Radiation Protectionin Diagnostic Radiology

0opic 1: Definition of medical expos(re



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IAEA

1 : Overview of Radiation Protection in Diagnostic Radiology

• Mr' S(ar") I am giento !nderstand t(at *CT e+aminations

"er&ormed on me

(ae gien me *,mS #(ereas *- mS

is t(e sa&e dose' I

#ant to &ile legal s!it

against t(e doctor'.(at do yo! &eel //


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IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology 3

Medical e+"os!re

ers!s

occ!"ational


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My resident doctor(as got $* mS in

(er last 0adge

re"ort as s(e #as

#earing t(e 0adge

#(ile getting (er

0ari!m st!dy' S(e

#ants o&& &romradiation #or1'

/////


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.(ile (olding (is

c(ild in diagnostic

e+amination Mr'

2ose"( got * mS'

As a mem0er o& t(e"!0lic #it( $ mS

dose limit) (e can

not get anyadditional radiation

dose t(is year'///////


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Dose constraints&or

Com&orters

!nder a category o&Medical e+"os!re


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T(ree ty"es o& e+"os!re

• 7edical 8xpos(re principally the expos(re of

persons as part of their

diagnosis or treatment

• Occ(pational 8xpos(re expos(re inc(rred at wor9%

and practically as a res(lt

of wor9

• P(&lic 8xpos(re incl(dingall other expos(res


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Medical e+"os!re

• 7edical 8xpos(re• 8xpos(re of persons as part of their diagnosis or

treatment

• 8xpos(res *other than occ(pational+ inc(rred9nowingly and willingly &y individ(als s(ch asfamily and close friends helping either in hospitalor at home in the s(pport and comfort of

patients• 8xpos(res inc(rred &y vol(nteers as part of a

program of &iomedical research


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IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology 1,

3rame#or1 o& radiological "rotection

&or medical e+"os!re

• -(stification

• Optimi)ation

• 0he (se of doses limits

is O0 PPL!"#L8• Dose constraints and

Diagnostic Reference

Levels R8

R8"O778D8D


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0opic 2: -(stification



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IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology 1;

T(e 4!sti&ication o& a "ractice

• 0he decision to adopt or contin(e any h(manactivity involves a review of &enefits anddisadvantages of the possi&le options% e.g.%choosing &etween the (se of < Rays or (ltraso(nd

• Often% the radiation detriment will &e only a smallpart of the total detriment

• 7ost of the assessments needed for the

'(stification of a practice are made on the &asis ofexperience% professional '(dgement% and commonsense


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T(ree leels o& 4!sti&ication

• =eneral level: 0he (se of radiation inmedicine is accepted as doing more good

than harm

• =eneric level: specific proced(re with aspecific o&'ective: chest radiographs for

patients showing relevant symptoms

• 0hird level: the application of the proced(reto an individ(al patient


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Generic 4!sti&ication 5I6

• !t is a matter for national professional &odies%sometimes in con'(nction with national reg(latorya(thorities

• 0he expos(res to staff *occ(pational+ and tomem&ers of the p(&lic sho(ld &e ta9en into acco(nt

• 0he possi&ility of accidental or (nintendedexpos(res *potential expos(re+ sho(ld also &econsidered

• 0he decisions sho(ld &e reviewed from time to timeas new information &ecomes availa&le


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Generic 4!sti&ication 5II6

• 0he reso!rces in a co(ntry or region sho(ld&e considered) e.g.% fl(oroscopy for chestimaging co(ld &e the proced(re chosen

instead of radiography for economicalreasons

• 0he 4!sti&ication of diagnostic expos(res forwhich the 0ene&it to the patient is not the

primary o&'ective needs specialconsideration% e.g.% radiography for ins(rancep(rposes


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Generic 4!sti&ication 5III6

• ny radiological examination forocc(pational% legal or health ins(rancep(rposes (nderta9en witho(t reference to

clinical indications is deemed to &e not '(stified (nless it is expected to provide(sef(l information on the health of theindivid(al examined or (nless the specific

type of examination is '(stified &y thosere(esting it in cons(ltation with relevantprofessional &odies.


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2!sti&ication &or an indiid!al "atient

5t(ird leel6

• 0o chec9 that the re(ired information is notalready availa&le

• Once the proced(re is generically '(stified%

no additional '(stification is needed forsimple diagnostic investigations

• >or complex proced(res *s(ch as "0% !R%

etc+ an individ(al '(stification sho(ld &eta9en into acco(nt &y medical practitioner*radiologist% referral doctor..+


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0opic ,: Optimi)ation



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T(e o"timi7ation o& "rotection 5I6

• Optimi)ation is (s(ally applied at two levels:• 0he design and constr(ction of e(ipment andinstallations

• Day to day radiological practice *proced(res+

• Red(cing the patient dose may red(ce the (antityas well as the (ality of the information provided&y the examination or may re(ire important extrareso(rces

• Optimi)ation means that doses sho(ld &e ?as lowas reasona&ly achieva&le@% compati&le withachieving the re(ired image (ality o&'ectives


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IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology 2,

T(e o"timi7ation o& "rotection 5II6

• 0here is a considera&le scope for dose red(ctions indiagnostic radiology *!"RP 16,+

• $imple% lowcost meas(res are availa&le for red(cing doseswitho(t loss of diagnostic information *!"RP 16,+

• 0he optimi)ation of protection in diagnostic radiology doesnot necessarily mean the red(ction of doses to the patient%i.e.% it may &e necessary to increase some doses to o&tainclinical image (ality

• ntiscatter grids im"roe the contrast of the image &(tincrease the dose &y a factor of 2/


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0opic /: Diagnostic Reference LevelsA

practical aspects



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IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology 2;

Diagnostic Re&erence Leels 5DRLs6 &or

medical e+"os!re 5as de&ined 0y t(e 8SS6

• val(e of dose% dose rate or activityselected &y professional &odies in

cons(ltation with the Reg(latory (thority to

indicate a leel a0oe #(ic( there sho(ld&e a review &y medical practitioners and

medical physicists in order to determine

whether or not the val(e is excessive% ta9inginto acco(nt the partic(lar circ(mstances

and applying so(nd clinical '(dgement


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• 0he Diagnostic Reference Levels areintended:

a+ to &e a reasona&le indication of doses for

average si)ed patients&+ to &e esta&lished &y relevant professional &odies

in cons(ltation with the Reg(latory (thority

c+ to provide g(idance on what is achieva&le withc(rrent good practice rather than on what sho(ld

&e considered optim(m performance


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• 0he DRLs are intended:

d+ to &e applied with flexi&ility to allow higherexpos(res if these are indicated &y so(nd

clinical '(dgemente+ to &e revised as technology and techni(es

improve


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• "orrective actions sho(ld &e ta9en asnecessary if doses or activities &all

s!0stantially 0elo# the DRLs and images

do not provide ade(ate clinical image

(ality


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IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology ,2

Diagnostic Re&erence Leels

• Bal(es of meas(red (antities a0oe #(ic( somespecified action or decision sho(ld &e ta9en

• 0he !"RP recommends the (se of Diagnostic

Re&erence Leels *DRL+ for patients *Report 16,+% asdoes the !8 in its !nternational #asic $afety $tandards

*!8 $afety $eries 11;% 2611+

• 0he DRL is intended for (se as

a convenient test for identifying

sit(ations where the levels of patient

dose are (n(s(ally high.


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IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology ,,


Practical as"ects 5I6

• Diagnostic Reference Levels are not doselimits

• DRLs co(ld &e assimilated to investigation

levels• DRL are not applica&le to individ(al patients.

"omparison with DRL shall &e only made

(sing mean val(es of a sample of patients• C(antities (sed for DRLs sho(ld &e easilymeas(red


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IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology ,/


Practical as"ects 5II6

• C(antities (sed for DRLs sho(ld &e(nderstood &y radiologists andradiographers

• DRLs sho(ld always &e (sed in parallel withimage (ality eval(ation *eno(ghinformation for diagnosis shall &e o&tained+

• DRLs can &e &ased on several (antities*s(ch as DP+ and parameters *s(ch asfl(oro time and n(m&er of images+


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IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology ,;


Practical as"ects 5III6

• DRLs sho(ld &e flexi&leE *tolerances sho(ld &eesta&lished: different patient si)es% differentpathologies% etc+. DRLs are not a &order line&etween good and &ad medicine

• Bal(es #8LOF DRLs may need optimi)ation if theimage (ality is inade(ate for clinical p(rposes.Bal(es #OB8 DRLs re(ire an investigation andoptimi)ation of < Ray system or protocols.

• 0he main o&'ective of DRLs is their (se in adynamic and contin(o(s process of optimi)ation


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0opic ;: Diagnostic Reference Levels and

8ffective Doses



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Diagnostic re&erence leels &or ad!lt radiogra"(y

8xamination

GP 8ntrances(rface dose per

radiograph*m=y+

"RP

>reeinair

*m=y+

L(m&ar spine P

/.2

L(m&ar spineL0

1/

L(m&ar spineL$-

2

&domen P ,./


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Diagnostic re&erences &or ad!lt radiogra"(y

8xamination

GP 8ntrances(rface dose perradiograph

*m=y+

"RP>reeinair

*m=y+

Pelvis P /

Gip 'oint P

"hest P 6.2 6.1;

"hest L0 1.6


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8xamination

GP 8ntrances(rface dose perradiograph

*m=y+

"RP>reeinair

*m=y+

0horacic spine P

,.;

0horacic spine

L0

16

Dental intraoral 2./ *2663+ 1.

Dental P 1.


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IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology /6


8xaminationGP 8ntrance s(rfacedose per radiograph

*m=y+

$9(ll P ,

$9(ll L0 1.;

Di ti & l l &


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Diagnostic re&erence leels &or

ad!lt CT

8xaminationHI ,

rd

C(artile%266

8"266

"RP"0D!F

Gead 6 42

"hest 13 ,6

L(m&arspine

22

&domen 15 ,; 22

*a+ Derived from meas(rements on the axisof rotation in water e(ivalent phantoms% 1;cm in length and 1 cm *head+ and ,6 cm

*l(m&ar spine and a&domen+ in diameter.

Di ti & l l &


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Diagnostic re&erence leels &or

mammogra"(y

verage gland(lar dose per cranioca(dal pro'ection

,.6 m=y *with grid+

Determined for a /.; cm compressed &reast consisting of;6J gland(lar and ;6J adipose tiss(e% for screenfilm

systems and dedicated 7otarget and 7ofilter

mammography (nits.


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IAEA

(tt"%99###'("a'org'!19#e09:PA#e0;:PA#e0Standard9

:PA#e0??>>$-@> *---) last reie#ed *--@

(tt"%99radiology'rsna'org9content9*-9?9@*@'&!ll'"d&B(tml

CT DRLs

(tt"%99###'("a'org'!19P!0lications9Radiation9:PARPDS

eriesRe"orts9:"aR"d-**9 :PA dental *' mGy

NCRP al!es &rom dra&t re"ortto 0e "!0lis(ed *-$*

1 : Overview of Radiation Protection in Diagnostic Radiology /,

So!rces &or DRL Val!es


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IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology //

Diagnostic re&erence leels &or ad!lt &l!orosco"y

Operation 7ode 8ntrance s(rface dose*m=yKmin+ *a+

ormal 2;

Gigh Level *&+ 166

*a+ !n air with &ac9scatter

*&+ >or fl(oroscopes that have an optional highlevel operational mode% s(ch as thosefre(ently (sed in interventional radiology

T i l && ti d &


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IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology /;

Ty"ical e&&ectie doses &rom

diagnostic medical e+"os!res

3rom% Re&erral Criteria 3or Imaging' CE) *---'

Diagnosticproced(re

0ypicaleffective dose*m$v+

8(iv. no. ofchest < rays

pprox. e(iv. periodof nat(ral &ac9gro(ndradiation

"hest *singleP film+

6.62 1 , days

$9(ll 6.63 ,.; 11 days

0horacic spine 6.3 ,; / months

L(m&ar spine 1., ; 3 months

T i l && ti d &

http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733771087http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733771087http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733771087http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733771087http://www.hpa.org.uk/Publications/Radiation/HPARPDSeriesReports/HpaRpd022/http://www.hpa.org.uk/Publications/Radiation/HPARPDSeriesReports/HpaRpd022/http://www.hpa.org.uk/Publications/Radiation/HPARPDSeriesReports/HpaRpd022/http://radiology.rsna.org/content/240/3/828.full.pdf+htmlhttp://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733771087http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733771087


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IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology /



Diagnosticproced(re




Gip 6., 1; 3 wee9s

Pelvis 6.3 ,; / months

&domen 1.6 ;6 months

!BH 2.; 12; 1/ months




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Diagnosticproced(re




#ari(m swallow 1.; 3; months

#ari(m meal , 1;6 1 months

#ari(m followthro(gh

, 1;6 1 months

#ari(m enema 3 ,;6 ,.2 years




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Diagnosticproced(re




"0 head 2., 11; 1 year

"0 chest 4 /66 ,. years

"0 &domen orpelvis

16 ;66 /.; years


Inestigation o& e+"os!re


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Inestigation o& e+"os!re58'S'S' ?'6

Registrants and licensees shall promptly investigate:

• any diagnostic expos(re s(&stantially greater thanintended or res(lting in doses repeatedly and

s(&stantially exceeding the esta&lished diagnosticreference levels% or (n(s(ally low expos(res

• any e(ipment fail(re% accident% error% mishap orother (n(s(al occ(rrence with the potential for

ca(sing a patient expos(re significantly differentfrom that intended.



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IAEA 1 : Overview of Radiation Protection in Diagnostic Radiology ;6

Inestigation o& e+"os!re58'S'S' ?'$@-6

Registrants and licensees shall:

a+ calc(late or estimate the doses received andtheir distri&(tion within the patient

&+ indicate the corrective meas(res re(ired toprevent rec(rrence of s(ch an incident

c+ implement all the corrective meas(res thatare (nder their own responsi&ility



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Inestigation o& e+"os!re58'S'S' ?'@6

Registrants and licensees shall:

d+ s(&mit to the Reg(latory (thority% as soon aspossi&le after the investigation or as otherwise

specified &y the Reg(latory (thority% a writtenreport which states the ca(se of the incident and

incl(des the information specified in *a+ to *c+% as

relevant% and any other information re(ired &y

the Reg(latory (thorityM ande+ inform the patient and his or her doctor a&o(t the

incident.

S


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S!mmary

• 8xpos(re of patients as part of their diagnosis ortreatment% has to &e '(stified

• Optimi)ation of patient expos(res means 9eepingdoses to a minim(m witho(t loss of diagnosticinformation

• Diagnostic Reference Levels are defined to serveas a reference for medical practitioners: if a level isexceeded some specified action or decision sho(ld&e ta9en

• DRLs are not dose limits.

.( t G t M I & ti


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.(ere to Get More In&ormation

• $afety Re(irements: Radiation Protection and $afety ofRadiation $o(rces: !nternational #asic $afety $tandards.Revision of !8 $afety $eries o.11;% !8% $eptem&er2611.

• !"RP 3,. Radiological Protection and $afety in 7edicine. nnals of the !"RP% 2*2+% 155.

• Radiation Protection 114. Referral =(idelines for !maging%8(ropean "ommission% 2664.

http:KKec.e(ropa.e(KenergyKn(clearKradioprotectionKp(&licati

onKdocK114N(pdateNen.pdf

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