The state of radiological protection; views of the radiation protection profession: IRPA13, Glasgow, May 2012.

The IRPA13 Congress took place from 14-18 May 2012 in Glasgow, Scotland, UK, and was attended by almost 1500 radiological protection professionals. The scientific programme of the Congress was designed to capture a snapshot of the profession's views of the current state of knowledge, and of the challenges seen for the coming years. This paper provides a summary of these results of the Congress in twelve key scientific areas that served as the structural backbone of IRPA13.

Radiologic and nuclear medicine studies in the United States and worldwide: frequency, radiation dose, and comparison with other radiation sources--1950-2007.

The U.S. National Council on Radiation Protection and Measurements and United Nations Scientific Committee on Effects of Atomic Radiation each conducted respective assessments of all radiation sources in the United States and worldwide. The goal of this article is to summarize and combine the results of these two publicly available surveys and to compare the results with historical information. In the United States in 2006, about 377 million diagnostic and interventional radiologic examinations and 18 million nuclear medicine examinations were performed. The United States accounts for about 12% of radiologic procedures and about one-half of nuclear medicine procedures performed worldwide. In the United States, the frequency of diagnostic radiologic examinations has increased almost 10-fold (1950-2006). The U.S. per-capita annual effective dose from medical procedures has increased about sixfold (0.5 mSv [1980] to 3.0 mSv [2006]). Worldwide estimates for 2000-2007 indicate that 3.6 billion medical procedures with ionizing radiation (3.1 billion diagnostic radiologic, 0.5 billion dental, and 37 million nuclear medicine examinations) are performed annually. Worldwide, the average annual per-capita effective dose from medicine (about 0.6 mSv of the total 3.0 mSv received from all sources) has approximately doubled in the past 10-15 years.

Improvement of early detection of breast cancer through collaborative multi-country efforts: Medical physics component.

PURPOSE: The International Atomic Energy Agency (IAEA) through a Coordinated Research Project on "Enhancing Capacity for Early Detection and Diagnosis of Breast Cancer through Imaging", brought together a group of mammography radiologists, medical physicists and radiographers; to investigate current practices and improve procedures for the early detection of breast cancer by strengthening both the clinical and medical physics components. This paper addresses the medical physics component. METHODS: The countries that participated in the CRP were Bosnia and Herzegovina, Costa Rica, Egypt, India, Kenya, the Frmr. Yug. Rep. of Macedonia, Mexico, Nigeria, Pakistan, Philippines, Slovenia, Turkey, Uganda, United Kingdom and Zambia. Ten institutions participated using IAEA quality control protocols in 9 digital and 3 analogue mammography equipment. A spreadsheet for data collection was generated and distributed. Evaluation of image quality was done using TOR MAX and DMAM2 Gold phantoms. RESULTS: QC results for analogue equipment showed satisfactory results. QC tests performed on digital systems showed that improvements needed to be implemented, especially in thickness accuracy, signal difference to noise ratio (SDNR) values for achievable levels, uniformity and modulation transfer function (MTF). Mean glandular dose (MGD) was below international recommended levels for patient radiation protection. Evaluation of image quality by phantoms also indicated the need for improvement. CONCLUSIONS: Common activities facilitated improvement in mammography practice, including training of medical physicists in QC programs and infrastructure was improved and strengthened; networking among medical physicists and radiologists took place and was maintained over time. IAEA QC protocols provided a uniformed approach to QC measurements.

An assessment of smear taker training in the Northern & Yorkshire cervical screening programme.

OBJECTIVE: To assess the impact of a regional smear taker training scheme within the Northern and Yorkshire Cervical Screening Programme. DESIGN: An analysis of cervical screening KC activity returns to the Department of Health before and after the introduction of a structured training programme for smear takers. SETTING: Northern and Yorkshire Region of England. SUBJECTS: Women participating in cervical screening. RESULTS: The introduction of a region-wide smear taker training programme has resulted in fewer inadequate cervical smears, fewer opportunistic smears and fewer women aged below 20 having cervical smears. The training programme is cost effective. CONCLUSIONS: It is recommended that all cervical screening programmes consider the introduction of smear taker training. It is a cost-effective approach to running the cervical screening programme.

Scene setting: criteria for acceptability and suspension levels in diagnostic radiology, nuclear medicine and radiotherapy.

The EC (European Commission) Directive on radiation protection of patients requires that Criteria for Acceptability of Equipment in Diagnostic Radiology, Nuclear Medicine and Radiotherapy be established throughout the member states. This paper reviews the background to this requirement and to its implementation in practice. It notes parallel requirements in the EC medical devices directive and International Electrotechnical Commission standards. It is also important to be aware and that both sets of requirements should ideally be harmonised due to the global nature of the equipment industry. The paper further reviews the type of criteria that can be well applied for the above purposes, and defines qualitative criteria and suspension levels suitable for application. Both are defined and relationships with other acceptance processes are considered (including acceptance testing at the time of purchase, commissioning and the issue of second-hand equipment). Suspension levels are divided into four types, A, B, C and D, depending on the quality of evidence and consensus on which they are based. Exceptional situations involving, for example, new or rapidly evolving technology are also considered. The publication and paper focuses on the role of the holder of the equipment and related staff, particularly the medical physics expert and the practitioner. Advice on how the criteria should be created and implemented and how this might be coordinated with the supplier is provided for these groups. Additional advice on the role of the regulator is provided.

Core curriculum for medical physicists in radiology. Recommendations from an EFOMP/ESR working group.

Some years ago it was decided that a European curriculum should be developed for medical physicists professionally engaged in the support of clinical diagnostic imaging departments. With this in mind, EFOMP (European Federation of Organisations for Medical Physics) in association with ESR (European Society of Radiology) nominated an expert working group. This curriculum is now to hand. The curriculum is intended to promote best patient care in radiology departments through the harmonization of education and training of medical physicists to a high standard in diagnostic radiology. It is recommended that a medical physicist working in a radiology department should have an advanced level of professional expertise in X-ray imaging, and additionally, depending on local availability, should acquire knowledge and competencies in overseeing ultrasound imaging, nuclear medicine, and MRI technology. By demonstrating training to a standardized curriculum, medical physicists throughout Europe will enhance their mobility, while maintaining local high standards of medical physics expertise. This document also provides the basis for improved implementation of articles in the European medical exposure directives related to the medical physics expert. The curriculum is divided into three main sections: The first deals with general competencies in the principles of medical physics. The second section describes specific knowledge and skills required for a medical physicist (medical physics expert) to operate clinically in a department of diagnostic radiology. The final section outlines research skills that are also considered to be necessary and appropriate competencies in a career as medical physicist.

Cumulative attendance, assessment and cancer detection rate over four screening rounds in five English breast-screening programmes: a retrospective study.

BACKGROUND: Data collection in the National Health Service Breast Screening Programme monitors performance in a different cohort of women each year. METHODS: This paper follows a single cohort study of 57,425 women (aged 50-53, when first invited) over four screening rounds to find: how many women attend screening and how often; how many were assessed; how many times they were assessed; and the number of cancers detected at each round. RESULTS: Average attendance in each round was 76.9% and has remained constant. Only 62% of women have attended all four rounds, but 89.9% have been screened at least once, the average number of attendances being 3.5. Average assessment rate decreased from 7.3 to 3.5%. A total of 11.3% of women were assessed once, 0.91% twice and 0.06% three times. Cancer detection rates have more than doubled from 3.3 per 1000 screened to 6.9. CONCLUSIONS: Current monitoring shows constant uptake over time, but when looking at a cohort of individual woman, a much larger percentage have 'ever' attended and a smaller number have attended all invitations. The chance of a woman being assessed at all, if she attends all four rounds, is 12.3%, which can be calculated by summating the recall rates in each round.

Patient and staff radiation dosimetry during cardiac electrophysiology studies and catheter ablation procedures: a comprehensive analysis.

AIMS: To perform a comprehensive analysis of all aspects of patient and in-room personnel radiation dosimetry in interventional electrophysiology. METHODS AND RESULTS: Measurements were performed during 19 diagnostic electrophysiology studies and 24 catheter ablations. Kerma-area product and exposure time values were 48.7 (6.4-230) Gy cm2 and 25.5 (4.4-79.2) min for ablation, and 12.5 (4.5-117.2) Gy cm2 and 4.5 (1.2-31) min for diagnostic studies, respectively. Patient effective doses were 15.2 (2.1-59.6) mSv for ablation and 3.2 (1.3-23.9) mSv for diagnostic procedures. Radiation risk to the patient was estimated to be up to eight cases of fatal cancer in 10,000 procedures. The risk of development of fatal cancer was less than 3x10(-6) per procedure to the primary operator. The risk for the nurse and technician was much lower. The dose per procedure for the primary operator was 7.1 microGy at the eyes, 0.79 microGy at the chest under the lead apron, 13.68 microGy at the chest over the apron, 3.82 microGy at the thyroid, 17.76 microGy at the left hand, and 12.11 microGy at the left knee. CONCLUSION: As far as radiation exposure is concerned, electrophysiology studies followed by radiofrequency ablation are safe procedures for both patient and personnel when performed in catheterization laboratories with modern equipment, experienced operators, and standard safety precautions.