Women in radiation (WiR)-a perspective for the strengthening of radiation protection.

Gender balance refers to the equitable treatment and access to opportunities for all genders. In order to achieve true gender balance, a variety of proactive approaches developed collaboratively, with insight from multiple perspectives, need to be implemented. With that purpose, the participation of women in professions related to radiation and radiation protection was prioritised and given high visibility by allocating a 'Women in Radiation' (WiR) Special Session at the 15th International Congress of the International Radiation Protection Association (IRPA), hosted by South Korea on 20 January 2021. In this session, various issues related to gender balance and equity/equality were highlighted by the panellists, and further elaborated in a subsequent discussion with attendees. The main goal of the WiR Special Session was to convene women from different organisations, career and age stages, disciplines and countries, in particular to consider the Asian-Oceanic vision and status of gender equality, along with other topics to support a 'Call for Action', with concrete recommendations subsequently provided to IRPA. The discussion stressed the main needs and challenges faced by women working in various radiation fields, along with raising awareness of possible professional and employment opportunities. This paper identifies some steps necessary to encourage, enhance and support the inclusion of more diversity in nuclear professions with specific emphasis on women. In conclusion, gender balance and equality must be at the heart of any strategic plan for the future of the radiological protection profession; international cooperation between relevant bodies is essential for success and could serve as a catalyst for specific policy statements aimed at achieving a balanced representation of women in radiological protection.

[Reporting and information system for significant events related to radiation exposures in medicine: Structure, responsibilities and reporting criteria]. / Melde- und Informationssystem für bedeutsame Vorkommnisse bei Strahlenanwendungen in der Medizin: Struktur, Zuständigkeiten und Meldekriterien.

The increasing frequency and complexity of medical radiation exposures to humans inevitably result in higher risks of harmful unintended or accidental radiation exposures. To ensure a high level of protection and its continuous improvement, the Directive 2013/59/Euratom thus requires to systematically record and analyze both events and near-miss events as well as, in the case of their significance, to disseminate information regarding lessons learned from these events promptly and nationwide to improve radiation protection in medicine. These requirements have been transposed into German legislation by the new radiation protection law and radiation protection ordinance that entered into force simultaneously on December 31th, 2018. The reporting and information system as provided by these regulations as well as the tasks, duties and powers of the parties involved are presented in the first part of this review article. In the second part, the established application-specified criteria for the significance - and thus the notification requirement - of (near-miss) events are itemized and explicated.

IRPA Consultation: is the system of protection 'fit for purpose' and can it be readily communicated? Views of the radiation protection professionals.

The system of protection, which provides the basic underpinning philosophy and principles for radiation protection, is constantly evolving in the light of developing scientific understanding and practical experience. Over recent times there has been significant learning from experiences relating to the Fukushima accident, and there is also increasing recognition of the importance of enhancing public understanding of radiation and risk. The practical application of radiation protection is undertaken by thousands of practitioners around the world, and it is IRPA's task to ensure that this experience is fed back for the benefit of all. This Memorandum reports the outcome of IRPA's consultation on the system of protection. The principal issues raised in the consultation include general perceptions of the system, risk uncertainties at low dose, the context of natural background exposure, dose limits and limitation, ALARA and reasonableness, and public understanding and communication of radiation and risk.

Radiation protection of medical staff.

The continuing increase in the worldwide use of X-ray imaging has implications for radiation protection of medical staff. Much of the increased usage could be viewed as simply a workload issue with no particular new challenges. However, advances in technology and developments in techniques have seen an increase in the number of X-ray procedures in which medical personnel need to maintain close physical contact with the patient during radiation exposures. The complexity of many procedures means the potential for significant occupational exposure is high, and appropriate steps must be taken to ensure that actual occupational exposures are as low as reasonably achievable. Further attention to eye protection may be necessitated if a lowering of the dose limit for the lens of the eye is implemented in the near future. Education and training in radiation protection as it applies to specific situations, established working procedures, availability and use of appropriate protective tools, and an effective monitoring programme are all essential elements in ensuring that medical personnel in X-ray imaging are adequately and acceptably protected.

Radiation protection: some philosophical and ethical issues.

The ethical issue of justification has become an urgent issue in radiology. There has been a shift in emphasis in the discussion from what has been regarded as a rather paternalistic attitude of practitioners to one that stresses the rights of the individual patient. This article comments on this current move on the part of the profession by offering certain relevant philosophical considerations. Using a medical scenario as the context to comment on this shift, it discusses important and fundamental issues, such as the autonomy and the rights of the patient in addition to the question of consent on the patient's part.

The importance and unique aspects of radiation protection in medicine.

Radiation protection in medicine has unique aspects and is an essential element of medical practice. Medical uses of radiation occur throughout the world, from large cities to rural clinics. It has been estimated that the number of medical procedures using radiation grew from about 1.7 billion in 1980 to almost 4 billion in 2007. In spite of these large numbers, there are many parts of the world without adequate equipment, where the ability to perform additional medical procedures would likely result in a net benefit. Medicine accounts for more than 99.9% of the per caput effective dose from man-made sources. The goal in medical exposure is not to give the lowest dose, but to provide the correct dose to enable the practitioner to make the diagnosis or cure a tumour. Too little or too much dose is problematic and the risk of any given procedure ranges from negligible to potentially fatal. Radiation protection in medicine must deal with the issues of not having dose limits, purposely exposing sensitive subgroups, and purposely using doses that could cause deterministic effects. Radiation accidents involving medical uses have accounted for more acute radiation deaths than from any other source including Chernobyl. Many physicians have little or no training in radiation protection, and many have no qualified medical physics support. In many countries, medical radiation devices and uses are only minimally regulated and the rapidly evolving technology is a challenge. Medicine also accounts for the largest number of occupationally exposed workers and collective dose.

Current issues and actions in radiation protection of patients.

Medical application of ionizing radiation is a massive and increasing activity globally. While the use of ionizing radiation in medicine brings tremendous benefits to the global population, the associated risks due to stochastic and deterministic effects make it necessary to protect patients from potential harm. Current issues in radiation protection of patients include not only the rapidly increasing collective dose to the global population from medical exposure, but also that a substantial percentage of diagnostic imaging examinations are unnecessary, and the cumulative dose to individuals from medical exposure is growing. In addition to this, continued reports on deterministic injuries from safety related events in the medical use of ionizing radiation are raising awareness on the necessity for accident prevention measures. The International Atomic Energy Agency is engaged in several activities to reverse the negative trends of these current issues, including improvement of the justification process, the tracking of radiation history of individual patients, shared learning of safety significant events, and the use of comprehensive quality audits in the clinical environment.

Radiation exposure of medical staff from interventional x-ray procedures: a multicentre study.

The purpose of this study was to analyse the radiation exposure of medical staff from interventional x-ray procedures. Partial-body dose measurements were performed with thermoluminescent dosimeters (TLD) in 39 physicians and nine assistants conducting 73 interventional procedures of nine different types in 14 hospitals in Germany. Fluoroscopy time and the dose-area product (DAP) were recorded too. The median (maximum) equivalent body dose per procedure was 16 (2,500) microSv for an unshielded person; the partial-body dose per procedure was 2.8 (240) microSv to the eye lens, 4.1 (730) microSv to the thyroid, 44 (1,800) microSv to one of the feet and 75 (13,000) microSv to one of the hands. A weak correlation between fluoroscopy time or DAP and the mean TLD dose was observed. Generally, the doses were within an acceptable range from a radiation hygiene point of view. However, relatively high exposures were measured to the hand in some cases and could cause a partial-body dose above the annual dose limit of 500 mSv. Thus, the use of finger dosimeters is strongly recommended.