The Inter-Agency Committee on Radiation Safety-30 years of international coordination of radiation protection and safety matters.

The Inter-Agency Committee on Radiation Safety (IACRS) was constituted in 1990, as a forum for collaboration and coordination between international bodies with regards to radiation safety. It consists today of representatives of eight intergovernmental member organizations (the European Commision, Food and Agriculture Organization, International Atomic Energy Agency (IAEA), International Labour Office, Organisation for Economic Co-operation and Development/ Nuclear Energy Agency (OECD/NEA), Pan American Health Organization, United Nations Scientific Committee on the Effects of Atomic Radiation and the World Health Organization) and five observer non-governmental organizations (International Commission on Radiological Protection, International Commission on Radiation Units & Measurements, International Electrotechnical Commission, International Radiation Protection Association and International Organization for Standardization). The IACRS provides a platform for interaction between these relevant international bodies to contribute to a common understanding of the scientific basis and legal framework for the application of the system of radiation protection, towards global harmonisation of radiation safety standards. The IACRS played a key role in the development of the International Basic Safety Standards (BSS) in 1996 and in its revision in 2014. Further, an IACRS specific Task Group-chaired by the IAEA-fosters the implementation of the BSS in a consistent and coherent manner in all Member States of the United Nations. The IACRS operates via a standing secretariat jointly provided by the IAEA and OECD/NEA and is chaired by one of its member organizations on a rotating basis for periods of about 18 months. This approach has proved to be effective and was the foundation for ensuring continuity of the work of the committee and at the same time allowing a rotating leadership for all member organizations. Currently, the IACRS is chaired by the WHO. The International Radiation Safety Framework under which the IACRS works is structured around four main areas: (a) science; (b) principles; (c) standards; and (d) practice. This paper presents briefly the mandates, roles and functions of the various international bodies that are relevant to the four above mentioned areas of work, discusses how these bodies coordinate their actions and complement each other to enhance radiation protection and safety worldwide and describes their contribution to the achievement of the Sustainable Development Goals. The paper also provides an overview of the main accomplishments of the IACRS since its inception 30 years ago, and an outlook on key challenges for its future activities.

Radiation protection in diagnostic radiology.

INTRODUCTION: The use of ionizing radiation is regulated by legislative bodies to limit both individuals' and the population's exposure to radiation. Germany has implemented the European 97/43/EURATOM directive in national law by updating the existing radiation protection regulations. The German Commission on Radiological Protection regularly publishes statements and recommendations on radiation protection in medicine and diagnostic radiology, such as the introduction of diagnostic reference levels and referral guidelines for radiological and nuclear medicine imaging. METHODS: Review of selected literature, national and international recommendations and legal texts. RESULTS: From a radiological protection perspective, clear justification for radiological examinations and techniques aimed at minimizing radiation dose while providing the required diagnostic information, are essential. DISCUSSION: Referring doctors should be sure to use existing guidelines for medical imaging, and liaise with radiologists and nuclear medicine specialists, with whom they share the responsibility for choosing appropriate imaging modalities.

Medical exposure of the population from diagnostic use of ionizing radiation in luxembourg between 1994 and 2002.

A national evaluation on radiation doses from diagnostic procedures (x rays and nuclear medicine) was conducted in Luxembourg for the period 1994-2002 aiming at the estimation of the annual collective dose. The calculations were based on a survey of frequencies of more than 250 types of radiological examinations and included more than 425,000 patients. This evaluation ensured the practical implementation of Article 12 of the European Directive 97/43/EURATOM, which obliges the Member States to determinate the population dose from medical exposure. The results show an increase of the annual effective dose per capita from 1.59 mSv in 1994 to 1.98 mSv in 2002. The impact of computed tomography to dose received from medical use of radiation has dramatically increased in this time period. Luxembourg has one of the highest computed tomography examination rates compared to other health care level I countries. The following measures to minimize medical exposures were proposed in the study: medical physicists should have a more central role to play in patient dosimetry in interventional and diagnostic radiology, especially concerning computed tomography. Also, the implementation of an electronic "X-ray patient card" for all irradiated patients--except dental--and the use of the European referral criteria that give guidance and recommend investigations in various clinical settings can both help to decrease medical radiation exposures.

[Evaluation of the national epidemiological program of breast cancer screening in the Grand Duchy of Luxembourg, 1999-2002]. / Evaluation epidémiologique du programme national de dépistage du cancer du sein au Grand-Duché de Luxembourg, 1999-2002.

In 1992 a national breast cancer screening programme was launched in Luxembourg with following characteristics; invitation at 2-yearly interval, 2 views, double reading for women aged between 50 and 64 and since 2001, those aged 65-69 are as well included. From the beginning on, one of the main concern was to respect a rigorous methodology, in accordance with the recommendations of the European Commission. This paper presents the early performance indicators of the years 1999-2002 of the "Programme Mammographie". Almost all histopathological results were obtained, because only one national pathology laboratory exists in Luxembourg, where also the national tumor's register is located. In ten years, a total of 91.432 mammograms were performed. The results of the early performance indicators are in agreement with the European Recommendations. A 36% detection rate of small size cancers, < or = 10 mm, and since 2000, more then 70% of node negative cancers are observed among women aged 50-64 attending the Programme. The cancer rate with a good prognostic factor for the patients is high. Despite good results, the rate of interval cancers is still too high, and two conclusions can be drown: the women's participation at screening has to be steady in time without trespassing a two years intervals, and after the detection of small cancer a high quality assessment should be followed by an adequate treatment, leading to a reduction of mortality and also to a decrease of morbidity by treatment.

[The situation of Medical Physics in Luxembourg]. / Die Situation der Medizinischen Physik in Luxemburg.

Medical Physics is recognized for the first time in the Healthcare System of the Grand Duchy of Luxembourg through the ordinance of 16 March 2001. This ordinance regulates the measures of quality assurance towards the radiation protection of patients, as well as the responsibilities and tasks of the Medical Physics Experts. The ordinance does not specify the number of qualified personnel required to perform all the quality controls demanded for the hospitals. In this work calculations were carried out, resulting in personnel requirements of 19 persons, 7 of whom as Medical Physics Experts. Also, a concept is presented proposing an optimum distribution of the personnel in order to ensure the practical implementation of the European Directive 97/43 EURATOM.

A breast cancer screening programme operating in a liberal health care system: the Luxembourg Mammography Programme, 1992-1997.

The national breast cancer screening programme in Luxembourg, the Mammography Programme (MP), was launched in 1992. Its primary goal was to set up an organised breast cancer screening with biennial invitation-reinvitation of women 50-64 years, 2-view mammography, technical quality assurance, double-reading procedures and close monitoring of performance. In 1994, the decision was taken by health authorities to only reimburse screening mammograms done within the MP. We evaluated the performance of 3 screening rounds that took place in 1992-1997. In 1992, 4,815 women had opportunistic screening and 4,790 attended the MP. In 1997, 861 women had opportunistic screening and 8,603 attended the MP. In 1997, the participation rate in the MP reached 50%. The referral rate in the MP was 10% for initial screening and 5% for subsequent screening. Echographic examinations accounted for 71% of referrals. Per 1,000 screened women, biopsy and cancer rates were 18.0 and 8.0 for initial screening and 10.3 and 5.8 for subsequent screening. Twenty-one percent of the breast cancers diagnosed in screened women were interval cancers. The age-adjusted proportion of tumours >20 mm was 56.1% before 1992, 45.1% for women not (yet) screened by the MP, 27.0% for interval cancers, 26.6% for initial screening and 12.0% for subsequent screenings. Tumour size distribution was similar to that observed in the Dutch Breast Cancer Screening Programme, 1990-1993, except that in the latter programme, no difference was observed between initial and subsequent screening. The Luxembourg experience shows that in a liberal health care system, a policy of organising the screening process by reimbursing only those mammograms done within the context of the organised screening programme can drastically reduce opportunistic screening. Further efforts in the Mammography Programme will aim at increasing participation and look at ways to decrease referrals to echography.