By Lenka Dojcanova, IAEA Office of Public Information and Communication

Medical procedures using radiation are saving lives every day around the globe. A strong national framework for radiation protection and safety ensures that patients are protected during these procedures. The IAEA last month piloted a model for a new type of advisory mission to assess such a framework in Estonia, which ensures that benefits outweigh the risks.

Every year, four billion diagnostic and therapeutic procedures using ionizing radiation are conducted around the world including radiotherapy, nuclear medicine and X-ray imaging such as X-rays and computed tomography. Medical professionals need to select the most appropriate medical procedures and perform them safely using the right dose to diagnose and treat diseases such as cancer.

While the IAEA is providing various peer reviews and advisory services related to radiation safety, there has not been a service focusing on the specific and comprehensive review of the national framework for radiation protection and safety in medicine.

“There are frequently observed gaps in the implementation of safety standards related to medical exposure around the world, which could have an impact on patients’ safety,” said IAEA Radiation Protection Specialist, Jenia Vassileva. “To improve the situation, the IAEA is stepping up its efforts in assisting countries not only on how to improve the regulatory framework but also on how to implement different aspects.”

Member States from Europe and Central Asia, a region with rapidly growing applications of advanced techniques in medicine, were the first to propose such missions under the Technical Cooperation Programme.

Following the draft  guidelines, a pilot mission was organized and an IAEA-led team of experts in regulatory and practical aspects of radiation protection in medicine compared the country’s actual practices with the International Basic Safety Standards (BSS), which set a number of requirements and responsibilities to achieve radiation protection in medical exposures. The team also assessed arrangements against the Specific Safety Guide on Radiation Protection and Safety in Medical Uses of Ionizing Radiation, which provides recommendations and guidance on fulfilling the BSS.

Pilot in Estonia

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 Head of the Climate and Radiation Safety Department at the Environmental Board of Estonia, Ilmar Puskar.

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 the mission Team leader, and Principal Advisor of the Regulatory body of Finland (STUK), Ritva Bly.

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.

Way forward

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 IAEA Director of Technical Cooperation Division for Europe, Eve-Kulli Kala. “Having good regulation and a framework for its implementation in medicine is a prerequisite for sustainable and efficient technical cooperation projects in this area.”