Changes Impacting on Radiation Protection in Medicine Since the Malaga Conference

Millions of X ray examinations, both diagnostic and interventional, nuclear medicine procedures and radiotherapy treatments are performed annually worldwide. The radiation dose to the population of the United States of America from medical radiation is now almost equal to that of background radiation, and increased more than seven times in the 25 years from the early 1980s to 2006. The main reason is that modern medicine demands rapid diagnosis and treatment. Radiology is an essential component of patient management, as many patients have multiple investigations using ionizing radiation, particularly computed tomography (CT), and some go on to have X ray guided treatment or radiotherapy. There has been an inexorable rise in the range and numbers of minimally invasive interventional techniques being performed using fluoroscopy, and these techniques have offered enormous benefits to many patients who otherwise may not be candidates for more invasive surgery. The range of radionuclides that can be used in medicine has also increased and the types of specific radiotherapy have become more complex. Despite these huge benefits, health professionals have to accept that some procedures deliver high radiation doses to patients. Radiation injuries, in interventional radiology and cardiology, and accidental exposures in radiotherapy are fortunately not common compared to the number of procedures or treatments performed, but were increasingly reported in the 1990s and 2000s