Patient doses in medical imaging including interventional Radiology International actions: ICRP recommendations and practices in Spain

The ICRP recommends that justification and optimization criteria be applied to medical exposures and that diagnostic reference levels (DRLs) be used in medical imaging including interventional radiology. For fluoroscopic guided interventional procedures, the relative 'complexity' of the procedure should be taken into account when establishing DRLs. The ICRP recommendations on patient dose management for different imaging modalities are summarized, especially for interventional procedures, digital radiology and computed tomography. Reference is also being made to the new publication on 'Education and Training in Radiological Protection for Diagnostic and Interventional Procedures' and the working documents on 'Radiological Protection in Paediatric Diagnostic and Interventional Radiology', 'Avoiding adverse radiation effects to doctors and patients in fluoroscopic guided procedures - practical guidelines' and 'Patient and staff Radiation Protection in Cardiology'. The second part of the paper deals with the application of the ICRP recommendations and the European Directive on Medical Exposures in medical imaging, in Spain. The requirements on RP training for medical professionals are described, including the mandatory 'second level' of training in RP for interventional radiology. The support and involvement of the medical physics experts in medical imaging are also discussed, together with the role of the Health Authority and the Nuclear Regulatory Authority. In Spain, a quality assurance program, including patient dose measurements, has been mandatory since 1999 and some hospitals have promoted pilot experiences to collect and process patient dose values in real time. As a conclusion and considering the global demand for 'safer medicine', it is suggested that the management of patient doses in imaging come first on the agenda, that automatic registration of patient doses in the X-ray systems be improved and that the Health and Regulatory Authorities implement a 'friendly'-graded approach in radiation safety for patients. (author)