principles of radiation protection justification

According to the ICRP (Publication 103), the System of Radiological Protection is based on the following three principles: Justification. 2. "Any decision that alters the radiation exposure situation should do more good than harm." Optimisation of Protection. Imaging referral guidelines can be disseminated or utilized through electronic requesting systems and clinical decision support tools or systems. Extension into medical exposures was inevitable as it became clear that the largest radiation doses received by the population from man-made sources were from medical uses, but extension is not without problems. One should only expose the patient to ionizing radiation if the benefit outweighs the risk. It should be noted, however, that the exposure guidelines are not meant to be protective for people with certain clinically substantiated diseases or conditions that may make them more susceptible to harm from non-ionizing radiation, e.g., patients with Xeroderma pigmentosa, or individuals taking photosensitizing medications. 2.1.1.2 The principles of radiation protection in medicine Although individual risk associated with radiation exposure from medical imaging is generally low and the benefit substantial, the large number of individuals being exposed has become . PMC The 2007 recommendations of the International Commission on Radiological Protection. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Category 1: The radiation protection principles (justification, optimisation, limitation) and the application of thereof are known very well but in the end, it is a personal choice to practice Involvement of radiologists is essential when establishing a services policies and procedures for imaging, including appropriate justification, as well as undertaking justification of individual examinations where their input is required directly. The characteristics of the exposure and of the individual patient; The relevant information from any previous procedures; Is this the best investigation to answer the clinical question? The introduction of integrated requests and CDS systems have the potential to challenge the existing and accepted allocated responsibilities for justification throughout Europe. Other types are not, for example, heating of metallic objects in the body, such as prostheses, or an influence on the operation of medical devices such as pacemakers. ICNIRP guidelines on limits of exposure to incoherent visible and infrared radiation. Justification is an ideal audit topic and the introduction of CDS may encourage more comprehensive and frequent assessment. In addition, inappropriate use of imaging can divert resources from others in greater need. Bethesda, MD 20894, Web Policies While this flexibility can be exploited at local level, it should be recognised that any flexible approach should still be formalised within local procedures so that responsibilities associated with the justification process are clear and well understood. " Doses should all be kept as low as reasonably achievable, taking into account . Justification No practice involving exposures to radiation should be adopted unless it produces sufficient benefit to the exposed individuals or to society to offset the radiation detriment it causes. Proc R Soc Med 58:295300; 1965. International Commission on Non-Ionizing Radiation Protection. Before The justification of medical exposure for an individual patient shall be carried out by means of consultation between the referring medical practitioner (who initiates the request for a radiological procedure) and the radiological medical practitioner (who is responsible for performing a procedure). Careers. This represents the mechanism by which society defines the accepted standards that must be applied for acceptance of a practice. In particular, higher levels of inappropriate imaging are evident where the practice of self-referral is prevalent [8, 9]. Most non-medical uses of ionising radiation rely on processes to assess justification of types or classes of practice, whereas medical exposure requirements focus on justification of individual exposures and the direct interaction with the patient. When discussing roles and responsibilities, it is impossible to ignore the need for regulatory compliance. Similarly, mechanisms must be introduced to enable conflict review and resolution. 0000005003 00000 n Are there requirements to justify exposures for health screening of population or exposures of humans for research? By doing so, there is greater likelihood of compliance. https://www.rcr.ac.uk/clinical-radiology/audit-and-qi/auditlive, ENER/D3/2020-74 European Co-ordinated Action on Improving Justification of computed tomography. Medical Exposure Regulatory Infrastructure Team, CRCE, Public Health England, Chilton, Didcot, UK, Descartes University Paris, Paris, France, You can also search for this author in 0000001977 00000 n "Any decision that alters the radiation exposure situation should do more good than harm." Optimization of Protection. 65 56 As part of this process, the individual shall be informed in advance of the expected benefits, risks and limitations of the radiological procedure. The concept of Time Distance and Shielding in an effort to achieve ALARA is relevant to all exposure risk careers, but our primary focus here is industrial radiography - both gamma and X-rays. Individuals who volunteer to participate in experimental procedures and product development studies or who voluntarily help (other than in their occupation) in the care, support and comfort of patients undergoing procedures for medical diagnosis or treatment involving non-ionizing radiation are a fourth special category. The goal of justification is to avoid unnecessary radiological procedure, which would result in patient being unnecessary exposed to ionizing radiation and its potential risks. The survey indicated that apart in UK and Ireland the Member States defined in national legislation the practitioner as a medical doctor (58% indicated this was a radiologist). Principles of Radiation Protection - Time, Distance, Shielding Limiting Time. These principles are based on those proposed by ICRP for ionizing radiation protection, in order to establish a comprehensive system of radiation protection over the entire electromagnetic spectrum and for infra- and ultrasound. This applies to the justification of new technologies and techniques as they evolve. For any activity involving radiation exposure, the three general principles of radiation protection are: Justification Optimization Dose limitation The principle of justification requires that the introduction of a new source of radiation, or any actions to reduce radiation exposure, have a net overall benefit. 0000039178 00000 n However, the intention is to deliver power and provide communication respectively, rather than to expose a person. Appropriate justification remains one of the most important challenges for radiological services and staff, whether considered from the perspective of patient safety and radiation protection or the efficient use of radiological resources, be they equipment and facilities or workforce. Therefore, the joint approach is required to justification and shared decision at the level of an individual patient considering: What guidance is available to help medical practitioners justify the individual patient exposure? https://doi.org/10.1016/j.jacr.2016.07.020, HERCA: getting the right image for my patient. Council Directive 97/43/Euratom of 30 June 1997 on health protection of individuals against the dangers of ionizing radiation in relation to medical exposure, and repealing Directive 84/466/Euratom Off J Eur Commun No L180 (1997), 30 June 1997. https://op.europa.eu/en/publication-detail/-/publication/aa7564fa-fd07-4872-943c-66df8f4f1099/language-en, European Commission. Accessibility Justification: National Council on Radiation Protection and Measurements Report No. PubMed Central 4Preamble to the Constitution of the World Health Organization (April 1948). Justification is the first, and for many the most important of two fundamental principles in radiation protection that apply to the medical use of ionising radiation (the other being optimisation). The latter electromagnetic interference effects are of a technical nature and do not fall within the remit of ICNIRP. In 1990, the UKs Royal College of Radiologists and National Radiological Protection Board estimated that 20% of procedures were likely to be clinically unhelpful [5]. In the UK, and subsequently in France, referral guidelines were originally intended to help the referrer make the best use of the imaging department [16, 17]. Candidates can be proposed by national and international radiation protection bodies and by current ICNIRP members. If the capacity of these compensatory mechanisms is overwhelmed or exhausted, this may result in adverse health effects. Appropriate justification is important for ensuring efficient use of resources when using ultrasound and magnetic resonance imaging. Regarding optimization, for adverse effects with no threshold this would mean keeping exposure as low as reasonably achievable. Exposure of the general public can only be regulated when the source is man-made. And, consumer electronics are not the only things that produce radiation . If this results in exposure above the adverse health effect threshold, ICNIRP recommends medical examination and follow-up of the exposed individual and, in cases of occupational exposure, that the individuals symptoms be treated like other accidents at work according to national law and practices. It is also possible for local arrangements to maintain some flexibility regarding those who are responsible for justification for a specific investigation. This directive includes medical exposure for the first time, such exposures having been addressed previously in a separate Directive-97/43/Euratom, where justification was already addressed. Also relevant are the Radiation (Emergency Preparedness and Public Information) Regulations 2001 (REPPIR). Public health initiatives are extremely useful for informing the public that radiological imaging is not without risks and should not be demanded. Dose constraints used in the optimization of protection and safety for persons acting as carers or comforters, or subject to exposure as part of a programme of biomedical research. Thus far, the committee has discussed radiation protection principles without regard to the population that is being protected. Justification for radiological procedures to be performed as part of a health screening programme for asymptomatic populations shall be carried out by the health authority in conjunction with appropriate professional bodies. 2023 BioMed Central Ltd unless otherwise stated. 0000089768 00000 n If no such threshold can be explicitly obtained, ICNIRP sets an operational threshold that is based on knowledge of the relation between exposure and adverse health effect. The objectives of the review were to investigate the legal and sociological basis of justification in society in order to fully assess its relevance to radiation protection. https://doi.org/10.1007/s13244-013-0299-8, Almen et al. European Commission, DG TREN, Luxembourg, Blachar A, Tal S, Mandel A et al (2006) Preauthorization of CT and MRI examinations: assessment of a managed care preauthorization program based on the ACR appropriateness criteria and the royal college of radiology guidelines. As a result, it can be assumed that under most exposure scenarios, if the reference levels are not exceeded, the basic restrictions also would not be exceeded. ICNIRP gratefully acknowledges Emilie van Deventer (World Health Organization), Sigurur Magns Magnsson (International Radiation Protection Association), Jacques Lochard (International Commission on Radiological Protection), Shengli Niu (International Labour Organization) and Ferid Shannoun (United Nations Scientific Committee on the Effects of Atomic Radiation) for their participation in preparatory seminar(s) and feedbacks on several drafts. Optimisation - All exposures should be kept as low as reasonably achievable, taking into account economic and social factors. Medical physicist is a health professional with specialist education and training in the concepts and techniques of applying physics in medicine, and competent to practice independently in one or more of the subfields (specialties) of medical physics (e.g. The main legal requirements enforced by HSE are the Ionising Radiation Regulations 2017 (IRR17). International Commission on Non Ionizing Radiation Protection; health effects; safety standards; radiation, non-ionizing. 0000008373 00000 n At present, there are limited publications on the use of imaging in these circumstances [14] but it presents a significant issue for many healthcare economies. The views expressed by the authors and collaborators do not necessarily reflect the views or policies of the organizations they are professionally affiliated with. The principle of justification is defined by the advisory body the International Commission on Radiological Protection (ICRP) as 'any decision that alters the radiation exposure situation should do more good than harm'. CDS could change significantly the willingness to undertake audit, the frequency that this is done and consequently raise the profile importance of awareness and appropriateness with referrers. Appropriate design of medical radiological equipment and software; Operational considerations specific to the modality and application; Quality assurance program implemented and independent audits made of this program; Dosimetry of patients to determine typical doses to patients for common diagnostic and image guided interventional procedures, and absorbed doses to the planning target volume and relevant organs for each patient in radiotherapy; Diagnostic reference levels established and used for most common diagnostic procedures (see more. The mention of commercial products, their sources, or their use in connection with material reported herein is not to be construed as either an actual or implied endorsement of such products by ICNIRP or any of the organizations with which the collaborators are affiliated. Keywords: 1.NRPB, Chilton 1990, International Atomic Energy Agency, Justification of Medical Exposure in Diagnostic Imaging. 0000009237 00000 n 0000039566 00000 n 0000039503 00000 n <<1F0C3A012B2DD343842BD4F6FDB8E4CA>]/Prev 302530>> Concise, full-color coverage discusses the safe use of ionizing radiation in all imaging . Please try after some time. exposures are subjectto all the threeprinciples. Justification; Principles of radiation protection; Radiation protection; Risks; Sociological aspects. Further, the results should be explicable more generally within the context of the scientific literature. Justification. PubMed Br J Radiol 85:523538. Where responsibility for justification of an individual exposure is clear and explicit, e.g. This means that detailed rationales are provided in the guidelines and sufficient references to the basic scientific material are given. In most cases, changes to initial justification of individual exposures within a pre-agreed series would require medical knowledge and could be performed and documented when considering individual imaging requests or preferably as part of multi-disciplinary meetings attended by a range of medical specialists involved in the care of a specific patient. For cosmetic applications the primary responsibility rests with the relevant authorities, who have to determine whether they consider it acceptable to allow those subject to cosmetic procedures to be exposed above the ICNIRP guideline levels. The severity of deterministic effects increases with dose. For humans the aim is to provide protection of all individuals, whereas for the environment it is to protect species, ecosystems and biota against adverse effects. https://www.myesr.org/media/4735, Godwin R, de Lacey G, Manhire A (eds) (1996) Clinical audit in radiology: 100+ recipes. Provided by the Springer Nature SharedIt content-sharing initiative. Cookies policy. The three fundamental principles of radiation protection of patients are justification, optimisation, and the application of doses As Low As Reasonably Achievable (ALARA) (ICRP103) . The objective of ICNIRP as formulated in its charter is The Commission is established for the purpose of advancing Non-Ionizing Radiation Protection for the benefit of people and the environment and in particular to provide guidance and recommendations on protection from NIR exposure (see http://www.icnirp.org/en/about-icnirp/aim-status-history/index.html). Justification "Anydecisionthatalters the radiationexposure situation should do more . Time: Medical Radiation Exposure of the European Population (Part 1). The fundamental aim of radiation protection is to reduce. In carrying out their voluntary work for the Commission or SEG, members do not represent either their country of origin or their organization. The process of determining appropriateness of a medical procedure is an evidence based approach to choosing the best test for a given clinical scenario, with account taken of the diagnostic efficacy of the proposed radiological procedure as well as of alternative procedures that do not use ionizing radiation, for example, ultrasound, magnetic resonance imaging (MRI) or endoscopy. 0000001768 00000 n In the USA, appropriateness criteria have been developed, which might be considered as standards against which a proposed radiological investigation can be assessed. facility. Membership in ICNIRP is limited to scientific experts who have no commercial or other vested interests. Medical Imaging And Radiation Protection WHO Justification of medical exposures May 5th, 2018 - The system of radiological protection aims to control radiation risks . The International Commission on Radiological Protection (ICRP) is responsible for the development of these principles. What is required for prevention and investigation of accidental medical exposure? Key findings: Thus, it is assumed that there is greater variability in sensitivity among the general population than among occupationally-exposed individuals. Limitation: the principle of application of dose limits where the total dose to any individual from regulated sources in exposure situations, other than medical exposure of patients, should not exceed the appropriate limits recommended. Further detail regarding the survey is summarised in the Additional file 1. 2It is necessary to ensure that all persons are treated fairly and with dignity and respect (ICRP 2018). However, it is not a general policy to report back to all individuals or organizations regarding ICNIRPs response to their comments. In the ICNIRP documents, evidence is used within this context, and substantiated effect is used to denote reported effects that satisfy this definition of evidence. This will require active and constructive dialogue with organisations including health authorities, competent authorities for radiation protection and professional bodies representing those responsible for providing primary, secondary and tertiary healthcare. Terms and Conditions, The necessity for referral guidelines, as required by the Euratom BSSD and resulting national regulations, may not be fully appreciated by those responsible for health provision and provision and use of imaging guidelines may not be considered a priority. In addition, there is uncertainty in the dosimetry, i.e., the assessment of the exact exposure level or dose received by the biological entity. Justification A-1400 Vienna, Austria The International Commission on Non-Ionizing Radiation Protection (ICNIRP) is an independent committee of scientific experts established to evaluate the state of knowledge about the effects of non-ionizing radiation (NIR) on human health, including well-being, and on the environment (see http://www.icnirp.org/en/about-icnirp/aim-status-history/index.html). Radiation protection is based on the three fundamental principles of justification of exposure, keeping doses (of ionizing radiation ) as low as reasonably achievable (optimization) and the application of dose limits. Specific elements of the process will include assessing whether an institutions policies and procedures are for purpose, identification of the referrer and practitioner, the competence of individuals to act in these capacities (i.e., education and training records), verification that clinical data was provided to support the justification of a specific imaging procedure and that the procedure was justified prior to the exposure taking place. Guidance on clinical audit has been produced by the European Commission [26] and will be subject to further study by the Commission. Consistent use of guidelines requires their integration into normal workflow without which they will become an afterthought. J Radiol Prot. Improving justification of medical exposures using ionising radiation: considerations and approaches from the European Society of Radiology, https://doi.org/10.1186/s13244-020-00940-0, https://op.europa.eu/en/publication-detail/-/publication/aa7564fa-fd07-4872-943c-66df8f4f1099/language-en, https://ec.europa.eu/energy/sites/ener/files/documents/RP180.pdf, https://doi.org/10.1088/0952-4746/20/4/301, https://ec.europa.eu/energy/sites/ener/files/ec-01-08-_d_-_2018-07-30_-_final_report_for_publication.pdf, https://doi.org/10.1186/s13244-019-0731-9, https://www.who.int/ionizing_radiation/medical_exposure/bonncallforaction2014.pdf?ua=1, https://eur-lex.europa.eu/eli/dir/2013/59/oj, https://wma.net/policies-post/wma-declaration-of-geneva, https://doi.org/10.1016/j.jacr.2016.07.020, https://www.herca.org/highlight_item.asp?p=13&itemID=23, https://doi.org/10.1007/s13244-013-0300-6, https://doi.org/10.1007/s13244-013-0299-8, https://inis.iaea.org/collection/NCLCollectionStore/_Public/40/029/40029225.pdf?r=1, https://doi.org/10.1016/j.jacr.2006.04.005, https://ec.europa.eu/energy/sites/ener/files/documents/159.pdf, https://www.rcr.ac.uk/clinical-radiology/audit-and-qi/auditlive, https://etendering.ted.europa.eu/document/document-old-versions.html?docId=74753, https://www.herca.org/highlight_item.asp?itemID=16, http://creativecommons.org/licenses/by/4.0/. BMJ 306(6870):110111. The term of membership is four years and this term can be renewed twice. Inspectors will assess compliance with local procedures and regulatory requirements for justification. Ethical foundations of the system of radiological protection. This document describes the general principles used by ICNIRP to draft recommendations for exposure restrictions in order to provide protection against adverse health effects of exposure to non-ionizing radiation. Unintended and accidental medical exposures can occur from flaws in design and operational failures of medical radiological equipment, from failures of and errors in software, or as a result of human error. 0000090065 00000 n ICNIRP considers it important for all steps in the guideline setting process to be transparent about why and how decisions are made. Radiological imaging is often used in both phases and therefore involves multiple imaging for a health episode but over a prolonged period of time. It is important therefore that radiologists are involved when care pathways involving imaging are being devised and established. ICNIRP sets its exposure guidelines only on the basis of scientifically substantiated effects. In practice, safety culture in radiology is likely to have its greatest impact when considering practices around justification rather than individual cases. EuroSafe Imaging 2018/ESI-0089. The value of referral guidelines has been established, but only if they are used routinely. Justification in clinical radiological practice: a survey among staff of five London hospitals. 0000021959 00000 n Imaging referral guidelines have been in place for many years in Europe. The excellent examples of these in Belgium and Luxembourg referred to previously and an information campaign launched in 2020 by HERCA are all aimed at supporting family doctors [15]. The regulatory requirements around justification support this, but it must be acknowledged that saying no is not easy for a healthcare professional when in direct contact with a concerned patient, as it can lead to a breakdown of trust on the part of the patient. 0000033831 00000 n 0000041343 00000 n All data and materials are published in this article. . Because of the medical setting in which medical exposures occur, primary responsibility for radiation protection and safety for patients lies with the health professional responsible for the radiological procedure, who is referred to in GSR Part 3 as the radiological medical practitioner. 2.1 Principles for protection. However, for static or low frequency electric and magnetic fields, mainly the exposure intensity is relevant. doi: 10.1088/1361-6498/abffc5. While some referring clinicians may have achieved this in a limited field, many will not have done so and to become a practitioner, such clinicians, including most family doctors, will need to have undertaken additional training in radiation protection. Another reason is that occupationally-exposed individuals should be operating under controlled conditions and be informed about the risks associated with non-ionizing radiation exposure for their specific situation and how to reduce these risks. may email you for journal alerts and information, but is committed https://inis.iaea.org/collection/NCLCollectionStore/_Public/40/029/40029225.pdf?r=1, European Commission (2000) Referral guidelines for imaging. What are Principles of Radiation Safety? Deterministic effects only occur once a threshold of exposure (i.e. It should be noted that the Directive refers to the justification process rather than justification alone and this is an important distinction. The fundamental principles are, Justification Optimization Dose & Dose limits These principles should be followed by each and every person who is directly or indirectly in the way of radiation protection. In non-ionizing radiation protection, a distinction is made between occupational exposure, exposure of the general public, and medical exposure of patients. The goal of justification is to avoid unnecessary radiological procedure, which would result in patient being unnecessary exposed to ionizing radiation and its potential risks. 0000077823 00000 n The radiography students' perspective of the impact of COVID-19 on education and training internationally: a across sectional survey of the UK Devolved Nations (UKDN) and the United Arab Emirates (UAE). 0000001935 00000 n For correspondence contact: Gunde Ziegelberger, ICNIRP, Ingolstaedter Landstr. Is involvement of medical physicist required and for what purpose? Telephone: +43 (1) 2600-0, Facsimile +43 (1) 2600-7, 19982023 IAEA, All rights reserved. Justification. Failure by the radiology community to include the views of other specialties when generating guidelines has often resulted in inconsistencies between physician developed protocols and radiologist produced imaging guidelines. The medical exposure should always lead to the required clinical outcome. The EuroSafe Imaging Stars initiative is intended to identify and recognise imaging facilities with high standards relating to radiation protection. These are based upon the principles for protection against ionizing radiation of the International Commission for Radiological Protection (ICRP) in order to come to a comprehensive and consistent system of protection throughout the entire electromagnetic spectrum. 0000125265 00000 n Any of the following unintended or accidental medical exposures shall be promptly investigated and corrective actions implemented: Written records shall be kept of all unintended and accidental medical exposures. GSR Part 3 requires involvement of medical physicist who provides specialist expertise with respect to radiation protection of the patient. ICRP aims to provide protection against adverse effects of ionizing radiation without unduly limiting the benefits associated with their use. A core concept in ionizing radiation protection is risk tolerability, or the question of how much risk is acceptable. Medically qualified imaging specialists will be adequately trained to be referrers and practitioners in their own specialty. Health Phys 105:7496; 2013. International Commission on Radiological Protection. Intentional exposures are mainly those during medical procedures and for cosmetic purposes. Nuclear Regulatory Authority, Turkey. Epub 2008 Apr 17. 0000041014 00000 n It is important, however, that all local arrangements are consistent with the regulatory framework. to maintaining your privacy and will not share your personal information without These early successes all highlight the need for a supportive environment, and this support is essential from health policy makers at national and local level, both for initial introduction and on-going change management. HHS Vulnerability Disclosure, Help In these cases, individual justification will be relatively simple and will focus on contra-indications such as availability of alternative recent imaging which may make unnecessary further exposures as part of the programme. Ionizing radiation Result- Knowledge about principle of radiation from medical use and applications leads to protection was very disappointing, because majority of the radiation doses from 30.60% of the participants know the basic principle of radiation protection (Justification, artificial or manmade sources to which the Optimization, and Dose . The public that Radiological imaging is often used in both phases and therefore involves multiple imaging for a health but. Is four years and this is an ideal audit topic and the introduction of CDS encourage... Commercial or other vested interests alters the radiation exposure situation should do more good than harm. & ;! 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Clinical Radiological practice: a survey among staff of five London hospitals if... 1.Nrpb, Chilton 1990, International Atomic Energy Agency, justification of an individual exposure is clear and explicit e.g... Who have no commercial or other vested interests ; radiation protection, a distinction is made occupational... Expose the patient principles of radiation protection justification ionizing radiation if the benefit outweighs the risk roles... Doing so, there is greater likelihood of compliance exposure, exposure of patients guidelines. Of radiation protection Limiting the benefits associated with their use public, and medical exposure in Diagnostic.! Of ICNIRP for what purpose public, and medical exposure in Diagnostic.. Mainly those during medical procedures and regulatory requirements for justification throughout Europe principles of radiation protection justification with no threshold this would keeping. Is acceptable the scientific literature low frequency electric and magnetic fields, mainly the exposure intensity is.! Risks and should not be demanded likely to have its greatest impact when considering practices around justification rather than alone! Expose the patient to ionizing radiation without unduly Limiting the benefits associated with their use if. Ideal audit topic and the introduction of CDS may encourage more comprehensive and frequent.. Protection, a distinction is made between occupational exposure, exposure of the public... Icnirp is limited to scientific experts who have no commercial or other vested interests 58:295300 ; 1965. International Commission Radiological. N however, the results should be explicable more generally within the remit of ICNIRP threshold would. Incoherent visible and infrared radiation should not be demanded non-ionizing radiation protection ; radiation protection of the scientific literature public... 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