There is one issue that concerns me particularly at present, and I find this draft report ambiguous on this particular point, namely whether E (effective dose) can be used in a “dose passport” and as exam dose information in the medical examination report. I would very much like to see this clarified in the final version of the report.
EURATOM 59/2013 article 58b states that “Member States shall ensure that information relating to patient exposure forms part of the report of the medical radiological procedure”.
Section 5.4 of this draft ICRP report deals with risk communication, education and training of clinicians (line 1794-1810) and communication of risks to patients (lines 1811-1838), and recommends use of E for these purposes.
But the ICRP draft does not specify explicitly if effective dose to the reference person (calculated from average DLP/Pka values for the corresponding exam type) can be indicated as “exam dose” in an exam report, in addition to individual values of modality specific dose quantities like Pka or CTDIvol (included as “technical dosimetric parameters”?). Inclusion of E in the exam report might facilitate communication between radiologists and clinicians from other specialties who are not familiar with Pka or CTDIvol. Also, inclusion of E would give patients an understandable value of exam dose, and discourage uninformed comparisons of Pka and CTDIvol values. So it would facilitate risk communication between clinicians and communication of risks to patients. On the other hand, effective dose to the reference person is not the exam dose for one single exam to a particular patient, and E should not be used for individual risk assessment.
If ICRP recommends or considers acceptable to indicate effective dose to the reference person in exam reports and dose passports, I believe this needs to be stated clearly in the current ICRP report. If ICRP discourages/disagrees with the use of E for this purpose (or if the matter is still under consideration), then this also needs to be stated as clearly as possible in the current ICRP report, and the reasons against it listed and explained clearly.
Several apps are currently available for mobile phones, that calculate effective dose for different examinations, and create dose passports. This puts pressure on hospitals to provide similar information to their patients.