Practical Aspects in Optimisation of Radiological Protection in Digital Radiography, Fluoroscopy, and CT

On behalf of EFOMP, I thank the ICRP for the efforts provided in drafting this important document, the second dedicated to optimization in medical imaging. In our opinion, the document will represent a valid support to make optimization in medical imaging more and more effective in clinical practice.

EFOMP agrees with the general structure of the document and, in particular, with the following key points:

the importance of introducing different optimization levels (basic, …, advanced), which can facilitate the optimization process at each medical imaging facility based on current conditions;

the importance of the collaboration within the optimization team which comprises radiologists, who have the clinical responsibility of the exposure, radiographers and medical physicists, to provide an effective and ever evolving optimization process;

the importance of promoting training in radiation protection and optimization and the need of adequate staffing levels. In this regard, EFOMP agrees with the following point

• 10 lines 335-336 “Indeed, without enough working hands and minds, the practical optimisation undertaken will inevitably remain at a superficial level.”;

radiation protection of the patient and that of the staff are often strongly interconnected. In this regard, EFOMP agrees with the following important points

• Pag 6 lines 177-179 “occupational protection should be managed in an integrated manner with patient protection.”
• 11 lines 392-393 “so this report will not deal with occupational exposure issues in any depth, but emphasises that occupational protection should be managed in an integrated approach with patient protection.”
• 48, lines 1434-1438. “Occupational exposure in interventional procedures is closely related to patient exposure and, therefore, management of occupational protection should be integrated with patient protection. Staff needs to apply the basic radiation protection principles and make effective use of protective devices. Measures to protect staff should not impair the clinical outcome, and should not increase patient exposure.”

Other specific comments

Pag. 25 lines 827-830 “Contact shielding is not generally recommended, and the effectiveness of shielding outside the FOV is minimal. However, consideration should be given to protection of the breast, gonads and thyroid where these organs lie within 5 cm of the primary beam (ICRP, 1982, 2013b) (Table 2.3).”

If deemed scientifically correct, we suggest removing this part “However, consideration should be given to protection of the breast, gonads and thyroid where these organs lie within 5 cm of the primary beam” and to modify the comments in Table 2.3 as well. In fact, the use of shielding is no more recommended in most cases and has been discouraged by many consensus papers, as correctly reported in the text. A strong position from ICRP on this point would be very important for the healthcare professional’s community.

Pag. 35, line 1071. We suggest modifying “medical radiation physicist” with “medical physicist”.

We suggest keeping the composition of the optimization team uniform across the text (radiologist, medical physicist, radiographer). Therefore, we suggest removing the following parts

• 53, box 3.9. we suggest removing “e.g., physicist / radiographer / x-ray engineer”.
• 78, lines 2326-2327 we suggest removing “The optimisation process … are needed.”
• 95, lines 2930-2931 we suggest removing “Beyond the core team … engineer,”.