Accept my copliments, the ICRP for putting up such a useful, informative and, an insightful document on practical aspects of radiological protection in digital radiology, fluoroscopy and CT. It is timely!
Some few points really stood out for me in this document. 1) The area of collaboration and teamwork to ensure success of the practical aspects in optimisation of radiological protection of digital radiography, fluoroscopy and CT. 2) Continuous education and training in radiation protection and radiological health literacy of all relevant stakeholders.
While I agree with most of the submissions in this document and comments by other experts and professional groups, I wish to make the following observations:
1) Globally, most health care systems are transitioning from "Facility-Based Care" to "People-Centred Care" (WHO, 2018) in line with the health-related Sustainable Development Goals (SDGs) of the United Nations with the Universal Health Coverage (UHC) as a driver. The goal is to take health care closer to people, where they are, and not waiting for people or patients to come to the health care facility. Taking health care closer to the people also includes digital (mobile, portable and hand-held) radiology services. Thus, facility managers, as highlighted in this document (331-332), should also capture health care managers beyond the four walls of the health care facility or clinics to include those involved in health outreach programmes and point of care services at community level to understand the optimisation processes for different populations, context and settings. The growing use of portable and hand-held digital X-ray imaging equipment for public health interventions demand special attention, especially in high demand and underserved populations as well as fragile, conflict and vulnerable settings (FCVs). The practical aspects of optimisation of radiological protection in these settings should be more explicit.
2) The use of patient gonadal shielding during x-ray based diagnostic imaging should be discntinued as a routine practice (455). This requires further explanation because we are at different levels of the optimisation process as highlighted in the document. More awareness expected in this area for experts in underserved populations.
3) Effective implementation of new technologies to achieve better patient care and outcome requires continuous collaborative efforts and continuous training and retraining.
4) Paediatric radiation protection needs special attention amidst the complexities of digital technologies in radiology, fluorocopy and CT that rarely capture the needs of children. The weight based DRLs recommended by the ICRP in 2017 for paediatric is yet to be implemented in most clinical settings.
Thank you for the opportunity to make an input to this rich document.