The topic of recurrent radiological imaging of patients attracted attention due to the recent studies indicating the magnitude of this phenomenon and the associated higher cumulated individual exposure to be more extensive than previously known. Recurrent imaging is used for managing various health conditions and chronic diseases such as malignancies, trauma, end-stage kidney disease, cardiovascular diseases, Crohn’s disease, urolithiasis, cystic pulmonary disease. The published studies, although available from only a part of the world, triggered discussion at international level, including two IAEA technical meetings with representatives of the IAEA Member states and international organization. The conclusions to date were reflected in the published Joint Position Statement and Call for Action by nine international organizations aimed to prompt greater dialogue and engage different stakeholders in developing and implementing strategies and solutions focused upon improved radiation protection of patients with medical conditions which prompt more frequent imaging procedures. Such actions include improved access to dose saving imaging technologies; improved imaging strategies and appropriateness process; specific optimization tailored to the clinical condition and patient habitus; wider utilization of the automatic exposure monitoring systems with an integrated option for individual exposure tracking in standardized patient-specific risk metrics; improved training and communication. These might need strengthening in the radiation protection framework to ensure that patients with medical conditions which prompt more frequent imaging procedures receive needed medical care, without undue exposure to ionizing radiation. Standardized and easily available dose information in patient-specific metrics is needed to improve risk quantification. Consensus is still lacking on the proper utilization of the dose information from the previous procedures, and the concern of misuse and misinterpretation, especially by referring physicians and patients, needs to be addressed. Like any other aspect of medical uses of ionizing radiation, the competence and awareness of users of dose information is paramount, and this is linked to the knowledge, education, training and communication. The integration of the clinical and exposure history data will support research studies and improved knowledge about radiation risks from low doses and individual radiosensitivity. The radiation protection framework will need to respond to the challenge of recurrent imaging and high individual doses. The radiation protection perspective complements the clinical perspective, and the risk to benefit analysis must account in holistic for all incidental and long-term benefits and risks for patients, their clinical history and specific needs. This is a step toward the patient-centric healthcare.
Keywords: Radiation protection of patients; Recurrent imaging; Patient exposure tracking; Justification; Optimisation
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Participants in clinical trials involving exposure to ionizing radiation are another group for whom recurrent imaging may be important. Some clinical trial proposals involve exposure to hundreds of mSv. Participants in such studies are typically patients with poor prognoses. Research Ethics Committees may seek to satisfy themselves regarding non-radiological risks (e.g. burden of participation in repeated imaging procedures) in addition to considering radiation detriment risks.
Such trials are important for the development of new drugs. Perhaps the revised Recommendations can address related issues, including the needs for accuracy and intelligibility of participant information sheets? Important to bear in mind that research participants are - or should be - volunteers, and need to give informed consent. From experience, risk statements drafted by researchers may inadvertently misrepresent radiation risks, reinforcing the need for education & training.