Radiological Protection of Patients in Diagnostic and Interventional Radiology, Nuclear Medicine and Radiotherapy Proceedings of an international conference held in Málaga, Spain, 26–30 March 2001, organized by the International Atomic Energy Agency and co-sponsored by the European Commission, the Pan American Health Organization and the World Health Organization RADIOLOGICAL PROTECTION OF PATIENTS IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY, NUCLEAR MEDICINE AND RADIOTHERAPY a PROCEEDINGS SERIES RADIOLOGICAL PROTECTION OF PATIENTS IN DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY, NUCLEAR MEDICINE AND RADIOTHERAPY PROCEEDINGS OF AN INTERNATIONAL CONFERENCE HELD IN MÁLAGA, SPAIN, 26–30 MARCH 2001, ORGANIZED BY THE INTERNATIONAL ATOMIC ENERGY AGENCY AND CO-SPONSORED BY THE EUROPEAN COMMISSION, THE PAN AMERICAN HEALTH ORGANIZATION AND THE WORLD HEALTH ORGANIZATION INTERNATIONAL ATOMIC ENERGY AGENCY VIENNA, 2001 c Permission to reproduce or translate the information contained in this publica- tion may be obtained by writing to the International Atomic Energy Agency, Wagramer Strasse 5, P.O. Box 100, A-1400 Vienna, Austria. © IAEA, 2001 VIC Library Cataloguing in Publication Data International Conference on Radiological Protection of Patients in Diagnostic and Interventional Radiology, Nuclear Medicine and Radiotherapy (2001 : Malaga, Spain) Radiological protection of patients in diagnostic and interventional radiol- ogy, nuclear medicine and radiotherapy : proceedings of an international con- ference held in Malaga, Spain, 26–30 March 2001 / organized by the International Atomic Energy Agency...[et al.]. — Vienna : The Agency, 2001. p. ; 24 cm. — (Proceedings series, ISSN 0074–1884) STI/PUB/1113 ISBN 92–0–101401–5 Includes bibliographical references. 1. Diagnosis, Radioscopic—Safety measures—Congresses. 2. Interventional radiology—Safety measures—Congresses. 3. Nuclear medicine—Safety measures—Congresses. 4. Radiotherapy—Safety measures—Congresses. I. International Atomic Energy Agency. II. Series. VICL 01–00268 Printed by the IAEA in Austria September 2001 STI/PUB/1113 d FOREWORD Medical applications of ionizing radiation (or ‘radiation’ for short) are accept- ed worldwide as essential tools for protecting and improving human health. However, they also represent by far the largest human-made source of radiation exposure. The United Nations Scientific Committee on the Effects of Atomic Radiation estimates that diagnostic medical applications of radiation account for about 95% of the expo- sure to radiation from human-made sources and about 12% of total exposure. Furthermore, there is certain to be a continuing increase in the prevalence of medical applications of radiation, including high dose procedures, as in the following cases: — Radiological interventional procedures, which are increasingly being used to replace surgery, can lead to very high radiation doses, both to patients and to medical staff, in some cases exceeding thresholds for deterministic effects. — The use of helical computed tomography (CT) has improved the diagnostic quality of CT examinations, and the procedures are faster and more flexible than with non-helical equipment. However, the increased number of procedures and the increased number of scans per procedure may lead to a significant increase in radiation exposure to patients. In diagnosis, the radiological protection objective is to keep doses as low as reasonably achievable while obtaining the necessary diagnostic information. According to the International Commission on Radiological Protection, doses from similar radiological investigations can differ by as much as two orders of magnitude. There is therefore considerable scope for dose reduction in diagnostic and interven- tional radiology and also in nuclear medicine. In therapy, the objective is to ensure that the target tissue is given the prescribed dose while minimizing the dose to sur- rounding healthy tissue. If the dose, dose distribution or dose fractionation is signif- icantly different from that prescribed, serious consequences can arise, as in recent incidents involving the accidental exposure of radiotherapy patients. The application of well designed quality assurance programmes is necessary in order to ensure the protection of patients. In October 1999 the IAEA General Conference issued resolution GC(43)/RES/12 requesting the Secretariat of the IAEA “to organize as soon as feasible, in close collab- oration with the World Health Organization and within the Agency’s current budgetary resources, an international meeting on the radiological protection of patients for the pur- pose of an exchange of information and the development of recommendations, as appropriate, regarding the radiological protection of patients”. In response to that request, the IAEA organized the International Conference on the Radiological Protection of Patients in Diagnostic and Interventional Radiology, Nuclear Medicine and Radiotherapy, which was co-sponsored by the European e Commission, the Pan American Health Organization and the World Health Organization, and which was hosted by the Government of Spain. The conference took take place in Torremolinos (Málaga), Spain, from 26 to 30 March 200l. Other international organizations and professional societies co-operated in the conference, namely the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), the International Commission on Radiological Protection (ICRP), the International Organization of Medical Physics (IOMP), the International Radiation Protection Association (IRPA), the International Society of Radiation Oncology (ISRO), the International Society of Radiographers and Radiological Technologists (ISRRT), the International Society of Radiology (ISR) and the World Federation of Nuclear Medicine and Biology (WFNMB). The conference was the first of its kind specifically focused on the radiological protection of patients. Apart from the opening and closing sessions, the conference pro- gramme comprised background sessions with papers by representatives of the co-spon- soring organizations and the professional societies, a briefing session with five papers to introduce the subject of the conference, 13 topical sessions and six round tables. The proceedings contain all the presentations and the summaries of all discus- sions, and also include the opening addresses and the conclusions and recommenda- tions. The contributed papers are provided on a CD-ROM which accompanies these proceedings. The IAEA gratefully acknowledges the support and generous hospitality extended to the conference participants by the Spanish authorities. EDITORIAL NOTE The Proceedings have been edited by the editorial staff of the IAEA to the extent considered necessary for the reader’s assistance. The views expressed remain, however, the responsibility of the named authors or participants. In addition, the views are not necessarily those of the governments of the nominating Member States or of the nominating organizations. Although great care has been taken to maintain the accuracy of information contained in this publication, neither the IAEA nor its Member States assume any responsibility for consequences which may arise from its use. The use of particular designations of countries or territories does not imply any judge- ment by the publisher, the IAEA, as to the legal status of such countries or territories, of their authorities and institutions or of the delimitation of their boundaries. The mention of names of specific companies or products (whether or not indicated as registered) does not imply any intention to infringe proprietary rights, nor should it be construed as an endorsement or recommendation on the part of the IAEA. The authors are responsible for having obtained the necessary permission for the IAEA to reproduce, translate or use material from sources already protected by copyrights. Material prepared by authors who are in contractual relation with governments is copyrighted by the IAEA, as publisher, only to the extent permitted by the appropriate national regulations. f CONTENTS EXECUTIVE SUMMARY . i OPENING SESSION Opening Address C. Villalobos Talero . 3 Opening Address J.Á. Azuara . 7 Opening Address A. Díez de los Ríos Delgado . 11 Opening Address R. Ruiz Cruces . 13 Opening Address F.A. Mettler . 15 Opening Address A.J. González . 17 Opening Address K. Schnuer . 23 Opening Address C. Borrás . 27 Opening Address H. Ostensen . 31 GLOBAL VIEW ON THE RADIOLOGICAL PROTECTION OF PATIENTS (Background Session) Role of the IAEA in the radiological protection of patients P. Ortiz López, A.D. Wrixon, A. Meghzifene, J. Izewska . 35 EU laws and guidance reinforce the radiological protection of patients M. Sarró Vaquero, D. Teunen . 47 Global view on the radiological protection of patients: PAHO position paper C. Borrás . 55 Global view on the radiological protection of patients: The World Health Organization position H. Ostensen . 67 The role of the United Nations Scientific Committee on the Effects of Atomic Radiation in relation to medical radiation exposures P.C. Shrimpton . 71 g International Commission on Radiological Protection F.A. Mettler . 77 Role and responsibilities of medical physicists in radiological protection of patients A. Niroomand-Rad . 79 The activities of the International Radiation Protection Association in relation to the radiological protection of patients G.A.M. Webb . 91 International Society of Radiology and Radiation Protection C.G. Standertskjöld-Nordenstam . 95 Global view