RE: Occupational vs. Medical Exposures

["J. J. Rozental" <josrozen@netmedia.net.il>]

RESPONSIBLE PARTIES

         In case of patients undergoing diagnostic or therapeutic
procedures, the medical practioner   is responsible to select the best
available radiopharmaceutical and its acitivity. The dose equivalent limit
do not apply. For this reason the practitioner shall optimize the protection
to patient. This only can be achieved by training in the field of radiation
protection that has been accepted as adequate by the Competent Authority. 

a) The Licensee (main responsible party) should ensure that for diagnostic
uses of radiation the imaging and quality assurance requirement of the
Radiation Safety Standards be fulfilled with the advice of a qualified
expert in either radiodiagnostic physics or nuclear medicine physics, as
appropriate;

b) Medical practitioners have the primary task and obligation of ensuring
overall patient protection and safety in the prescription of, and during the
delivery of, medical exposure;

c) Training criteria should be specified or subject to approval, as
appropriate, by the Regulatory Authority in consultation with relevant
professional bodies.

        The legal person responsible for a source to be used for medical
exposure shall include in the application for authorization:

(i) The qualifications in radiation protection of the medical practitioners
who are to be designated by name in the registration or license; or

(ii) a statement that only medical practitioners with the qualifications in
radiation protection specified in the relevant regulations or to be
specified in the registration or license will be permitted to prescribe
medical exposure by means of the authorizes source.


JUSTIFICATION:

        When we mention the word justification, we use it in general terms,
as we can learn in any Radiation Protection Standards. However, to
understand really the meaning of Justiffication we should read specific
Guidelines to determine for each responsible party the measures and
resources needed to achieve the protection and safety objectives and to
assure that the resources  are provided and the measures properly
implemented. This is valid to any occupational exposure, medical exposure or
public exposure, including both normal and potential exposures.

        The justification of each type of diagnostic examination by
radiography, fluoroscopy or nuclear medicine should consider guidelines
according to those established by the WHO

a) A Rational Approach to Radiodiagnostic Investigations, WHO Technical
Report Series 689 (1983);

b) Rational Use of Diagnostic Imaging in Pediatrics. WHO Technical Report
Series 757 (1987);

c) Effective Choices for Diagnostic Imaging in Clinical Practices, WHO
Technical Report Series 795, (1990)

EXAMPLE OF APPLICATION:

        I can mention the Brazilian example (and good experience): There is
an formal Agreement among the Brazilian College of Radiology, The Brazilian
Association of Medical Physics and the Brazilian Nuclear Energy Commission
to Certify medical practitioners in the areas of Nuclear Medicine,
Radiotherapy and Diagnostic as well as Medical Physics (also in one of the
above areas). 
On basis of this Agreement the  Brazilian Association of Medical Physics has
specific Courses on Radiation Protection approved by the Brazilian Nuclear
Energy Commission to train medical practitioners. This training Course is a
pre-requirement, and specific part for future formal examination in order to
Certify medical practitioners or medical physics in Radiation Protection,
according with the specific area.
        Personally, in the year 1974 I was one of the responsible to
introduce  and to implement this agreement valid up to the present.

J. J. Rozental
josrozen@netmedia.net.il
Israel 


At 10:25 AM 7/1/99 -0500, you wrote:
>The physician's job is not to estimate the population risk from a given
>dose, so why would you expect him to know the answer.  If you asked a
>physicist to diagnose a cancer and prescribe the proper radiotherapy,
>I'll bet that you would not get an accurate, quantitative
>response.        
>
>Though there is not a lot of information included about the U.K., if
>U.S. uses twice the radiography and has similar health statistics, then
>maybe the heath effects from the extra radiography are negligible.
>
>I think the great interest in reducing occupational dose may be due, in
>part, to job security.  If the public were more educated on effects of
>radiation, there were probably be less fear, fewer overly restrictive
>regulations and fewer physicists employed in the area of radiation
>protection.  I am not saying that those in rad. protection are trying to
>scare the public, but the area of rad. protection would likely be
>greatly reduced in size if regulations were based on risk informed
>decisions and actual radiation studies (hormesis, etc...).
>
>This is my personal opinion and not that of the company for which I
>work.
>
>kevin.goldsmith@wepco.com
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>
jjrozental

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