Introduction and Scope

In the vast majority of medical applications of ionizing radiations, the associated benefits largely overcome the risks of detrimental effects associated to the exposure of workers, members of the public and patients. However, the use of ionizing radiation for medical purposes must strictly follow and comply to the internationally agreed basic standards, regulations and good practices of radiological protection and safety.

The International System of Radiological Protection is based on three fundamental principles: the principle of Justification (of the procedures), the principle of Optimisation (of the protection and procedures) and the principle of Dose Limitation. The latter, though, is not applicable to the use of ionising radiation for medical purposes. In the field of medical applications of ionising radiation, important progress has been made in the last few years,, in relation to the implementation of the principle of Optimisation. It has been internationally recognised, however, that additional effort should be devoted in the coming years to effectively improve the observance and implementation of the principle of Justification. Such efforts must involve all the actors and stakeholders (medical doctors, physicists, technologists and other Health professionals, regulators and competent authorities, researchers, academia, trainers, professional and scientific societies, associations of patients, the public, the equipment manufacturers, amongst others).

Other important and hot topics in the field of radiological protection and safety in the medical applications of ionizing radiation are related to:

  • The dissemination of the use of new techniques, new technologies and methodologies using Computorised Tomography (CT). These involve higher exposures for both the staff and the patients. Of particular relevance, the paediatric exposures to ionizing radiation in the framework of medical examinations, which is a major concern at an international level, considering the higher radiosensitivity of organs and tissues in newborns, children and adolescents.
  • The increase in the number of procedures in Interventional Radiology and Cardiology, which can lead to:
    • The exposure of highly sensitive organs, such as the thyroid and the eye lens to considerable values of radiation dose, with further associated risk in body extremities (hands and fingers) of the staff involved in these procedures.
    • Excessive radiation doses to the patients which can lead to tissue effects, namely on their skin.
  • The growing use of new radionuclides, as well as new radiopharmaceuticals, in Nuclear Medicine, both for diagnostic purposes, in oncological, cardiovascular, and neurological diseases, among others, as well as for therapeutic purposes. This raises the need to adapt the medical procedures and to avoid high exposures both for the staff and for the patients.
  • The radiological safety of patients in external radiotherapy and brachytherapy and the prevention of incidents or accidents arising from various causes, such as those reported internationally throughout the last decades in different countries.
  • The induction of secondary cancers or other non-cancer diseases, namely of cardiovascular and cerebrovascular nature, in the post-radiotherapy treatment phase. This issue has been a concern which has received special attention by the international community.
  • The need to develop efforts to promote the continuous awareness of all stakeholders (including decision makers), for the effective implementation of a radiological protection and safety culture at all levels.
  • Radiological risk communication (what to communicate and at what level?) associated to medical exposures.
  • The very important role of education and training in the implementation and management of Radiological Protection and Safety in the various medical procedures and examinations involving the use of of ionizing radiation.
  • Exposure to low-doses of ionising radiation, which are characteristic of medical applications of ionising radiation for diagnostic purposes. This topic deserves great attention by the experts, considering the scarcity of scientific data and knowledge on the radiosensitivity of organs and tissues as a function of age of the exposed individuals as well as related to other aspects such as the individual susceptibility.

Finally, the Directive 2013/59/EURATOM, that deal with the basic standards and regulations concerning the safety of the use and applications of ionising radiation should be transposed to the national law until  the 6th of February 2018. It addresses many Radiological Protection and Safety topics and it can be anticipated that it will have considerable repercussions in all topics related to medical applications of ionising radiation, namely in the implementation of the justification in medical examinations, in the optimisation and dose reduction for staff and patients. It will also address aspects of Education & Training of the medical staff, as well as in what relates to the regulatory system of medical radiological practice, among others. It will also incorporate the definition of the Medical Physics Expert, predicting the corresponding levels education and training, and continuous professional learning, in view of its recognition by the competent authorities.

We believe that it is timely and relevant to trigger, in Portugal, thorough fruitful technical and scientific discussions (also in the regulatory, legal, socio-economic, clinical, etc. components) of the aforementioned topics. Such discussions will be facilitated and fostered by the organisation of the Conference "Proteção Radiológica na Saúde 2013" ("Radiological Protection in Health 2013", in the translation to English), which will primarily gather Portuguese stakeholders, but which will count among its participants eminent members of the international community of experts. The involvement of all national actors and stakeholders is of the utmost importance in view of the aimed success of this initiative.