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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "271" "paginaFinal" => "273" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "María Luisa España López" "autores" => array:1 [ 0 => array:3 [ "nombre" => "María Luisa" "apellidos" => "España López" "email" => array:1 [ 0 => "marisaespana7@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "President of the National Commission of Radiophysics. Member of the Advisory Committee of the Nuclear Safety Council. Former President of the Spanish Protection Society Radiological" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Hablamos de nuevos retos en protección radiológica en radiodiagnóstico?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The latest European directive<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> represents a much-needed update to the legal framework for radiodiagnostic exposures both in occupational and public settings, as well as for medical exposures,<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">2–5</span></a> which are the source of the greatest dose increase to the population due to exposure to artificial sources of radiation,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a> and this is where some of the most significant innovations have been established. In order to analyse these changes, it is helpful to know where we have come from, to critically assess the progress we have made and to positively address the challenges we face, which will require the commitment of all the professionals involved in the justification and optimisation stages of these procedures.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Radiological protection for medical exposure first appeared in Spanish legislation in 1990, in Royal Decree 1132/1990, now partially repealed, which establishes fundamental radiological protection measures for people undergoing medical examinations and treatments. The role of the qualified radiophysics expert—and later that of the radiophysics specialist—also appeared for the first time in said decree, in addition to important issues such as justification, optimisation, training and accreditation requirements, the registration of diagnostic imaging facilities, and the respective responsibilities of the professionals involved in medical exposures.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This marked the beginning of the legal framework for radiological protection in medical exposures for diagnostic imaging, but its implementation took several years. In 1995, the first royal decree on quality criteria for diagnostic imaging was published in Spain, which was later repealed by R.D. 1976/1999. It should be noted that in this update there is a clear example which shows that optimisation does not always mean a dose reduction, as the reference level for mammography, which was 7 mGy in 1995, was set at 10 mGy in 1999, to guarantee an image quality suitable for diagnosis. Sometimes, a decrease in radiation dose is presented as an isolated safety and quality parameter, but its validity stems from its connection with a certain diagnostic image quality. This is the objective of the optimisation, the success of which is determined by the cooperation of diagnostic imaging specialists, radiophysics specialists and senior diagnostic imaging technicians.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Since we started, we have heard promises of optimisation linked to new technologies, such as that digital radiology was to be accompanied by a decrease in the radiation dose and an image repeat rate of zero. However, we have also observed how in many cases doses were increased, and images continued to be repeated, since detecting repeats became more difficult, as well as how the availability of advanced dose optimisation tools, in multislice computed tomography (MSCT) equipment or C-arms, did not result in processes for the optimisation and improvement of the procedure. To this end, several causes can be assessed, but one of them—perhaps the most important—is the training of professionals.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The new directive states that “a high level of competence and a clear definition of responsibilities and tasks among all professionals involved in medical exposure is fundamental to ensure adequate protection of patients undergoing medical radiodiagnostic and radiotherapeutic procedures.” The prior and continued radiological protection training of all professionals,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a> particularly when a new technique or new technology is implemented, is also included in the Joint Position Statement by the International Atomic Energy Agency (IAEA) and World Health Organization (WHO), the “Bonn Call for Action”,<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> in which it is also recommended that the use of new training platforms be promoted in order to reach the widest range of groups possible. This is the direction we should be moving in. New platforms can facilitate the training of all professionals and such training is required not only in large hospitals, but also in less complex diagnostic imaging departments, so as to ensure that in-depth knowledge of the new technology allows it to be properly applied in optimisation processes that will improve clinical practice.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The challenges that have generated the most debate include the requirements related to the patient's dosimetric information and its incorporation into new radiology equipment, as well as the inclusion of computed tomography (CT) as a high-dose medical exposure.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The directive specifies the different capabilities that radiology teams should have in relation to dosimetric information: for interventional radiology, a device or feature reporting the amount of radiation produced by the equipment; also, for interventional radiology and for CT, a notification at the end of the procedure about the relevant parameters for assessing the patient's dose, and also the capacity to transfer them to the examination record. The latter information will also be required for any new equipment, although it will only be transferred to the examination record if it is applicable. Evidently, efforts are focused on interventional and CT equipment, given that these two radiodiagnostic procedures are considered high-dose. With a great deal of common sense, the legislation does not talk about recording doses, but about the parameters needed to assess them and the information related to exposure, since the dose depends not only on technical parameters, but also on the characteristics of each patient. While it is true that the accuracy required for radiodiagnostic dosimetry is generally lower than in radiotherapy, this should not be an excuse for dosimetric information not being rigorous enough. Consequently, it should be estimated by a radiophysics specialist, who must also validate the dosimetric indicators provided by the equipment.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Dosimetry in diagnostic imaging has two fundamental objectives: to check the good practices standards for optimising the dose and image quality, and to assess the health risk. Therefore, recording millions of pieces of dosimetric data does not provide any added value to the optimisation if these data are not analysed or verified. To this end, dose management systems are of great help, since they also allow us to establish optimisation processes for a greater number of procedures.</p><p id="par0045" class="elsevierStylePara elsevierViewall">A significant challenge is the information that must be provided to the patient, and in this regard, professional organisations must take on a leading role, preparing documents to ensure that this information is understandable and scientifically sound,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a> in contrast to the information often accessed by patients on social networks. There is currently some debate regarding the implication of recent epidemiological studies at low doses in the linear no-threshold model, used to estimate the risk of stochastic effects. However, the international organisations involved continue to support the use of this model for radiological protection purposes.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">11,12</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In diagnostic procedures, information on the level of radiological risk can be standardised for each type of procedure, while the information for more complex therapeutic procedures should perhaps be individualised.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Experience has shown us how the publication of technical notes endorsed by the societies involved has facilitated the provision of information to patients by dismantling certain fallacies, such as in the case of the use of protection material in mammography or in paediatrics,<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">13,14</span></a> and in that sense we should continue to promote the standardisation of information and establish criteria so that this information is tailored to the risk level.</p><p id="par0060" class="elsevierStylePara elsevierViewall">At present, we cannot even consider radiological equipment being commissioned without the required acceptance tests or periodic quality controls that ensure that all the physical parameters, which influence the dose and image quality, are within the established tolerances.</p><p id="par0065" class="elsevierStylePara elsevierViewall">If we analyse the progress made, radiological protection has improved the quality and safety of diagnostic imaging, but it is true that there is still lots of room for improvement, both in terms of medical and occupational exposures, and the main international organisations involved are promoting actions with this as the objective.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">15,16</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The new challenges in radiological protection in diagnostic imaging not only require a regulation guaranteeing its implementation, but also that the culture of optimisation, both in occupational and medical exposures, is more integrated in the daily activities of all diagnostic imaging departments, and for this reason, it is essential that all the professionals involved work together towards this objective.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: España López ML. ¿Hablamos de nuevos retos en protección radiológica en radiodiagnóstico? Radiología. 2019;61:271–273.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Directiva 2013/59/EURATOM del consejo de 5 de diciembre de 2013 por la que se establecen normas de seguridad básicas para la protección contra los peligros derivados de la exposición a radiaciones ionizantes. (DO L 13 de 17 de enero de 2014)." ] ] ] 1 => array:3 [ "identificador" => "bib0090" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Real Decreto 1085/2009, de 3 de julio, por el que se aprueba el Reglamento sobre instalación y utilización de aparatos de rayos X con fines de diagnóstico médico. Boletín Oficial del Estado n.° 173. 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Journal Information
Editorial
Are new challenges in radiological protection being discussed in diagnostic imaging?
¿Hablamos de nuevos retos en protección radiológica en radiodiagnóstico?
María Luisa España López
President of the National Commission of Radiophysics. Member of the Advisory Committee of the Nuclear Safety Council. Former President of the Spanish Protection Society Radiological