Justification of medical exposures

The system of radiological protection aims to control radiation risks without unduly limiting the potential benefits for individuals and for society. The new International Radiation Basic Safety Standards (BSS) have expanded the requirements for justification of medical exposures pand optimization of protection and safety in medicine. A substantial fraction of radiation imaging procedures is unjustified and does not provide a net benefit. An area of special concern is the unnecessary use of radiation in medical imaging when clinical evaluation or other imaging modalities could provide an accurate diagnosis. Referral criteria for medical imaging are consensus statements based on the best available evidence, to assist decision making process when choosing the best imaging procedure for a given patient. Although they are advisory rather than compulsory, there should be good reasons to deviate from them. Justification of procedures and optimization of protection are the two pillars of radiological protection in health care, and they are embedded in the notion of good medical practice. However, health professionals are not familiar with these principles and, in particular have a low awareness of radiation protection aspects of justification. A stronger collaboration between radiation protection and health care communities is needed to improve the radiation protection culture in the medical practice.

Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards

Justification and use of clinical imaging referral guidelines

Key representatives of the world’s leading medical imaging societies met in Geneva between 1-3 March 2010 in the first global expert meeting on referral guidelines for appropriate use of medical imaging convened under WHO auspices in nearly two decades. Experts from international, regional and national professional societies as well as representatives from the International Atomic Energy Agency and the European Commission, met in a WHO-hosted consultation on the issue in. Diagnostic imaging and interventional radiology procedures are increasingly used to accurately diagnose a wide range of illnesses and injuries. But inappropriate use of such technologies can lead to unnecessary exposures. Reduction of unnecessary radiation exposure by justification of radiological medical procedures is a major goal for the Global Initiative.

The use of imaging referral guidelines as decision support tools can contribute to that goal. The 36 experts agreed upon a roadmap to promote guidelines’ development, implementation and use. Since then, WHO has continued and expanded its collaboration with the IAEA, ISR, WONCA and other key stakeholders to support Member States for the adoption, adaptation, implementation and use of imaging referral guidelines (e.g. advocacy and guidance tools, education and training of referring physicians).

Meeting report

Justification of the use radiation for medical imaging of asymptomatic people

Decision making tools such as evidence-based clinical imaging referral guidelines can enhance justification of medical imaging in patients with clinical conditions (i.e. current or past signs and/or symptoms). In contrast, consensus still does not exist regarding criteria for justification of medical imaging of asymptomatic people outside approved population screening programmes, for individual health assessment (IHA). WHO started a project to develop a conceptual framework for justification of these radiological procedures.

An international expert consultation to address the justification of the use of computed tomography (CT) in asymptomatic people for IHA was convened on 15-17 October 2014 in Munich, Germany, hosted by the BfS as a WHO Collaborating Centre. The consultation mapped out the current status of the practice in different regions of the world and identified some key issues related to the justification process, clinical governance and regulatory approaches. Building on the outcomes of that consultation WHO is organizing an International Stakeholders Workshop on Justification of the Use of CT in for IHA of Asymptomatic People that will be held on 26-28 September 2016 in Seoul, Korea, hosted by the Korean Society of Radiology.