The first major step to overcoming the fragmentation and lack of visibility for radiation protection in the medical field was the development of a common strategic research agenda (SRA).
To achieve this,
representatives of the medical associations dealing with ionising radiation worked together to identify the most important topics in radiation protection research in medical applications.
The most important research topics for effective medical care and radiation protection are summarised in five main themes:
1.
Measurement and quantification in the field of medical applications of ionising radiation
A key priority for radiation protection research in radiation oncology,
nuclear medicine,
and also interventional and diagnostic applications of ionising radiation,
is to improve techniques and methods for measurement and quantification.
Key research aspects in measurement and quantification research are:
- Characterisation of exposure to radiation
- Individual dosimetry
- Quality metrics for diagnostic imaging and therapy
- Sources and influences of uncertainty
2.
Normal tissue reactions,
radiation-induced morbidity and long-term health problems
Improving health risk estimates is another key priority for radiation protection research.
The key research aspects in tissue reactions and biological risk research are:
- Exposure-associated cancer risk,
as related to dose,
dose-distribution,
and dose-rate dependence
- Non-cancer effects in various tissues and radiobiology-based effect models for individual morbidity endpoints
- Individual patient-related radiation sensitivity and early biomarkers of response and morbidity
- Radiobiological mechanism of radiation-induced side-effects and protective strategies
3.
Optimisation of radiation exposure and harmonisation of practices
According to the European Basic Safety Standard (BSS) (2013/59/EURATOM) [1],
the radiation protection of individuals subject to public or occupational exposure must be optimised with the aim of keeping the magnitude of individual doses,
the likelihood of exposure and the number of individuals exposed as low as reasonably achievable.
The optimisation of the protection of individuals subject to medical exposure should be consistent with the medical purpose of the exposure.
Simultaneously,
the EU Directive on patients’ rights in cross-border healthcare (2011/24/EU) [2] calls for a concerted strategy in terms of harmonisation of clinical practices,
meeting patients' expectations of the highest quality healthcare,
including when they seek treatment away from home.
High variability of mean effective doses or organ doses of patients across Europe persists across all medical ionising radiation procedures and is seen at various levels (even within single countries and hospitals) [3] despite technological developments facilitating reductions in patient dose.
This highlights the importance of harmonisation of medical procedures using ionising radiation and the development of new,
efficient optimisation methods,
including evaluation criteria.
For this optimisation,
there needs to be a general definition as to what an acceptable level of quality is,
what kind of optimisation should be performed and what the optimal level is.
Key research aspects to maximise the clinical outputs of the procedures while minimising the exposure of patients and staff are:
- Patient-tailored diagnosis and treatment,
including an expert system for optimisation
- Full exploitation and improvement of technology and techniques
- Clinical and dose structured reporting
- Protection of staff,
patients,
carers and general public
4.
Justification of the use of ionising radiation in medical practice
The principle of justification of use is one of the key pillars of radiation protection underlined in the EU BSS Directive [1],
focusing on weighing the benefits versus the risks.
Further important elements are patient communication,
as the basis for shared decision-making including the patient rights for influencing the decision,
as well as the appropriateness of the radiological procedure with respect to the clinical setting.
The key research aspects in research into the justification of the use of ionising radiation in medical practice are:
- Benefit and risk assessment and communication
- Improvement of use of evidence-based guidelines
5.
Infrastructures for quality assurance
To investigate tissue reactions,
optimisation procedures and benefit and risk evaluations it is important to rely on quality-assured data gathered under well-defined conditions,
which are also necessary for various other reasons including legal questions pertaining or specific to the research to be performed.
In addition,
the clinical system of medical applications of ionising radiation has to be standardised and its effectives in radiation protection evaluated.
Key aspects related to infrastructure and quality assurance are:
- Data coding,
collection and management
- Biobanks
- Developing key performance indicators for quality and safety
- Audit systems
- Education and training metrics
The EURAMED SRA is considered a living document,
and hence any comments and suggestions by stakeholders or facilitators of medical radiation protection are most welcome.
The current version was approved by the boards of the five societies in November 2015,
and has been available since July 2016 at www.euramed.eu.
In addition,
it has been submitted for publication to Insights into Imaging.