We focused on the roadmap of a radiology department in the establishment of a radiation protection program in accordance with guidelines introduced by international societies and initiatives such as the Eurosafe Imaging Campaign. We listed the main steps below which radiology departments should accomplish to overcome the barriers in establishment of a radiation safety policy.
a. Establishment of dose team in the department
A radiation dose safety team is mandatory for a radiation department to establish a radiation safety policy. This team should include chief of the department as head of the team, a faculty member interested in radiation safety with researches on this area, a medical physicist and a radiographer (Figure 1). Organizing the whole radiation safety policy is the responsibility of the head of the team. The decision-making process in the renewal of radiology equipments mostly depends on the chief of the department so being a member of the radiation safety team may be a reminder for the chief of the department to consider radiation safety issues in the renewal of the radiology equipments.
A faculty member in the radiation safety team may have a crucial role in implementing new radiation dose reduction techniques in the department. Assessment of image quality of imaging examinations while reducing the radiation dose can also be performed by a faculty member in the radiology department.
Medical physicists have a crucial role in the radiation safety policy of radiology departments. The balance between dose reduction and image quality can be achieved with the guidance of a medical physicist. An expert in imaging physics can reveal tips and tricks in reducing radiation dose values, protecting department staff from scattered radiation and facilities of new equipments in terms of radiation dose reduction [1].
Radiographers are necessary for a radiation safety team in a radiology department. Radiographers are familiar with the challenges in practice and their point of view may be important in overcoming the obstacles. Their opinions are required especially for the feasibility of recommendations of the radiation safety team.
b. Education of technicians and increasing awareness for radiation protection
The education of technicians about radiation protection issues should be one of the major tasks for the radiation safety team. The education of technicians should include essential principles of patient and staff safety. A radiology technician should be aware of the potential risks of ionizing radiation exposure. Awareness of technicians about hardware and software facilities of new equipments should be maintained.
c. Implementation of a dose management system
Radiation dose management systems are indispensable for radiology departments. These systems monitor the radiation dose values of imaging protocols and imaging equipments as well as find the discrepancies between the radiation dose values of CT examinations performed in different equipments in the department [2]. Radiation dose reduction strategies in imaging studies can be accomplished by monitoring the dose levels in the department, finding the mistakes and opportunities, optimizing the protocols and changing the behavior of radiology staff with an awareness of responsibility in radiation dose reduction. Dose monitorization systems not only detect the drawbacks of imaging strategy but also they can be used to optimize the imaging protocols in the department.
d. Definition of dose reference levels (DRLs)
Determination of DRLs necessitates the usage of dose management systems which can easily define the DRL values of imaging protocols. Although DRLs are used to be determined according to imaging protocols recent radiation safety activities indicate that DRLs based on clinical indication are more valuable for comparison radiation dose levels of a department. Radiology departments should determine the institutional DRLs with appropriate methods under the guidance of radiology communities. The definition of institutional DRLs will contribute to the maintenance of national DRLs.
e. Continuous monitoring of department for Eurosafe Imaging Star Criteria
Continuous monitoring of radiology departments in terms of radiation safety can be achieved by comprehensive evaluation criteria which were introduced by Eurosafe Imaging Initiative. According to these criteria radiology departments are assigned with ‘Eurosafe Imaging Stars’. These criteria enable radiology departments to determine their deficiencies in radiation safety and to prepare homework to complete which includes objectively defined criteria.