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IAEA Technical Meeting on Radiation safety impact of newer imaging and
radiation therapy technologies in medicine
Buenos Aires, Argentina; 18-19 October 2008
The meeting was held in Buenos Aires as a pre-IRPA12 satellite session. On 18 October,
the panellists met to discuss strategic issues, and on 19 October, there was a full day
educational session that was attended by about 80 persons. The speakers included experts
in imaging and radiation therapy (both physical and clinical aspects), manufacturers and
radiation safety experts.
It was reiterated that the medical application of ionizing radiation is increasing at a much
faster pace than any other source of ionizing radiation exposure to mankind. The newer
imaging techniques such as multi-detector CT (MDCT), PET/CT, digital imaging and
complex radiotherapy techniques are finding increasing application in most countries. As
per UNSCEAR estimates, annually worldwide there are about 3-4 billion diagnostic xray examinations, 37 million nuclear medicine procedures, 7-8 million radiation therapy
patients and 7 million occupationally exposed medical workers. This has resulted in a
marked increase in both the dose per person and the collective dose. This is in contrast to
natural background exposures which have remained essentially unchanged for thousands
of years, exposures from fallout which have decreased, and exposures from occupational
exposure and nuclear power which have remained relatively unchanged over the last
decade. The increase in exposure in not bad so long as clinical benefits outweigh the
risks, and risks have been minimized to maintain the benefits. Further points made
included the following:
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Some patients are undergoing tens of imaging procedures within the space of one
year;
Patient doses in radiography have decreased significantly during the past few
decades, whereas doses to patients in computed tomography (CT) have not shown
a decrease, rather have increased as a result of a change in utilization;
In some situations, high staff doses and cataracts are being seen at lower than
expected doses
Radiotherapy is becoming more complex, manual calculations are not feasible;
there is additional dose to treatment volume, to nearby critical structures and to
the whole body which needs careful accounting for and can pose secondary
cancer risks;
A very large part of unnecessary exposure stems from unjustified examination;
Manufacturers are continuously developing newer methods to achieve patient
dose management. Manufacturers feel that radiation dose has now become a
marketing tool. The role of manufacturers in radiation protection is increasing,
even though the role and responsibility of the operator remains. In many imaging
techniques, patient dose management is shifting to manufacturers and, thus, there
is greater responsibility on the part of manufacturers;
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For many years in the past, the focus has been on regulation, authorization, and
radiation monitoring of staff whereas patient protection has only recently started
to receive attention
The speed at which technology is changing poses challenges to the development,
assessment and implementation of radiation dose management programmes.
Future directions
 There is a need to have wider consultation on this issue through the participation
of users, manufacturers, regulators, radiation protection experts and patients;
 Strengthen the framework and application of justification;
 Requiring audit may be more effective than strict regulatory controls;
 Strengthen regulatory and cooperative actions between radiation safety
organizations and manufacturers;
 Establish effective plans to deal with unintended exposures in radiotherapy;
 Assess the status in Member States in terms of the needs of newer technology,
and developing guidelines for support by the IAEA;
 Build and ensure radiation safety capabilities while supplying newer technology
by the IAEA;
 Develop a methodology for long-term record of patient doses;
 Any plan needs to deal with rapidly changing technology