Technological advancements, progress achieved and the identification of challenges in medical uses of ionizing radiation, were among key topics discussed at a meeting held recently at the IAEA headquarters in Vienna, which focused on the radiation protection of paediatric and pregnant patients.
The hybrid meeting, from 27 February to 1 March, was attended by over 90 health professionals, radiation protection experts and regulators from 45 IAEA member countries and 17 international organizations.
The participants, knowledgeable in areas relating to the medical application of ionizing radiation in diagnostic and interventional radiology as well as in nuclear medicine and radiation therapy exchanged information on these specialised fields. They also identified needs to further develop guidance and tools, so that improvements are made to ensure paediatric and pregnant patients undergoing medical radiological procedures receive the best care, with risks relating to radiation exposure minimized as much as possible.
"The meeting's focus was to assess how to further improve radiation safety for this specific group of patients, who can benefit greatly from medical radiological procedures," said Jenia Vassileva, an IAEA Radiation Protection Specialist. "This can be achieved by reviewing the status and latest developments of methods and technology to optimize radiation protection; providing a platform to share information on successes and challenges; and attention to medical radiological processes to ensure that a balance is achieved between benefits and risks for paediatric and pregnant patients."
Discussions covered the latest data on medical uses of ionizing radiation; updates from epidemiology on the risks to health from radiation exposure in utero and in childhood; management of medical exposure in pregnancy during X-ray imaging; and nuclear medicine and radiotherapy. Other subjects included: breast feeding during radiopharmaceutical procedures; developments and challenges in patient dose assessment and monitoring; advances and needs in radiation protection optimization during paediatric imaging; nuclear medicine and radiotherapy; justification and appropriateness of imaging for children; and the role of different stakeholders in fostering risk-benefit dialogue in paediatric healthcare.
"Widening awareness means that the physicians must understand the risks associated with various medical radiological procedures. This means being able to select the most appropriate procedure for the patient condition and communicate the potential risks and benefits to the patients, the parents or caregivers," Vassileva said.
Experts shared successes and challenges in their countries on the appropriate use of imaging for children, such as protocols designed to facilitate good patient outcomes and teamwork among radiologists, technologists, medical physicists, hospital managers, regulators, clinicians and patients.
Donald Frush, Professor of Radiology at Duke University Medical Center in Durham, North Carolina, and chair of the meeting, stressed: "There is a lot of science in the work we do, but also an art in how we deal with patients. We should be more mindful of this, the way we are promoting this narrative. We need to build trust through developing a global approach, and today's meeting provides a unique opportunity for us to learn from and exchange ideas with one another."
Echoing this view, Andrés García-Bayce, Head of the Imaging Department at Pereira Rossell Hospital in Uruguay and President of the World Federation of Pediatric Imaging, said: "Building trust and education in paediatric radiology are the best strategies to gain confidence on the appropriate use of imaging for children."
Information about the growing role of artificial intelligence (AI) was also shared. It emerged during discussions that AI has implications for radiation protection; however, further attention will be required to ensure its proper use. The need for a multidisciplinary approach to AI based tools for safe and effective clinical implementation was identified.
During the meeting, participants were informed of the IAEA's activities and resources on radiation protection of paediatric and pregnant patients. These included the International Basic Safety Standards; Safety Guide SSG-46; Safety Report Series no. 71; training materials including e-learning courses, webinars and posters; and technical assistance. These free resources along with information for health professionals and patients are available on the IAEA Radiation Protection of Patients (RPOP) website. New resources under development, such as guidance for patient shielding in X-ray imaging were also introduced.
Participants also noted the importance of communication among professionals and the involvement of representatives from all possible stakeholders, including patients and caregivers, to broaden awareness on the importance of radiation protection for paediatric and pregnant patients. The development of good communication skills and training was highlighted as particularly important in facilitating communication in different cultures and considering a variety of perspectives in order to provide relevant messages to patients and parents on the benefits and risks from medical radiological procedures.
In their discussions on new projects that involved different stakeholders and increased awareness on the radiation protection of paediatric and pregnant patients, participants referred back to the Bonn Call for Action, initiated in 2012 by the IAEA and the World Health Organization. This platform calls for a holistic approach and international cooperation aimed at identifying and implementing solutions to address existing and emerging challenges. It also underscored 10 main actions and related sub-actions for the strengthening of radiation protection in medicine. These actions apply to protecting children from radiation exposure, with a special emphasis given to strengthening investigations into low-dose health effects and radiological risks from external and internal exposures, especially in children and pregnant women. The importance of establishing, using and regularly updating diagnostic reference levels as a tool to optimize of radiation protection was also underscored.
The meeting concluded by reiterating the need for continuous international cooperation to ensure that every medical procedure involving ionizing radiation is appropriately selected and optimally performed to achieve the expected medical outcome at lower possible risk for each patient. More efforts are needed to improve informed decision making and the risk-benefit dialogue between care providers, patients, and parents.
