Dimitris Katsifarakis Radiological Technologist ISRRT /ECRRT representative 10 th EAN workshop

1. The role of Radiological technologists/ Radiographers in ALARA implementation and the influence of MED 97/43 on that. Dimitris Katsifarakis Radiological Technologist ISRRT /ECRRT representative 10th EAN workshop Prague, Sept/2006

2. The reason for the survey • The questionnairewas intended to focus on the status of the directive in the countries and • how it was (or will be)implemented and • how that has (or will) effect the position of the Radiographer as a health careprofessional.

3. Method • Α simple questionnaire with limited numberof questions , to keep it simple and to the point. • Of course this limited the amount ofinformation that could be gathered.

4. Response • The Questionnaire e-mailed in August 2002, to • 27 council members in Europe, ofwhich • 15 were EU countries and • 12 were non-EU ountries. • 9 of the non-EU countries join the EU in 2004 or soon after that • the response was from 14 EU countries and 6 non-EU member countries • (74% response).

5. Transposition of the MED • Has the European Directive MED/97/43/Euratom been transposed into your nationallegislation? The MED has not beenimplemented (2002) into the legislation of2 EU countries (France - only inparts and is underway in Ireland). No answers came from Italy. InIceland and Norway the Radiation Protection legislation has beenchanged recently and adapted tothe MED.

6. Radiographer’s role Is the radiographer’s role,as the person entitled to carry out a radiological examination/treatmentunder the authority of a radiologist/ oncologist, recognized in your national legislation?

7. Radiographer’s role:If YES, is their role in radiation protection recognized by the legislation? • Through legislation in almost all the countries (16 = 84%) the profession of radiographers (diagnostic area) is recognizedfor the role they play in radiation protection. • Radiographer’s profession is recognized in fewer countries (13 = 76%) when it comes to radiation therapy.

8. Radiographer’s role:If YES, are they the only person entitled to do this? • in many countries they are not the only profession that can have this responsibility.

9. who else can perform this role officially? Ιt is interesting to note that professions that don't have much education in RP are named: • Nurses, • OtherParamedicals • Persons with medical education andknowledge in RP, under the authority ofradiologist/oncologists • Engineers

10. Is there any other profession or person who uses X-rays ‘unofficially’? • Nurses with any qualification in theater andinterventional radiology • Other trained to take certain x-rays and use C-arm • Other persons who areconsidered to be adequatelyeducated and trained inradiology/radiation therapyand radiation protection, butwho do not have an officialdiploma for the legallyrequired level in RP

11. Responsibility for the examination Can radiographers be approved as responsible for the way anexamination/treatment is carried out? Diagnostic: Yes 83% Rad.therapy:Yes 64%

12. Responsibility for the QC Can radiographers be approved as technically responsible for the Quality Controlof theequipment?Diagnostic 84% Rad.Therapy 71%

13. Responsibility for the QC Who else might be responsible for the QC? • Radiologist, • medical physicist • engineer • medical doctors

14. Education ofradiographers Are there any requirements in your national legislation for the education ofradiographers? Yes 95%

15. Continuing education Are there any requirements in your national legislation for the continuing education? Yes, are in place in more and more countries

16. Licensing system for Radiographers • Is there an approval or licensingsystem in your country for radiographers before theycan start work? • Yes 74%

17. Responsibility for the examination • Can radiographers be approved as clinically responsible(indication/justification) for the examination/treatment, (i.e. be practitioners)? • Yes:53%diagnostic area

18. Terms from MED • Practitioner: a medical doctor, dentist or otherhealth professional, who is entitled to take clinicalresponsibility for an individual medical exposurein accordance with national requirements. • - Clinical Responsibility: responsibility regardingindividual medical exposures attributed to apractitioner, notably: justification; optimization;clinical evaluation of the outcome; Cooperationwith other specialists and the staff, as appropriate,regarding practical aspects; obtaining information,if appropriate, of previous examinations; Providingexisting radiological information and/or records toother practitioners and/or prescribers, as required;giving information on the risk of ionizing radiationto patients and other individuals involved, asappropriate.

19. Theposition of radiographers Has the transposition of the directive affected/changed (or will affect/change) theposition ofradiographers in your country?

20. Discussion • It is clear from this survey that the legal responsibility of radiographers for radiation protection is very different in the countries participating in this survey. • It depends on the structure of the legislation system in each country and how the legislations have delegated the responsibility into the health care system.

21. Discussion • Radiographers everywhere will always have the professional responsibility for protecting their patients, their co-workers, members of the public and themselves from unnecessary radiation.

22. Conclusions • 1.The ECRRT should make the EU commission aware of the fact that the implementationof the MED has been very different in the member states and that in some countries,professions that do not have adequate education and training are responsible for justification and optimization of radiation exposure in medicine.

23. ConclusionsCompetence as a key term • 2. If and when the directive is reviewed, there should be clearer instructions to themember countries to focus on competence rather than professions in their RP legislation Example: • In the UK the legislation only referes to the competence of the persons in question and has no reference to professions or professional titles. • Competence is also a base for this responsibility in the Netherlands and in Germany.

24. Conclusions • 3. It is the opinion of the ECRRT that there is a need for a European Standard for theminimum level of education and training in Radiation Protection.

25. Conclusions • 4.There are new countries joining the EU. Radiographers in thesecountries can benefit from this work when the legislation is changed toimplement the relevant RP directives of the EU including the MED. It is important for them toget involved with the legislation body and stress the importance of competence in RP. • 5. Advise should be given by the ECRRT to representatives from the new EU memberstates, in connection with the implementation of the MED in these countries.

26. Radiographer and ALARA • ICRP -16: …Radiographers are in a key-position regarding radiation protection and according to their skill and knowledge they can affect in broad levels the amount of radiation they administered.

27. Thank you for your attention dimitka@panafonet.gr