Meet your Regulator Workshop with FANR licensees October 2011

1. Meet your RegulatorWorkshop with FANR licenseesOctober 2011 Optimisation of Medical Exposure Radiological Protection of Patients

2. Average annual frequency of diagnostic medical and dental examinations, by health-care level, 1997 - 2007 FREQUENCY (per 1000 population) HEALTH-CARE LEVEL

3. Trend in radiation exposure from diagnostic radiology

4. Annual average per caput effective dose of ionizing radiation due to diagnostic medical and dental X-ray examinations, by health-care level, 1997 - 2007 PER CAPUT DOSE (mSv) HEALTH-CARE LEVEL

5. Annual frequency of diagnostic nuclear medicine examinations, by health-care level, 1997 - 2007 FREQUENCY (per 1000 population)

6. Estimated number of diagnostic nuclear medicine examinations conducted annually, 1985 – 1990, 1991 – 1996 and 1997 - 2007 EXAMINATIONS (millions) SURVEY PERIOD

7. Estimated annual data on radiotherapy treatments aworldwide, 1997 – 2007 Source: Committee survey on medical radiation usage and exposures, 1997 – 2007. aComplete course of treatment. bExcluding treatments with radiopharmaceuticals. cAssumed value in the absence of data. dGlobal data include several countries not represented by levels I-IV.

8. Estimated annual collective dose of ionizing radiation due to medical exposures, 1997 – 2007 (Totals may not add precisely because of rounding)

9. Total annual collective effective dose of radiation due to medical exposures (excluding radiotherapy) COLLECTIVE EFFECTIVE DOSE (man Sv)

10. THE CHALLENGE • How to do we – regulators, health authorities, radiological professionals – ensure that the increasing radiation dose is improving patient care? • First, is the exposure justified? • Second, is the exposure optimised? • Third, how does the exposure compare with ‘best practice’?

11. RE-VISITING JUSTIFICATION • Medical exposures are generically justified • Medical guidelines and professional standards should generically justify certain exposures - a certain indication justifies a spinal plain X-ray; in what circumstances might a CT scan be appropriate for this indication • Justification for the individual patient REGUALTORS CAN REQUIRE A PROCESS, BUT HAVE NO OTHER ROLE. IT IS FOR THE HEALTH PROFESSIONALS.

12. OPTIMISATION • Calibration and quality assurance • The machine delivers the right dose or the correct amount of the correct radionuclide is injected • Deciding the dose • Taking account of the particular patient, what is the dose to be delivered to get a good result • Or take what the machine delivers • Paediatric patients • Limiting the radiotherapy dose to the healthy tissue • Equipment that provides information on patient dose

13. MEASUREMENT – THE ROLE OF DRLs (ICRP 103) • ‘Diagnostic reference levels are used in medical imaging to indicate whether, in routine conditions, the levels of patient dose from, or administered activity (amount of radioactive material) for, a specified imaging procedure are unusually high or low for that procedure.’ • The DRLs ‘are selected on the basis of a percentile point on the observed distribution of doses to patients or to a reference patient. The values should be selected by professional bodies in conjunction with national health and radiological protection authorities and reviewed at intervals that represent a compromise between the necessary stability and the long-term changes in the observed dose distribution’. • UAE national diagnostic reference levels?

14. ACCIDENT PREVENTION IN RADIOTHERAPY • Integral part of design of equipment and premises; • and of working procedures • Application of ‘defence in depth’ • Multiple defences against the consequences of failure.

15. Thank You