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An analysis and review of the fundamental psychological basis of decision making has been undertaken in respect of radiation protection of the patient in medicine. Both clinical and scientific aspects of patient protection have been considered. Every stage of the clinical process of radiological examinations, from referral through to diagnostic outcome, has been shown to be subject to proven psychological effects including biases, framing, anchoring and prospect theory, which deals with perceived gains and losses. Such factors also influence the scientific aspects of radiation protection of the patient. Justification for the use of single dose reference level (DRL) values has employed framing with substitution or manipulation by accessibility in order to promote their usefulness. The use of DRLs as presently proposed constrains a diverse patient population to a reference or representative person. This approach is shown to represent a public health initiative that largely ignores the ethical basis of patient protection inherent in the Hippocratic Oath. [ABSTRACT FROM AUTHOR]

A review of the role and relevance of the principles of radiation protection of the patient in diagnostic radiology as specified by ICRP has been undertaken when diagnostic risks arising from an examination are taken into account. The increase in population doses arising from diagnostic radiology over the past 20 years has been due to the widespread application of higher dose CT examinations that provide significantly more clinical information. Consequently, diagnostic risks as well as radiation risks need to be considered within the patient radiation protection framework. Justification and optimisation are discussed and the limitations imposed on patient protection by employing only a radiation risk framework is highlighted. The example of radiation protection of the patient in breast screening programmes employing mammography is used to highlight the importance of defined diagnostic outcomes in any effective radiation protection strategy. [ABSTRACT FROM AUTHOR]

In 1973, International Commission on Radiological Protection Publication 22 recommended that the acceptability of radiation exposure levels for a given activity should be determined by a process of cost-benefit analysis. It was felt that this approach could be used to underpin both the principle of ALARA as well for justification purposes. The net benefit, B, of an operation involving irradiation was regarded as equal to the difference between its gross benefit, V, and the sum of three components; the basic production cost associated with the operation, P; the cost of achieving the selected level of protection, X; and the cost Y of the detriment involved in the operation: B = V - (P + X + Y). This article presents a theoretical cost-risk-benefit analysis that is applicable to the diagnostic accuracy (Levels 1 and 2) of the hierarchical efficacy model presented by National Council on Radiation Protection and Measurements in 1992. This enables the costs of an examination to be related to the sensitivity and specificity of an X-ray examination within a defined clinical problem setting and introduces both false-positive/false-negative diagnostic outcomes into the patient radiation protection framework. [ABSTRACT FROM AUTHOR]

The International Commission on Radiological Protection (ICRP) has indicated that the diagnostic reference level (DRL) has the optimisation of protection as its objective for diagnostic and interventional procedures [International Commission on Radiological Protection. Protection against ionising radiation from external sources: ICRP Report 105 (2007)]. An important aim of this paper was to demonstrate a straightforward and cost-effective mechanism for undertaking patient dose audits that can be employed in the production of local and regional DRLs for use by medical physics experts in the provision of scientific support services to diagnostic radiology. The process developed employs electronic X-ray examination records obtained from multiple hospital sites transferred to a central processing and reporting facility. Results of a large-scale audit of patient doses resulting from CT examinations are presented. Doses are expressed in terms of dose length product (DLP) and were collected by remotely accessing electronic examination records held in hospital radiology information systems. Data were collected from 18 hospital sites involving up to 123 different types of examinations covering an ∼18-month period from July 2011 to December 2012. In total, 177 000 CT examination records were collected. Values have been validated against equivalent records obtained from digital imaging and communications in medicine (DICOM) header data and found to be in excellent statistical agreement. Extremely large variations in DLP values were noted for many examinations when data for all scanners were pooled. Results are discussed in relation to other surveys and differences highlighted in terms of the variations in methodologies employed and the numbers of examination records investigated. A mechanism for establishing DRLs is proposed, which could help to unify mechanisms for establishing DRLs for CT examinations. [ABSTRACT FROM PUBLISHER]

These consensus guidelines were jointly commissioned by the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE). They provide an evidence-based framework for the use of surveillance colonoscopy and non-colonoscopic colorectal imaging in people aged 18 years and over. They are the first guidelines that take into account the introduction of national bowel cancer screening. For the first time, they also incorporate surveillance of patients following resection of either adenomatous or serrated polyps and also post-colorectal cancer resection. They are primarily aimed at healthcare professionals, and aim to address:Which patients should commence surveillance post-polypectomy and post-cancer resection?What is the appropriate surveillance interval?When can surveillance be stopped? two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument provided a methodological framework for the guidelines. The BSG's guideline development process was used, which is National Institute for Health and Care Excellence (NICE) compliant.two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps The key recommendations are that the high-risk criteria for future colorectal cancer (CRC) following polypectomy comprise either :two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps This cohort should undergo a one-off surveillance colonoscopy at 3 years. Post-CRC resection patients should undergo a 1 year clearance colonoscopy, then a surveillance colonoscopy after 3 more years., Competing Interests: Competing interests: JE – Clinical advisory boards: Lumendi, Boston Scientific; Speaker fees: Olympus, FalkColin Rees – Research grant: ARC medical, Norgine, Olympus. Expert witness: ARC medical Matt Rutter – Speaker fees: SwissSCWeb, Pentax; Research Grant: Olympus; Consultancy: Norgine DJMT – Speaker fees: Bracco, Guerbet., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)