Search

The visual arts are rooted in the life of the wider community and may lack explicit medical physics reference. Nevertheless, they can be influential and can illustrate, communicate, and inform. They may also inspire, challenge, heal, give pleasure, help put one's life in perspective and enrich the experience of being a practicing scientist working in medical physics. Eighteen works from 12 artists are presented. They are a convenience sample from the author's experience. Two (Irish), though less well known, speak powerfully to scientists. Two are of the eighteenth century. The remaining works are modern from Europe, North America and Japan. All inform and challenge our behaviour as medical physicists. Headings guiding the paper address: historical perspectives; similarities of method between science and the arts; the hand as special expressions of being human; communicating science; science and a sense of wonder; borders to science; and the importance of a quiet, still, reflective approach. The author's experience complements observations published by others. The artworks described delight and are an able ally in validating a life spent in science. They refresh it and are accessible to those willing to take a risk on the approach, with sensibility and an openness. The impact of art on science and medicine is also visible in under explored institutional art collections such as those housed at the IAEA in Vienna or WHO in Geneva.

Sleep loss is associated with cognitive decline in the aging population and is a risk factor for Alzheimer’s disease (AD). Considering the crucial role of immunomodulating genes such as that encoding the triggering receptor expressed on myeloid cells type 2 (TREM2) in removing pathogenic amyloid-β (Aβ) plaques and regulating neurodegeneration in the brain, our aim was to investigate whether and how sleep loss influences microglial function in mice. We chronically sleep-deprived wild-type mice and the 5xFAD mouse model of cerebral amyloidosis, expressing either the humanized TREM2 common variant, the loss-of-function R47H AD-associated risk variant, or without TREM2 expression. Sleep deprivation not only enhanced TREM2-dependent Aβ plaque deposition compared with 5xFAD mice with normal sleeping patterns but also induced microglial reactivity that was independent of the presence of parenchymal Aβ plaques. We investigated lysosomal morphology using transmission electron microscopy and found abnormalities particularly in mice without Aβ plaques and also observed lysosomal maturation impairments in a TREM2-dependent manner in both microglia and neurons, suggesting that changes in sleep modified neuro-immune cross-talk. Unbiased transcriptome and proteome profiling provided mechanistic insights into functional pathways triggered by sleep deprivation that were unique to TREM2 and Aβ pathology and that converged on metabolic dyshomeostasis. Our findings highlight that sleep deprivation directly affects microglial reactivity, for which TREM2 is required, by altering the metabolic ability to cope with the energy demands of prolonged wakefulness, leading to further Aβ deposition, and underlines the importance of sleep modulation as a promising future therapeutic approach.

Enkephalins are opioid peptides that modulate analgesia, reward, and stress.In vivodetection of enkephalins remains difficult due to transient and low endogenous concentrations and inherent sequence similarity. We present an analytical method for Met- and Leu-Enkephalin detection in the mouse Nucleus Accumbens shell after acute stress. This approach increases spatiotemporal resolution, optimizes the detection of Met-Enkephalin through methionine oxidation, and provides insight into the relationship between Met- and Leu-Enkephalin following stress.

Objective Justification is a key principle of radiation protection in medicine: it requires that, among other things, all radiological procedure must provide more benefit than harm. While medical imaging has improved patient care, a substantial fraction of exams is unjustified and does not provide a net benefit. Computed tomography (CT) is used increasingly for imaging asymptomatic people for individual health assessment (IHA). This arises, for example, in some instances of use of CT for coronary artery calcium scoring, early detection of lung and colon cancers, and whole-body surveys. These practices are often performed outside formally organized screening programmes, and the evidence for their benefits and harms is usually weak or absent. They are often not part of established healthcare pathways, arrangements for transferring results from them to the healthcare system are usually absent, and quality assurance programmes are seldom in place. Method WHO organized international workshops in 2014 (Munich), 2016 (Seoul), 2017 (Quebec) and 2018 (Copenhagen), and stakeholders’ feedback was collected. The new International Radiation Basic Safety Standards (BSS) were considered in these deliberations. The BSS require that all radiological procedures on asymptomatic individuals, which are not part of approved health screening programmes, be justified by the practitioners involved, and that the individual presenting be informed of the expected potential benefits, potential harms and limitations. Based on these an international expert group published a paper identifying the issues and options open to policy makers and practitioners. The role of both health authorities and radiation regulators was addressed. Concerns included justification and appropriateness of procedures, safety, quality, process evaluation, optimization, protocols, staff education, training, performance, documentation, mechanisms for integrating the results into established care pathways, ethics and health economics issues, information on benefits, harms and other outcomes to citizens, patients and professionals. Results Structured definitions and descriptions of CT-IHA practices have been developed, described and compared with more formal radiation screening programmes. In addition, these definitions/descriptions are reviewed in the context of more widespread screening activities in medicine and public health. The considerations involved go beyond radiation-induced cancer risks, and the obvious radiation related legal and good practice requirements. They include public health, ethics, over-diagnosis, over-treatment, false positives, false negatives, indeterminate results and incidental findings, among others. A framework is presented to assist policy development by health authorities, radiation protection regulators, and other relevant stakeholders. It provides for improving clinical governance and regulatory compliance. Notable uncertainties are involved in treating both benefits and harms as well as in the overall experience of persons in receipt of CT-IHA, and these are addressed. This paper summarizes the structure and content of the new WHO document.

Medical physics and other contributions from physics to medicine are relatively well known, if not well documented in Ireland. Less well known are contributions from medicine to the development of physics, which can and do occur. This paper addresses examples of all three. The methods employed include documentary research and interviews with those who share(d) the stage in the area. Documentary evidence for historical aspects of medical physics over the last century are relatively sparse and incomplete. Notwithstanding this, they can and do enable a picture to be built up of how the arrangements in place now have come about, particularly when they are accompanied by mature recollections of the participants. Good critically assessed and accessible sources have been identified covering the seventeenth to nineteenth century material presented. Examples are presented based on the work of significant contributors, each with strong Irish connections, including Robert Boyle, Erwin Schrodinger, Fearghus O'Foghludha, and Edith Stoney the first female medical physicist. Their contributions are striking and continue to be relevant now. The findings provide a rich context and heritage for medical physics in Ireland and in the international community. They will include the contemporary period in a second paper, Part 2 of this study.

The EC (European Council) Directive on radiation protection of patients requires that criteria for acceptability of equipment in diagnostic radiology, nuclear medicine and radiotherapy be established throughout the member states. This study reviews the background to this requirement and to its implementation in practice. It notes and considers parallel requirements in the EC medical devices directive and International Electrotechnical Commission standards that it is also important to consider and that both sets of requirements should ideally be harmonised due to the global nature of the equipment industry. The study further reviews the types of criteria that can be well applied for the above purposes, and defines qualitative criteria and suspension levels suitable for application. Both are defined and relationships with other acceptance processes are considered (including acceptance testing at the time of purchase, commissioning and the issue of second-hand equipment). Suspension levels are divided into four types, A, B, C and D, depending on the quality of evidence and consensus they are based on. Exceptional situations involving, for example, new or rapidly evolving technology are also considered. The publication and paper focuses on the role of the holder of the equipment and related staff, particularly the medical physics expert and the practitioner. Advice on how the criteria should be created and implemented is provided for these groups and how this might be coordinated with the supplier. Additional advice on the role of the regulator is provided.

The EC (European Commission) Directive on radiation protection of patients requires that Criteria for Acceptability of Equipment in Diagnostic Radiology, Nuclear Medicine and Radiotherapy be established throughout the member states. This paper reviews the background to this requirement and to its implementation in practice. It notes parallel requirements in the EC medical devices directive and International Electrotechnical Commission standards. It is also important to be aware and that both sets of requirements should ideally be harmonised due to the global nature of the equipment industry. The paper further reviews the type of criteria that can be well applied for the above purposes, and defines qualitative criteria and suspension levels suitable for application. Both are defined and relationships with other acceptance processes are considered (including acceptance testing at the time of purchase, commissioning and the issue of second-hand equipment). Suspension levels are divided into four types, A, B, C and D, depending on the quality of evidence and consensus on which they are based. Exceptional situations involving, for example, new or rapidly evolving technology are also considered. The publication and paper focuses on the role of the holder of the equipment and related staff, particularly the medical physics expert and the practitioner. Advice on how the criteria should be created and implemented and how this might be coordinated with the supplier is provided for these groups. Additional advice on the role of the regulator is provided.

In 1997 the European Commission published Radiation Protection 91: 'Criteria for acceptability of radiological (including radiotherapy) and nuclear medicine installations'. This document specified the minimum criteria for acceptability. It has been used to this effect in legislation, codes of practice and by individual professionals. In a single document, it defined a level of performance at which remedial action was required. The document specified a series of parameters which characterised equipment performance and acceptable levels of performance. In its time it proved to be a useful document which was applied in member states to various degrees. Since the publication of Report 91 in 1997, a series of weaknesses emerged over time. Development of new radiological systems and technologies, as well as improvements in traditional technologies, has created circumstances where the acceptability criteria were in need of review. These weaknesses were recognised by the European Commission and a tender for its revision was issued. The criteria were developed by a team drawn from a broad range of backgrounds including hospitals, industry, government bodies, regulators and standardisation organisations. Representatives were mainly from Europe, but individuals from the American Association of Physicists in Medicine and International Atomic Energy Agency were included in the drafting process. This study describes the process employed in developing the revised document and the consultation process involved. One of the major difficulties the revision team encountered was related to an understanding of the actual meaning of the EC Directive. The view taken by the revision team was that Article 8, paragraph 3 places responsibilities on both the holders of radiological equipment and competent authorities. The acceptability criteria have been produced consistent with the European Commission's Medical Exposures Directive, which requires that patient exposures are optimised and justified.

A recent outreach project brought together the American University of Afghanistan and four world renowned US universities with branch campuses in Qatar’s Education City. Librarians in Qatar often collaborate with each other, but this unusual effort was the first time their collaboration reached across international borders to extend assistance to another country. The experience became a cultural exchange that brought together these dramatically different worlds. By utilizing technologies that make connecting and collaborating so easy these days, four librarians with backgrounds in public and technical services worked together to share their expertise, culminating in a learning visit by an AUAF library assistant to Doha. The sharing of skills and knowledge was a wonderful experience on many levels, and made a distinct difference in a part of the world that needs and wants so much to change.

This summary report presents aspects of work that was carried out as part of the European Commission SENTINEL Project (Safety and Efficacy for New Techniques and Imaging using New Equipment to Support European Legislation). It arises from the discussions at a workshop organised by the first author at Hairmyres Hospital, East Kilbride in September 2006. The second author facilitated the workshop and moderated the discussion. The paper notes key points from the discussion and provides some pertinent comments.

This review presents airborne noise test results collected over the last eight years during the Auckland apartment boom and aims to improve the industry's information base when considering the difference between walls of known laboratory performance and the measured field performance for the same nominal wall construction. Statistical analysis of the field results collected for various drywall constructions is presented in STC, R′w and DnT, w criteria with subsequent guidance when establishing and negotiating suitable on-site project criterion for multi-level construction contracts. Probabilities of achievement of various ratings are provided based on four projects using three wall types. Given the desire within the New Zealand industry to offer an upgrade on the existing site rating of FSTC 50, the authors suggest an R′w rating in the low 50 dB range is appropriate and achievable.

The implementation of an X-ray Quality Assurance (QA) program is a legal requirement in Europe as stipulated in the EU Council Directive 97/43/EURATOM (MED). A review of the literature has identified that European countries are performing some level of QA testing of their dental X-ray equipment, although the type and level to which testing is performed can differ. The European SENTINEL co-ordination action proposed to collate a survey of equipment data for both conventional and digital dental X-ray installations among the SENTINEL partners. The European QA results confirm that systems can be operated below tolerance, and in some cases significantly so, while still in clinical use. This can occur despite servicing of equipment. The results have emphasised the fact that there is a requirement for the medical physics/engineering professions to become more closely involved in the management of dental radiology equipment. This also includes their involvement in the development and delivery of appropriate training courses for dentists and suppliers of dental radiology equipment.

Relatively high organ doses absorbed by patients in interventional cardiology suggest the opportunity to define these patients as a cohort to be followed forward in time in an epidemiological study of the cancer risks associated with exposure to low-dose ionising radiation. In this paper, the UNSCEAR 2000 Report risk estimates for the most exposed organs/tissues in cardiac interventional procedures are reviewed, as well as the critical features of such an epidemiological study that is anticipated to have an intrinsically low statistical power because of the low levels of risk and possible confounding factors. To overcome these limitations, data collected in different institutions can be combined provided that a common design and conduct are used for dose assessment. A minimum dataset to be collected on a patient basis is proposed that can be implemented routinely in most facilities. This data should be linked to the local patient information system in order to retrieve all the exposures of a given patient.

Interventional cardiology (IC) is a rapidly growing field of medical specialisation. Such procedures are complex and may subject patients and operators to higher levels of risk than those encountered in general radiology. Acceptance testing and quality assurance (QA) of radiological equipment, including IC equipment, is a requirement of the EU Medical Exposures Directive (MED) (97/43/EURATOM). In addition, the MED identifies interventional radiology as an area of special concern. This study presents the results of a survey of 17 IC systems (including several flat panel detector systems) in Irish hospitals. The results of the survey indicate large differences in patient doses between manufacturers for equivalent levels of measured image quality. In addition, all systems were found to have failed one or more acceptance tests, with 60% of systems demonstrating significant problems at acceptance testing. The results of the survey demonstrate the importance of acceptance testing and QA in IC. The results also provide baseline data, which may be used in the development of future QA guidelines.

Contains fulltext : 165689.pdf (Publisher’s version ) (Open Access) An international expert consultation was convened by the World Health Organization (WHO). The purpose of the meeting was to review the use of CT in examining asymptomatic people. This is often referred to as individual health assessment (IHA). IHA was identified as a global phenomenon unenthusiastically tolerated, and not actively promoted, structured, or regulated in most countries. This paper identifies the state of the art for IHA and some considerations in relation to its justification, in different regions of the world. The outcomes reached include the following: questions around terminology and culture of IHA practice; review of IHA in some countries, regions, and international bodies; dilemmas for participants in IHA; risk communication, education, and training for professions and public; the desirability of guidelines and clinical audit; social, ethical, public health, and resource considerations; and a framework for IHA and regulatory considerations. Three subcategories of examination for asymptomatic individuals were identified: formal screening programs; examinations for which the evidence base or risk profile is incomplete; and opportunistic examinations with little or no evidence or risk profile to suggest they have any merit. The latter challenges the justification principle of radiation protection. In addition, the issue of the costs, direct and indirect, associated with false positives and/or equivocal/incidental findings were highlighted. These and other considerations make it difficult to view some IHA as a bona fide medical activity. To allow it to be viewed as such requires that it be conducted within a robust clinical governance framework that includes regulatory dimensions.

There are numerous methods for assessing image quality in diagnostic X ray. In our study we assessed how imaging quality assurance methods perform in practice. Physics assessments were based on IPEM protocols using Leeds test objects. Clinical assessment was based on a questionnaire. A total of 15 systems in three European locations were assessed, covering a range of image intensifier-TV digital fluoroscopy units. Analysis of 274 clinical questionnaires showed that clinical and physics assessments did not place systems in the same order, based on a given image quality parameter. In almost all the comparisons, low level correlation was measured for statistical comparison of rank order (r s < 0.3). However, broad agreement was observed between physics and clinical assessments for image quality associated with contrast and noise. This study emphasises the importance of maintaining links with clinical assessment, when developing quality assurance metrics, and measuring the mutual performance of clinical and physical assessments of image quality.

Interventional radiology has seen rapid growth in cardiology and represents an alternative to hazardous surgery. Recently there has been a substantial growth in the number of procedures being performed and interventional cardiology (IC) procedures are the most common interventional procedures in Europe. Advances in imaging technology have facilitated the development of increasingly complex radiological IC equipment. Currently, the technology is developing at a rate ahead of supporting research, equipment standards and a regulatory framework. International standards play a key role in the design, manufacture and performance of radiological IC equipment. A survey of 12 IC systems (15 imaging chains) was conducted in Irish hospitals. The aim of the study was to assess the imbalance between rapidly advancing technology and existing standards and to propose recommendations for new IC equipment standards. The results demonstrate the need for definitive equipment requirements and standardisation in the design, manufacture, acceptance and maintenance of IC equipment.

An International Atomic Energy Agency (IAEA) TechnicalMeeting on Justification of Medical Exposure and the Use ofAppropriatenessCriteriawasheldonMarch12-14,2013with3aims: (1) to explore what clinical imaging guidelines (CIG) arecurrently available, (2) to define the problems associated withclinical imaging guideline creation and use, and (3) to begin toestablishconcreteplansforinternationalcollaborationtoachievewideruseofCIG.TheunderlyingconceptisthattheuseofCIGcan improve patient care by improving the appropriate use ofimaging. This meeting was the second of 3 annual workshops,with further ones planned [1], and was organized and supportedbytheIAEAincooperationwiththeWorldHealthOrganization.Sixty medical professionals and regulators, from more than 30countries, participated. The 4 papers that follow in this issueevolved from the meeting, based on presentations, breakoutsessions,anddiscussions.Theintentofthisintroductoryarticleisto put the 4 papers into perspective, by specifically addressingwhatCIGare,whytheyaredifficulttobothproduceanddeploy,and why and how they are important.Several terms are used to describe the concept of guidelinesforclinicalimaging,including“appropriatenesscriteria,”“referralguidelines,” and “justification criteria” [2-5]. CIG (a term usedthroughout the papers) are developed using well-described,transparent methodology and available peer-reviewed literaturetocreaterecommendationsthatindicatewhichimagingexams,ifany,aremostlikelytobeclinicallyusefulinaspecificsetting.CIGare intended to inform the decision of the health care provider,thepatient,andtheradiologistastowhichimagingtest(again,ifany)torequestandperform.Buttheguidelinesarenotabsolute:The ultimate decision is based on many factors, includingpatient-specific ones (eg, risk factors, preferences), disease prev-alence, and availability of expertise and equipment. That is, ifMRI is the best choice but no MRI unit is available, thenchoosing anotherexamis reasonable. If ultrasound wouldbe thebest choice, but no local expertise is available in this area, thenanother imaging study may be recommended.The ACR Appropriateness Criteria on low-back pain pro-vide a good example of the intent of the guidelines. This topicincludes 6 variant scenarios. They range from “acute low backpain with no red flags” (as described in the text), for which therecommendation is that no imaging be done, to cauda equinasyndromewithmultipleorprogressivedeficits,withMRIratedas“usuallyappropriate”andlumbo-sacralx-rayandCTas“possiblyappropriate.” In this setting, based on clinical judgment, ifneither MRI norCT is available, then x-ray may be appropriate.A widely held belief is that imaging is often inappropriatelyused,withbothoveruse(by20%-50%)andunderuse.Amongtheexplanations for overuse are financial self-interest, medicolegalconcerns,expedience,andpatientdesire.Concernabouttheriskofionizingradiationmayleadtoinappropriateunderuse,asmaylackof availability of equipment or expertise. All stakeholders have ahigh level of interest in improving the quality of care and makingthe practice of medicine increasingly evidence based; the use ofsound guidelines is one important approach to this goal.Basingallmedicaldecisionsonrelevantevidenceisnotalwayspossible,becauseevidenceisessentiallynevercompleteforagivendisease, patient, and setting. Many organizations have produceddocuments that provide guidance or otherwise support evidence-based medicine. For example, the Cochrane Collaboration, amultinational nonprofit organization dedicated to improvinghealthcarethroughevidence-basedmedicine,producessystematicreviewsthatcanbeusedasthebasisofcare[6].Severalsocietiesandorganizations produce methodologically sound guidelines specif-ically for imaging. These include the American College of Cardi-ology[5],thegovernmentofWesternAustralia[7],andradiologysocieties such as the Royal College of Radiologists in the UnitedKingdom [4], the Canadian Association of Radiologists [8],theFrench Radiology Society [9], and the ACR [3].Methods for guideline development for clinical care arefairly well defined, based on an approach developed by the

A recent international meeting was convened by two United Nations bodies to focus on international collaboration on clinical appropriateness/referral guidelines for use in medical imaging. This paper, the second of 4 from this technical meeting, addresses barriers to the successful development/deployment of clinical imaging guidelines and means of overcoming them. It reflects the discussions of the attendees, and the issues identified are treated under 7 headings: ■ Practical Strategy for Development and Deployment of Guidelines; ■ Governance Arrangements and Concerns with Deployment of Guidelines; ■ Finance, Sustainability, Reimbursement, and Related Issues; ■ Identifying Benefits and Radiation Risks from Radiological Examinations; ■ Information Given to Patients and the Public, and Consent Issues; ■ Special Concerns Related to Pregnancy; and ■ The Research Agenda. Examples of topics identified include the observation that guideline development is a global task and there is no case for continuing it as the project of the few professional organizations that have been brave enough to make the long-term commitment required. Advocacy for guidelines should include the expectations that they will facilitate: (1) better health care delivery; (2) lower cost of that delivery; with (3) reduced radiation dose and associated health risks. Radiation protection issues should not be isolated; rather, they should be integrated with the overall health care picture. The type of dose/radiation risk information to be provided with guidelines should include the uncertainty involved and advice on application of the precautionary principle with patients. This principle may be taken as an extension of the well-established medical principle of "first do no harm."

Data management and sharing are growing concerns for scientists and funding organizations throughout the world. Funding organizations are implementing requirements for data management plans, while scientists are establishing new infrastructures for data sharing. One of the difficulties is sharing data among a diverse set of research disciplines. Astrobiology is a unique community of researchers, containing over 110 different disciplines. The current study reports the results of a survey of data management practices among scientists involved in the astrobiology community and the NASA Astrobiology Institute (NAI) in particular. The survey was administered over a 2-month period in the first half of 2013. Fifteen percent of the NAI community responded (n=114), and additional (n=80) responses were collected from members of an astrobiology Listserv. The results of the survey show that the astrobiology community shares many of the same concerns for data sharing as other groups. The benefits of data sharing are acknowledged by many respondents, but barriers to data sharing remain, including lack of acknowledgement, citation, time, and institutional rewards. Overcoming technical, institutional, and social barriers to data sharing will be a challenge into the future. Key Words: Data management—Data sharing—Data preservation. Astrobiology 14, 451–461.

Using a piezoelectric transducer, the frequency and pattern of ocular microtremor (OMT) between 50 normal subjects and 50patients with multiple sclerosis were compared. Controls were age matched. All records were analysed blindly. The frequency of OMT in the normal group was 86 (SD 6) Hz, which was significantly different from that of the multiple sclerosis group (71 (SD) 10Hz, p

Evidence exists which supports the hypothesis that electrical stimulation of appropriate parameters can fulfil the fundamental requirements for an effective evoked potential taste stimulus. Nevertheless, it had previously been considered that electrical taste stimulation is inadequate for evoking gustatory brain potentials. Consequently, the majority of the earlier attempts to record gustatory evoked potentials (GEPs) reported in the literature have employed chemical stimulus techniques. The design of an electrical taste stimulator and its interface to an evoked potential recording unit is described. The first human brain potentials recorded with this system are presented, among which are those attributable to taste pathway activation. Following future work to unequivocally confirm that taste evoked brain potentials are achievable with this system, it has potential to become a clinically valuable tool.

OBJECTIVE: This study was undertaken to establish whether measurement of ocular microtremor (OMT) activity could be used as a method to establish brain stem death. Presently, the diagnosis of brain stem death can be made using clinical criteria alone. OMT is a high-frequency, low-amplitude physiological tremor of the eye caused by impulses emanating from the brain stem. There have been a number of reports indicating that the recording of OMT may be useful in the assessment of comatose states and in establishing brain stem viability or death. METHODS: We obtained the OMT recordings of 32 patients suspected of having brain stem death using the piezoelectric strain gauge technique. This method involves mounting the piezoelectric probe in a headset and lowering the rubber-tipped end piece onto the anesthetized scleral surface of the subject. The signal produced is recorded on audiomagnetic tape and later played back and analyzed on an electrocardiographic tape analyzer. RESULTS: In 28 patients, initial clinical assessment confirmed the diagnosis of brain stem death and no OMT activity was recorded from these subjects. In three patients in whom initial clinical assessment demonstrated brain stem function, OMT activity was present; when brain stem death was subsequently diagnosed in these three patients, no OMT activity could be demonstrated. In the remaining patient, two of three OMT recordings demonstrated activity in spite of the absence of clinical evidence of brain stem function. A post mortem revealed bacterial cerebritis in this subject. CONCLUSION: The results suggest that OMT is a sensitive method of detecting brain stem life and that it could play an important role in the assessment of brain stem death.

The use of dual-energy X-ray absorptiometry (DXA) scanners for measuring bone mineral density (BMD) is on the increase. A single DXA scan is a relatively low-dose diagnostic X-ray examination; however, radiation protection (RP) issues should not be trivialised. One objective of the EU 6th Framework SENTINEL co-ordination action was to develop training syllabi in RP and quality assurance (QA) for BMD, and this study presents the results. An EU-wide survey was carried out which confirmed that there was a need for an accredited DXA RP training course in many EU states. There is also limited published guidance on acceptance testing/QA for DXA. Two training syllabi were developed: one on RP and one on QA of DXA systems. A training course was delivered in Ireland in 2006 by the Medical Physics & Bioengineering Department of St James's Hospital, Dublin. Following the training course, a PC-based training CD was developed and will be made available. A harmonised approach to training will promote consistent approaches to radiation safety across the EU.

The EU Council Directive 97/43/EURATOM (MED) states that Member States shall ensure that adequate theoretical and practical training is provided for dental practitioners working with ionising radiation; this also includes the provision of continuing education and training programmes, post-qualification. The area of dental radiology is specifically mentioned in this legally binding document. The Department of Medical Physics and Bioengineering, St James's Hospital, Dublin, is particularly interested in the area of radiation protection training and routinely provides educational courses both at national and international levels. A recent review of their dental radiation protection course was undertaken in conjunction with a number of Principal Dental Surgeons within the Health Service Executive in Ireland. The revised course was delivered to over 200 dental staff members at two separate meetings during 2006. The response from attendees was very positive. It is proposed to extend this course to other dental professionals, working both in the Irish private and public health sectors in the future.

The field of diagnostic radiology continues to generate interesting lines of physics research even though it is over a century since X-rays were first used for medical imaging. One of these concerns scatter processes which are well known to be a major influence on the quality of X-ray images. The components, effects, reduction and measurement of scatter and the potential of computerized scatter correction schemes are reviewed in this paper. The effect of scatter on indices of image quality is considered using analytical models and published experimental results. Scatter measurement based on the widely applied opaque disc technique and a novel aperture technique are discussed in detail. In addition, computerized scatter correction based on convolution filtering schemes and interpolated local sampling schemes are critically reviewed. The treatment focuses on fluoroscopy- fluorography, although extensive reference is also made to other radiographic imaging techniques.

This study reports on the development and evaluation of a protocol for testing DEXA systems, which can be incorporated into a routine medical physics/engineering service. Methodologies are reported for (1) scatter measurement, (2) estimation of reference dose and (3) enquiry into potential sources of overexposure. Results show that fan-beam and cone-beam systems require shielding if the walls or operator are within 1 m of the table. Patient reference dose was estimated using the dose-area product (DAP). This varied over an order of magnitude from 2 to 36 mGy cm2 in the range of systems studied. The inquiry into potential sources of overexposure revealed some weaknesses in current practise including a design which prevents the inclusion of DAP metres; beam non-uniformity; incorrect specification of patient dose and the risk of overexposure when tube operates during patient positioning.

Radiology is a significant positive contributor to modern healthcare. However, its benefits come at a price, and it now accounts for over 98% of manmade human radiation exposure. For many years, radiologists tended to regard diagnostic radiation dosage as a nonissue. However, patients can receive significant exposures, without receiving any information and, sometimes without commensurate benefit. This chapter surveys social, legal, and medical/radiological issues and the related unresolved ethical questions. The approach taken is exploratory and tentative. Major ethical problems include the frequency of poor justification of medical exposures in practice. Recent work in this area has uncovered significant deficiencies in practice, including non compliance with the law. Three areas of special concern are briefly introduced. They are deliberate nonmedical human exposures; the lack of alignment between the ethical framework for radiation protection and its medical counterparts and finally, situations where the patient to be irradiated is pregnant. A working list of 6 principles/values is proposed for radiology. Three of these are fundamental to medical ethics and appear to have wide applicability in all cultures. From the areas identified as being in need of ethical reflection, justification communication of risk and openness, transparency, and accountability are probably the most central and important.

Objective: Medical ethics has a tried and tested literature and a global active research community. Even among health professionals, literate and fluent in medical ethics, there is low recognition of radiation protection principles such as justification and optimization. On the other hand, many in healthcare environments misunderstand dose limitation obligations and incorrectly believe patients are protected by norms including a dose limit. Implementation problems for radiation protection in medicine possibly flow from apparent inadequacies of the International Commission on Radiological Protection (ICRP) principles taken on their own, coupled with their failure to transfer successfully to the medical world. Medical ethics, on the other hand, is essentially global, is acceptable in most cultures, is intuitively understood in hospitals, and its expectations are monitored, even by managements. This article presents an approach to ethics in diagnostic imaging rooted in the medical tradition, and alert to contemporary social expectations. ICRP and the International Radiation Protection Association (IRPA), both alert to growing ethical concerns, organized a series of consultations on ethics for general radiation protection in the last few years. Methods: The literature on medical ethics and implicit ICRP ethical values were reviewed qualitatively, with a view to identifying a system that will help guide contemporary behaviour in radiation protection of patients. Application of the system is illustrated in six clinical scenarios. The proposed system is designed, as far as is possible, so as not to be in conflict with the conclusions emerging from the ICRP/IRPA consultations. Results and conclusion: A widely recognized and well-respected system of medical ethics was identified that has global reach and claims acceptance in all cultures. Three values based on this system are grouped with two additional values to provide an ethical framework for application in diagnostic imaging. This system has the potential to be robust and to reach conclusions that are in accord with contemporary medical, social and ethical thinking. The system is not intended to replace the ICRP principles. Rather, it is intended as a well-informed interim approach that will help judge and analyse situations that arouse ethical concerns in radiology. Six scenarios illustrate the practicality of the value system in alerting one to possible deficits in practice. Advances in knowledge: Five widely recognized values and the basis for them are identified to support the contemporary practice of diagnostic radiology. These are essential to complement the widely used ICRP principles pending further development in the area.

In a working group of the Belgian Hospital Physicists Association (BHPA), a new protocol has been developed for comprehensive testing of computed tomography scanners. The tests were selected to verify if the scanner is technically adequate, if preprogrammed patient protocols are up-to-date, and if exposure values displayed at the console are sufficiently correct. In addition, they will ensure that the participating medical physics expert (MPE) gets a full understanding of the system to enable him/her to guide optimization processes and allow automated patient dosimetry. Several new test procedures had to be developed. The tests go beyond the criteria identified in the EC guidance document radiation protection (RP) 91 and its successor RP 162. The results of the tests of the BHPA protocol are discussed in the light of the acceptability criteria in RP 91 and RP 162. It is concluded that the ensemble of tests in the BHPA protocol and in RP 162 provide very useful information on the scanner and, more importantly, how the scanner is being used on patients. It is expected that major optimization studies will be triggered by annual testing based on the new documents.

Radiological equipment must be assessed against criteria for acceptability to ensure that it meets the minimum standards for patient safety. This assessment is typically led by a medical physicist with input from radiology staff and the equipment supplier. Equipment that does not meet the criteria requires action and may be suspended from clinical use. European Commission report RP 91 will be revised and replaced as RP 162. It has been drawn up to aid medical physicists with the assessment process and provide guidance on suspension levels. This paper details several cases where the criteria in the proposed RP 162 were applied in general radiography, computed radiography, digital radiography and fluoroscopy. The factors considered by the medical physicist and the outcome of each case are presented. The proposed RP 162 report improves on its predecessor and provides a robust set of criteria for ensuring that patient safety within the EU medical exposures framework is optimised.

Quality assurance protocols and standards of performance for X-ray mammography equipment are probably the most developed of any in the area of diagnostic radiology, due to the exacting demands on image quality required in population-based breast cancer screening programmes. Both qualitative and quantitative acceptability criteria have been published for X-ray mammography by considering the image quality needed clinically in screening programmes. Consequently, the task of developing a consensus for acceptability criteria appears to be relatively easy at first glance. However, there are two contentious issues that must be considered; the first is whether standards based on breast cancer screening can be transposed to equipment used for women referred for imaging with breast symptoms. The second relates to the use of image-quality assessment based upon the observation of details in test phantoms. In respect of the former, there was general agreement that only one set of acceptability criteria should apply to mammographic X-ray equipment. With regard to image-quality assessment, the weakness of the observer-based methods was recognised and a consensus position developed. This paper describes the development of a consensus on acceptability criteria and proposes both qualitative and quantitative criteria for use on all mammographic equipment. Some test approaches and criteria for image displays, in particular, were omitted from the document as concerns about their robustness emerged during the consultation phases of the revision. Clearly, further scientific work is needed in these areas.

The Radiation Protection of Patients Unit of the International Atomic Energy Agency (IAEA) is concerned about the effectiveness of justification of diagnostic medical exposures. Recent published work and the report of an initial IAEA consultation in the area gave grounds for such concerns. There is a significant level of inappropriate usage, and, in some cases, a poor level of awareness of dose and risk among some key groups involved. This article aims to address this.The IAEA convened a second group of experts in November 2008 to review practical and achievable actions that might lead to more effective justification.This report summarises the matters that this group considered and the outcome of their deliberations. There is a need for improved communication, both within professions and between professionals on one hand, and between professionals and the patients/public on the other. Coupled with this, the issue of consent to imaging procedures was revisited. The need for good evidence-based referral guidelines or criteria of acceptability was emphasised, as was the need for their global adaptation and dissemination.Clinical audit was regarded as a key tool in ensuring that justification becomes an effective, transparent and accountable part of normal radiological practice. In summary, justification would be facilitated by the "3 As": awareness, appropriateness and audit.