Bonn Call For Action: 10 Actions To Improve Radiation Protection in Medicine in The Next Decade

BONN CALL FOR ACTION
10 Actions to Improve Radiation Protection

in Medicine in the Next Decade
Joint Position Statement by the IAEA and WHO
The International Atomic Energy Agency (IAEA) held the “International Con-
ference on Radiation Protection in Medicine: Setting the Scene for the Next
Decade” in Bonn, Germany, in December 2012, with the specific purpose of
identifying and addressing issues arising in radiation protection in medicine.
The conference was co-sponsored by the World Health Organization (WHO),
hosted by the Government of Germany through the Federal Ministry for the
Environment, Nature Conservation and Nuclear Safety, and attended by 536
participants and observers from 77 countries and 16 organizations. An impor-
tant outcome of the conference was the identification of responsibilities and a
proposal for priorities for stakeholders regarding radiation protection in medi-
cine for the next decade. This specific outcome is the Bonn Call-for-Action.
There is no doubt that the application of ionizing radiation and radioactive

materials in diagnostic, interventional and therapeutic procedures in medicine
is beneficial for hundreds of millions of people each year. However, employing
radiation in medicine has to involve a careful balance between the benefits of
enhancing human health and welfare, and the risks related to the radiation
exposure of people. There is a need for a holistic approach which includes part-
nership of national governments, civil society, international agencies, research-
ers, educators, institutions and professional associations aiming at identifying,
advocating and implementing solutions to address existing and emerging
challenges; and leadership, harmonization and co-ordination of activities and
procedures at an international level.
The aims of the Bonn Call-for-Action are to a) strengthen the radiation pro-
tection of patients and health workers overall; b) attain the highest benefit with
the least possible risk to all patients by the safe and appropriate use of ionizing
radiation in medicine; c) aid the full integration of radiation protection into
health care systems; d) help improve the benefit/risk-dialogue with patients
and the public; and e) enhance the safety and quality of radiological procedures
in medicine.
The Bonn Call-for-Action highlights ten main actions, and related sub-actions,
that were identified as being essential for the strengthening of radiation pro-
tection in medicine over the next decade. The actions are not listed in order of
importance. Action by all stakeholders is encouraged.
01
Enhance the implementation of the
principle of justification
Introduce and apply the 3A’s (awareness, appropriateness and audit),
which are seen as tools that are likely to facilitate and enhance
justification in practice;
Develop harmonized evidence-based criteria to strengthen the

appropriateness of clinical imaging, including diagnostic nuclear
medicine and non-ionizing radiation procedures, and involve all
stakeholders in this development;
Implement clinical imaging referral guidelines globally, keeping

local and regional variations in mind, and ensure regular updating,
sustainability and availability of these guidelines;
Strengthen the application of clinical audit in relation to justification,

ensuring that justification becomes an effective, transparent and
accountable part of normal radiological practice;
Introduce information technology solutions, such as decision support

tools in clinical imaging, and ensure that these are available and freely
accessible at the point-of-care;
Further develop criteria for justification of health screening programmes

for asymptomatic populations (e.g. mammography screening) and for
medical imaging of asymptomatic individuals who are not participating
in approved health screening programmes (e.g. use of CT for individual
health surveillance).
Enhance the implementation of the
principle of optimization of
02
protection and safety
Ensure establishment, use of, and regular update of diagnostic reference
levels for radiological procedures, including interventional procedures, in
particular for children;
Strengthen the establishment of quality assurance programmes for

medical exposures, as part of the application of comprehensive quality
management systems;
Implement harmonized criteria for release of patients after radionuclide

therapy, and develop further detailed guidance as necessary;
Develop and apply technological solutions for patient exposure records,

harmonize the dose data formats provided by imaging equipment, and
increase utilization of electronic health records.
03
Strengthen manufacturers’ role in
contributing to the overall safety regime
Ensure improved safety of medical devices by enhancing the radiation
protection features in the design of both physical equipment and
software and to make these available as default features rather than
optional extra features;
Support development of technical solutions for reduction of radiation

exposure of patients, while maintaining clinical outcome, as well as of
health workers;
Enhance the provision of tools and support in order to give training for
users that is specific to the particular medical devices, taking into account
radiation protection and safety aspects;
Reinforce the conformance to applicable standards of equipment with

regard to performance, safety and dose parameters;
Address the special needs of health care settings with limited

infrastructure, such as sustainability and performance of equipment,
whether new or refurbished;
Strengthen cooperation and communication between manufacturers and

other stakeholders, such as health professionals and professional societies;
Support usage of platforms for interaction between manufacturers and health

and radiation regulatory authorities and their representative organizations.
Strengthen radiation protection education
and training of health professionals
04
Prioritize radiation protection education and training for health
professionals globally, targeting professionals using radiation in all
medical and dental areas;
Further develop the use of newer platforms such as specific training

applications on the Internet for reaching larger groups for training purposes;
Integrate radiation protection into the curricula of medical and dental

schools, ensuring theestablishment of a core competency in these areas;
Strengthen collaboration in relation to education and training among

education providers in health care settings with limited infrastructure
as well as among these providers and international organizations and
professional societies;
Pay particular attention to the training of health professionals in

situations of implementing new technology.
05
Shape and promote a strategic research
agenda for radiation protection in medicine
Explore the re-balancing of radiation research budgets in recognition of
the fact that an overwhelming percentage of human exposure to man-
made sources is medical;
Strengthen investigations in low-dose health effects and radiological

risks from external and internal exposures, especially in children and
pregnant women, with an aim to reduce uncertainties in risk estimates
at low doses;
Study the occurrence of and mechanisms for individual differences in

radiosensitivity and hyper-sensitivity to ionizing radiation, and their
potential impact on the radiation protection system and practices;
Explore the possibilities of identifying biological markers specific to

ionizing radiation;
Advance research in specialized areas of radiation effects, such as

characterization of deterministic health effects, cardiovascular effects,
and post-accident treatment of overexposed individuals;
Promote research to improve methods for organ dose assessment,

including patient dosimetry when using unsealed radioactive sources,
as well as external beam small-field dosimetry.
Increase availability of improved global
information on medical exposures and
06
occupational exposures in medicine
Improve collection of dose data and trends on medical exposures
globally, and especially in low- and middle-income countries, by
fostering international co-operation;
Improve data collection on occupational exposures in medicine

globally, also focussing on corresponding radiation protection
measures taken in practice;
Make the data available as a tool for quality management and for trend
analysis, decision making and resource allocation.
07
Improve prevention of medical radiation
incidents and accidents
Implement and support voluntary educational safety reporting systems
for the purpose of learning from the return of experience of safety related
events in medical uses of radiation;
Harmonize taxonomy in relation to medical radiation incidents and

accidents, as well as related communication tools such as severity scales,
and consider harmonization with safety taxonomy in other medical areas;
Work towards inclusion of all modalities of medical usage of ionizing

radiation in voluntary safety reporting, with an emphasis on
brachytherapy, interventional radiology, and therapeutic nuclear medicine
in addition to external beam radiotherapy;
Implement prospective risk analysis methods to enhance safety in

clinical practice;
Ensure prioritization of independent verification of safety at critical steps,

as an essential component of safety measures in medical uses of radiation.
Strengthen radiation safety culture in
health care
08
Establish patient safety as a strategic priority in medical uses of ionizing
radiation, and recognize leadership as a critical element of strengthening
radiation safety culture;
Foster closer co-operation between radiation regulatory authorities,

health authorities and professional societies;
Foster closer co-operation on radiation protection between different

disciplines of medical radiation applications as well as between different
areas of radiation protection overall, including professional societies and
patient associations;
Learn about best practices for instilling a safety culture from other areas,
such as the nuclear power industry and the aviation industry;
Support integration of radiation protection aspects in health

technology assessment;
Work towards recognition of medical physics as an independent

profession in health care, with radiation protection responsibilities;
Enhance information exchange among peers on radiation protection and

safety-related issues, utilizing advances in information technology.
09
Foster an improved radiation
benefit-risk-dialogue
Increase awareness about radiation benefits and risks among health
professionals, patients and the public;
Support improvement of risk communication skills of health care

providers and radiation protection professionals – involve both
technical and communication experts, in collaboration with patient
associations, in a concerted action to develop clear messages tailored to
specific target groups;
Work towards an active informed decision making process for patients.

Strengthen the implementation of safety
requirements globally
10
Develop practical guidance to provide for the implementation of the
International Basic Safety Standards in health care globally;
Further the establishment of sufficient legislative and administrative

framework for the protection of patients, workers and the public at
national level, including enforcing requirements for radiation protection
education and training of health professionals, and performing on-site
inspections to identify deficits in the application of the requirements of this
framework.
Radiation Protection of Patients Unit (RPOP)
Radiation Safety and Monitoring Section (RSM)
Division of Radiation, Transport and Waste Safety (NSRW)
INTERNATIONAL ATOMIC ENERGY AGENCY (IAEA)
Vienna International Centre, PO Box 100
1400 Vienna, Austria
www.rpop.iaea.org/
E-mail: Patient-Protection.Contact-Point@iaea.org
Radiation Programme
Department of Public Health, Environmental
and Social Determinants of Health (PHE)
Cluster of Family, Women’s and Children’s Health (FWC)
WORLD HEALTH ORGANIZATION (WHO)
Avenue Appia 20
1211 Geneva-27, Switzerland
www.who.int/ionizing_radiation/about/med_exposure/en/
E-mail: globalinitiative@who.int

Bonn Call For Action: 10 Actions To Improve Radiation Protection in Medicine in The Next Decade

Uploaded by

Copyright:

Available Formats

Bonn Call For Action: 10 Actions To Improve Radiation Protection in Medicine in The Next Decade

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Bonn Call For Action: 10 Actions To Improve Radiation Protection in Medicine in The Next Decade

Uploaded by

Copyright:

Available Formats

BONN CALL FOR ACTION

10 Actions to Improve Radiation Protection

There is no doubt that the application of ionizing radiation and radioactive

Develop harmonized evidence-based criteria to strengthen the

Implement clinical imaging referral guidelines globally, keeping

Strengthen the application of clinical audit in relation to justification,

Introduce information technology solutions, such as decision support

Further develop criteria for justification of health screening programmes

Strengthen the establishment of quality assurance programmes for

Implement harmonized criteria for release of patients after radionuclide

Develop and apply technological solutions for patient exposure records,

Support development of technical solutions for reduction of radiation

Reinforce the conformance to applicable standards of equipment with

Address the special needs of health care settings with limited

Strengthen cooperation and communication between manufacturers and

Support usage of platforms for interaction between manufacturers and health

Further develop the use of newer platforms such as specific training

Integrate radiation protection into the curricula of medical and dental

Strengthen collaboration in relation to education and training among

Pay particular attention to the training of health professionals in

Strengthen investigations in low-dose health effects and radiological

Study the occurrence of and mechanisms for individual differences in

Explore the possibilities of identifying biological markers specific to

Advance research in specialized areas of radiation effects, such as

Promote research to improve methods for organ dose assessment,

Improve data collection on occupational exposures in medicine

Harmonize taxonomy in relation to medical radiation incidents and

Work towards inclusion of all modalities of medical usage of ionizing

Implement prospective risk analysis methods to enhance safety in

Ensure prioritization of independent verification of safety at critical steps,

Foster closer co-operation between radiation regulatory authorities,

Foster closer co-operation on radiation protection between different

Support integration of radiation protection aspects in health

Work towards recognition of medical physics as an independent

Enhance information exchange among peers on radiation protection and

Support improvement of risk communication skills of health care

Work towards an active informed decision making process for patients.

Further the establishment of sufficient legislative and administrative

You might also like