Introduction interventional radiology, the department’s scope has grown to include nuclear
The Health Protection Agency (HPA) is an organisation with a commitment to Many clinical medicine and radiotherapy. It has been able to develop in this way through its
improving public health. It is an independent agency whose role is to provide expanded remit, by recruiting clinical personnel, and by working with a greater
an integrated approach to protecting UK public health through the provision of departments range of professional bodies involved in medical exposures. As technology
support and advice. Its radiation protection division’s remit includes the provision of develops, it is important that practice continues to optimise that technology and
independent advice on radiological practice and radiation safety in the UK. Part of the rely on the the Medical Exposure Department will continue to evolve to match these new
work of the Medical Exposure Department of the HPA is to assist and support a range demands in healthcare.
of organisations, including clinical departments, in addressing issues which may ‘green book’
affect radiological practice and patient safety. It is an impartial resource equipped The staff of this department come from a range of backgrounds which includes
with the knowledge and skills to work in partnership with health care professionals radiographers, physicists and radiobiologists. Their collective experience includes all
within the clinical setting. The intention of this article is to heighten awareness of types of medical exposures, dosimetry and government policy. An awareness of current
this resource at the HPA and to demonstrate how it is working to improve radiation practical issues is maintained through radiographers employed by the department
protection and patient safety at local, national and international levels. undertaking regular clinical placements and remaining registered with the HPC.
Challenges to clinical practice This understanding of current practices and clinical issues supports the department
Although the principle areas where medical exposures are employed in the clinical with the ongoing provision of advice to the public and professionals. This may be
environment – diagnostic imaging, interventional radiology, nuclear medicine and in the form of a telephone call or e-mail from an individual regarding a specific
radiotherapy – have diverse working practices, common themes in the challenges matter, or through working with a clinical department, more of which is described
that face professionals working in these modalities are apparent. later in this article. Whilst advice is mainly provided to healthcare professionals,
professional bodies, government departments and agencies, the public also often
The assurance of patient safety combined with optimal service efficiency, whilst contacts the HPA for advice in relation to medical exposures that either they, or a
maintaining compliance with legislation are the cornerstones of everyday clinical family member, have or is about to undergo.
practice. The ongoing demands facing healthcare professionals in the safeguarding
of these cornerstones are well known. Working with government, agencies and professional
bodies
Many initiatives and publications from national and international organisations Formal advice via publications on clinical dose is still provided to the government
and bodies have attempted to assist departments in achieving a safe and timely and healthcare professionals, but this has now been expanded to include closer
service, and new ones will continue to be published in the future. However, working with the professional bodies and, where appropriate, the provision of
individual departments often have to interpret the advice and apply it locally informal advice to individual professionals and clinical departments.
without assistance. The Medical Exposure Department is a small and flexible
group who can offer some support to clinical departments in translating national Work on reference doses continues in radiography, fluoroscopy and CT. This
recommendations into local practice with the aim of improving patient safety in directly influences the national diagnostic reference levels
1
(DRLs) set by the
the context of compliance with legislation. Department of Health, which informs justification and optimisation decisions.
Dose surveys
2
, compiled in five year cycles, are undertaken to provide the basis
About the Medical Exposure Department for these reference doses. The next survey on medical and dental imaging is
The National Radiological Protection Board (NRPB) was originally established currently underway and will reflect changes in technology and associated practice
in 1970 and in its 35 years developed an international reputation for science, by focusing on CR/DR as well as paediatrics. It is also intended to start the next
providing advice to government and working with a range of organisations with CT scanning survey this year which will consider changes brought about by the
interests in radiation protection. In 2005, the NRPB was incorporated into the HPA increasing use of multi-slice CT scanners. These surveys are dependent on the
and later that year the Medical Exposure Department was formed. imaging community being able to provide as much data as possible and, to ensure
that these published documents are a true reflection of the UK’s working practice,
This department builds on the valuable work in radiation protection carried it is essential that dose data is provided for inclusion in the patient dose database.
out by the NRPB. Whilst the NRPB’s main focus was on diagnostic imaging and For advice concerning the management of a pregnant female referred for a
2009
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IMAGING & ONCOLOGY
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