The International Committee of the Italian Radiation Protection Association (AIRP-IC) representing also the Italian Medical Radiation Protection Association (AIRM) and the Italian Medical Physics Association (AIFM) has always and continuously appreciated the interest of ICRP on educational and training activities. This interest is now becoming even more evident and clear with this document concerning the education to radioprotection in the various medical and health uses and applications.
The committee specifically appreciates the way this document is well recognising, in addition to the role played by the academic institutions, also the role played by the scientific and professional societies, in promoting and supporting the education and in organizing and accrediting various courses in radiological protection for medical exposures. These societies are since long time operating with care and deep knowledge in this field.
The document appears to be written in an accurate, complete and well structured way and, as a result, the reading is fluent and it allows an easy comprehension.
Educating the healthcare staff is definitely a very complex activity since it may involve and it can be addressed to persons with a very different base education and who may be required to operate with a different level of involvement in the use of ionizing radiation. The breakdown of the healthcare professionals in 15 categories, used in this document in order to give proper recommendations for their training, clearly shows this complexity. At the same time, the picture given both for the contents of the different courses and for the training hours suggested for each course, appears to be so adequate and complete to be taken possibly into consideration and used by the Faculty of Medicine for the base education of the medical students and for their subsequent specialized training involving or interested in the use of the ionizing radiation.
Moreover it can be very useful the suggestion, as in paragraph 3.2 on course topic, to consider the ICRP publication “Radiation and your patient: a Guide for medical practitioners”. For example the AIRP-IC had completed and distributed the Italian translation of this document.
In paragraph 1.4, in the first category, radiologists, nuclear medicine physicians and radiation oncologists are listed as those physicians who are trained in the ionising radiation medical specialties. In the same paragraph the second category lists: cardiologists, vascular surgeons and urologists , as other physicians who utilise ionising radiation methods in their practice. However in paragraph 2.2 where the different 15 categories are listed in detail, requiring education and training, radiologists, nuclear medicine physicians and cardiologist are reported respectively in categories 1, 2 and 3, while category 4 includes other medical specialist using x-rays (physicians involved in fluoroscopy in urology, gastroenterology, orthopaedic surgery, neurosurgery or other specialities) and category 5 includes other medical specialists using nuclear medicine. In the whole chapter 2, the oncologists are not mentioned and considered.
As a suggestion it could be useful and consistent with paragraph 1.4, that oncologists were also included specifically in paragraph 2.2 .
In line 286 it is written: “The patient’s personal physician should be informed when there is possibility of radiation effects”. The sentence appears to be too generic and vague since just before in the text, it was mentioned the probability of stochastic health effects that could be reduced and not completely avoided.
In paragraph 1.3.2., with regard to digital radiology procedures, the sentence starting respectively in line 317 “Different medical imaging tasks require different levels of image quality. The use of more radiation to give a higher level of image quality should be avoided where this has no additional benefit for the clinical purpose” could be moved one before the one starting in line 314 “Digital techniques have the potential to improve the practice of radiology, but higher doses than necessary may be delivered without any corresponding improvement in image quality” , since the second one seems to be more general than the first one. Moreover the above sentence starting with “Different medical….” appears to have no particular meaning and it can be applied to a lot of procedures if carried out without optimization and without quality controls. It could be useful to briefly add specific argumentations.
In line 402 “clinicnal task” to be corrected with “clinical task”
In the abstract, from line 88 it is written “The present publication expands considerably on these basic recommendations with regard to various categories of medical practitioners, and other healthcare professionals that perform or provide support for diagnostic and interventional procedures utilising ionizing radiation”. In the introduction, from line 134 is written “…this is the first report to specifically address the topic of the delivery of education and training for medical staff and other healthcare professionals involved in use of ionizing radiation for diagnostic (radiography, fluoroscopy and nuclear medicine) and interventional (fluoroscopically guided) procedures.”
In paragraph 1.4, from line 396 is written “The present report is limited to RP training for diagnostic and interventional procedures, and nuclear medicine therapy”. In the summary of this document at point 3 it is written . “There should be RP training requirements for physicians, dentists and other health professionals who request, conduct or assist in medical or dental procedures that utilise ionising radiation in diagnostic and interventional procedures, nuclear medicine and radiation therapy”
Moreover in Annex A with the subparagraph “additional RP aspects for Therapeutic Nuclear Medicine procedures”, it is clearly considered the therapeutic use of radiopharmaceuticals.
The suggestion is to indicate from the beginning of the document, in the abstract and in the introduction the fields of diagnostic and interventional procedures, and nuclear medicine therapy, as clearly indicated in the lines 396 and 397.
In Annex A, in the list of subjects to be included in the training for Nuclear Medicine, it could be also added a general attention for incontinent patients.
In line 1316, as one of the subject to be included in the training and education, is written: “Nuclear medicine diagnostics in breast feeding females; temporal and/or complete abandoning of breast feeding….”. The suggestion is to indicate ”….temporal or complete abandoning…”