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Submitted by Osimani Celso, International Committee of Italian Radiation Protection Association
   Commenting on behalf of the organisation
Document Radiological protection in paediatric diagnostic and interventional radiology
 

Comments on “Radiological Protection in PAEDIATRIC DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY”


BY THE INTERNATIONAL COMMITTEE OF THE


ITALIAN RADIATION PROTECTION ASSOCIATION


 


The International Committee of Italian Radiation Protection Association (AIRP), also representing the Italian Medical Radiation Protection Association welcomed the document, as indispensable, well defined and of high interest in the field of Radiological Protection in Medicine. This document will have a good practical application in all the medical facilities where cases of diagnostic and interventional radiology are present, in addition to the areas already specialised in the examination and treatment of paediatric patients.


 


 


GENERAL COMMENTS


 


The contents of chapter 2 ‘Basic concept of radiological protection’ should already be well known in the field of ionizing radiation use in medicine. Nevertheless, this chapter provides a useful overview of the whole document in a clear and essential manner. However, more than this, it should also be of further interest to go into greater depth to consider the protection of children: if  paragraph 2.2 on the biological basis for radiological protection is maintained general, as it is, with no specific attention to children, a new paragraph specifically dedicated to the biological basis for the radiological protection of children should be added. This would be as a summary of all the knowledge in the field of radiation risk for children. It would also be useful to report, as already done in previous ICRP Publications, that for the exposure of young children, the attributable lifetime risk of death (total cancers) would be higher, perhaps by a factor of 2 or 3


 


 


Regarding the justification principles, in paragraph 3.1 of chapter 3 ‘General aspects of radiological protection in paediatric diagnostic imaging’, specific attention is appropriately given to the justification of paediatric examination. However, more than this in view of the sentence  ‘…every examination should result in a net benefit for the individual or for public health ’, even if  we know that in general ‘the total benefits from a medical procedure include not only the direct health benefits to the patient, but also the benefits to the patient’s family and to society,’ it would be useful, here in this document dedicated to children, to add some comments to attempt to explain better the justification for paediatric exposure with the benefit for public health.


 


In this document dedicated to non adult patients it would be useful to specify, if possible, the differences in the terms used throughout the text:  new born, infants, young children, children, small children, older children, young adult and paediatric patients.


 


The document is well detailed in giving technical criteria for radiological protection of paediatric patients and includes consideration for the protection of staff and the involvement of children in research projects.  However, throughout the document, it was not taken in to consideration the aspects of informing the patient or the parent about the benefits and risks of the diagnostic treatment.. The aspects of communicating with the parents and of the consent for the examination could be of interest for this document. It should be remembered that when paediatric patients are involved, often, the parents are generally anxious for them and in particular in relation to all kinds of risk, including the potential risks related to the diagnostic tests.


It should be noted that, in this document, informing and interaction with parents of the paediatric patient are only  mentioned 3 times: i) when physical restraint of the patient is unavoidable, the parents are informed about the procedure and what is required from them; ii) regarding the possibility to omit the CT brain scan after head trauma for children younger than 2 years, the judgement of the  parents that the child is acting as normal,  is one of the criteria taken into consideration, together with no loss of consciousness and other observations, iii) in preparing the young child patient in the case of the CT procedure, interaction is also considered with the parents who may ease the child’s discomfort  by staying with the child throughout the procedure. More attention to the communication and involvement of parents in paediatric diagnostic and interventional radiology should be presented in this document.


 


SPECIFIC COMMENTS


 


 Page7,   -line 110 to be changed to: (ICRP, 2003c) and ICRP 103 (ICRP, 2007d)


               -line 138 to be changed to:  procedures (ICRP 2007d).


 


Page 10, -line 186 and 187: ‘…will rise steeply to 100%’ do not need change of line.


 


Page 16, -lines 362 and 363 indicate ‘Radiological examinations requested purely for medico-legal purposes, such as bone-age request in immigrant adolescents, are not medically justified.’ This sentence is welcomed. At the same time it is suggested to consider the opportunity to explain that if a decision was reached to proceed with radiological examinations for legal purposes, even if not justified from the medical point of view, the radiological procedures have unequivocally to respect the optimization process.


 


Page 49,  -caption of the Table 5: CDTI to be changed to CTDI