Responsibilities in medical radiation practices
According to the Radiation Act, a physician must always assess the justification for an examination that causes exposure to radiation in advance, taking into account the purpose of the procedure and the status of the person in question.
The attending physician assesses the justification first
The justification is first assessed by the patient’s attending physician, who must have the basic knowledge of the health effects of ionizing radiation and the patient’s radiation exposure in different procedures. Where possible, the physician must also obtain the necessary information on the patient’s previous examinations.
National or international referral recommendations, information concerning the typical radiation doses caused by examinations and, as necessary, consulting a specialist in the field are recommended references when considering the justification of a specific examination. The physician must take into account any alternative examination methods, such as ultrasound and magnetic imaging and other methods that reduce exposure to radiation. The justification must be assessed very carefully especially before the examination of children, young adults or pregnant women. Even the need for routine examinations must be carefully considered.
The physician responsible for the procedure verifies the justification and optimization
The physician responsible for a procedure involving exposure to radiation has the obligation to verify the justification and optimization of the procedure. The physician responsible is usually a radiology specialist or nuclear medicine specialist. In an operating room, cardiology and during gastroenterological procedures, for example, the physician responsible may be a specialist in the field in question with the necessary knowledge on radiation protection.
As necessary, the physician responsible for the examination can negotiate with the attending physician on the justification, change the examination or refuse the examination. Refusing an examination and the reason for refusal must always be recorded in the patient’s documentation and notified to the referring unit and the patient.
The patient must be notified of the benefits and risks of the procedure
The patient must be provided with open and honest information on the planned examination involving radiation exposure and its alternatives so that the patient can approve or refuse the examination (Act on the Status and Rights of Patients).
When informing the patient, it is important to consider the patient’s background and avoid causing unnecessary distress. It is natural for the attending physician to primarily inform the patient when assessing the justification for the examination. A nurse or physician in the medical imaging unit may provide further information to the patient, if needed.
The radiology nurse inspects the equipment and shielding
Before targeting radiation at a human being, the person performing the procedure – in practice, usually the radiology nurse – shall have a special obligation to ensure that:
- the safety and shielding arrangements of the radiation source are in proper condition and the equipment to be used functions faultlessly
- the patient is properly protected and radiation exposure is limited to the parts of the body that are intended to be irradiated
- any radiopharmaceuticals being administered to the patient have been properly checked.
The responsibilities are defined in the regulations and guides
Chapter 10 of the Radiation Act defines the responsibilities for performing a medical procedure involving exposure to ionizing radiation. The Decree of the Ministry of Social Affairs and Health on the medical use of radiation (423/2000) sets forth qualification requirements for the referring physician, physician responsible for the procedure and the person performing the procedure. Guide ST 1.7 presents requirements for the radiation protection training of personnel involved in the medical use of radiation with regard to basic, specialization and supplementary training.