Editorial:

Article Outline

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Sometimes it is useful to sit back and recall a bit of history. To the layman, protection against ionising radiation (if at all known to be something else than non-ionising radiation) is usually taken to be concerned with the nuclear fuel cycle. Yet the biggest man-made source of exposures is not at all nuclear power but medical uses of radiation. Radiation in medicine is a wonderful tool that has permitted amazing improvements in diagnostic capability, great curing capacity, and invaluable palliative treatments. That same tool can also be lethal unless treated with the utmost respect — and that is where ICRP, the International Commission on Radiological Protection, started.

The huge medical benefits of radiation were recognised almost immediately after the discovery of ionising radiation at the end of the 19th century. The dangers of radiation soon became increasingly apparent, and in 1928, what is now ICRP was established by the 2nd International Congress of Radiology under the name of the International X-Ray and Radium Protection Committee. Thus, it was the medical community that first saw the need for a specific international organisation devoted to protection and, to this day, the Commission retains a special relationship with the International Society of Radiology (the professional organisation catering for physicians specialising in the use of radiation).

Back in 1928, the primary concern was that occupational exposure of medical staff could, and did, lead to serious deterministic harm and even death. With improved standards, this hazard seemed to be virtually eliminated several decades ago. Increasing awareness about possible late stochastic effects necessitated a refocusing onto the risk of cancer and onto patients rather than staff.

At much the same time, increasing use of radiation in other contexts than medicine, and increasing attention to natural sources of radiation, were the main reasons why the Commission was re-organised and given its present name in 1950. Although one of the standing committees of ICRP is specifically devoted to radiation in medicine, the majority of the reports in the Annals of the ICRP deal with matters other than medical exposures.

Unfortunately, it has turned out that neither occupational hazards for medical staff nor deterministic harm from exposure to radiation are problems entirely of the past. Medical science is taking great strides all the time, and more and more subjects are competing for time on the syllabus of all medical students.

Regrettably, this has often led to absurdly short or entirely missing education in radiological protection. As a consequence, really serious skin damage and worse is again being experienced, primarily in patients but also in staff. The situation may be aggravated if inexperienced staff encounter modern fluoroscopic equipment with easily operated, potent boost options that, if used indiscriminately, produces images of a clarity which may appear seductively ‘good’ but is not always clinically required.

There are also a number of other problem areas, among them accidents in radiotherapy, high patient doses in computed tomography, doses to family and public from radiopharmaceuticals used for therapy, and the topic of the present report, pregnant patients and staff exposed to medical radiation.

The Commission is planning to address all of these problems in forthcoming reports. In so doing, it will highlight specific situations, often drawing on existing information and reports, but organising the material in a different, more context-oriented way than the Commission's existing reports on medical radiation which are laid out according to a logical hierarchy.

Furthermore, the Commission is keen to reach such ‘shop-floor’ medical staff who are involved in the day-to-day management of radiation. As a means towards this end, the style of this report, and the planned reports just described, is somewhat different than that of recent reports in the Annals of the ICRP (which has unfortunately come to be perceived by many physicians as aiming at health physicists, administrators, and regulators, but not at themselves). Wide-spread distribution will also be given major consideration.

This is not to say that the Commission plans to abandon its traditional type of report. Comprehensive scientific treatises will continue to be a mainstay in the Commission's series of publications. However, the impact will be augmented by also supplying topical reports aimed at special user groups, in this case medical staff. In so doing, the Commission is targeting its classical, original audience, and using a style reminiscent of that in its earliest publications. In short, with this report and forthcoming companion reports on medical radiation problems, ICRP is going back to basics.