Objective To assess the cancer risk in children and adolescents following exposure to low dose ionising radiation from diagnostic computed tomography (CT) scans.

The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) is undertaking web based surveys to obtain data to establish national diagnostic reference levels (DRLs) for diagnostic imaging. The first set of DRLs to be established are for multi detector computed tomography (MDCT). The survey samples MDCT dosimetry metrics: dose length product (DLP, mGy.cm) and volume computed tomography dose index (CTDIvol, mGy), for six common protocols/habitus: Head, Neck, Chest, AbdoPelvis, ChestAbdoPelvis and Lumbar Spine from individual radiology clinics and platforms. A practice reference level (PRL) for a given platform and protocol is calculated from a compliant survey containing data collected from at least ten patients. The PRL is defined as the median of the DLP/CTDIvol values for a single compliant survey. Australian National DRLs are defined as the 75th percentile of the distribution of the PRLs for each protocol and age group. Australian National DRLs for adult MDCT have been determined in terms of DLP and CTDIvol. In terms of DLP the national DRLs are 1,000 mGy cm, 600 mGy cm, 450 mGy cm, 700 mGy cm, 1,200 mGy cm, and 900 mGy cm for the protocols Head, Neck, Chest, AbdoPelvis, ChestAbdoPelvis and Lumbar Spine respectively. Average dose values obtained from the European survey Dose Datamed I reveal Australian doses to be higher by comparison for four out of the six protocols. The survey is ongoing, allowing practices to optimise dose delivery as well as allowing the periodic update of DRLs to reflect changes in technology and technique.

As in any medical intervention, there is either a known or an anticipated benefit to the patient from undergoing a medical imaging procedure. This benefit is generally significant, as demonstrated by the manner in which medical imaging has transformed clinical medicine. At the same time, when it comes to imaging that deploys ionising radiation, there is a potential associated risk from radiation. Radiation risk has been recognised as a key liability in the practice of medical imaging, creating a motivation for radiation dose optimisation. The level of radiation dose and risk in imaging varies but is generally low. Thus, from the epidemiological perspective, this makes the estimation of the precise level of associated risk highly uncertain. However, in spite of the low magnitude and high uncertainty of this risk, its possibility cannot easily be refuted. Therefore, given the moral obligation of healthcare providers, 'first, do no harm,' there is an ethical obligation to mitigate this risk. Precisely how to achieve this goal scientifically and practically within a coherent system has been an open question. To address this need, in 2016, the International Atomic Energy Agency (IAEA) organised a summit to clarify the role of Diagnostic Reference Levels to optimise imaging dose, summarised into an initial report (Järvinen et al 2017 Journal of Medical Imaging 4 031214). Through a consensus building exercise, the summit further concluded that the imaging optimisation goal goes beyond dose alone, and should include image quality as a means to include both the benefit and the safety of the exam. The present, second report details the deliberation of the summit on imaging optimisation.

Optimization is one of the key concepts of radiation protection in medical imaging. In practice, it involves compromising between the image quality and dose to the patient; the dose should not be higher than necessary to achieve an image quality (or diagnostic information) needed for the clinical task. Monitoring patient dose is a key requirement toward optimization. The concept of diagnostic reference level (DRL) was introduced by the International Commission on Radiological Protection as a practical tool for optimization. Unfortunately, this concept has not been applied consistently worldwide. To review the current strengths and weaknesses worldwide and to promote improvements, the International Atomic Energy Agency organized a Technical Meeting on patient dose monitoring and the use of DRLs on May 2016. This paper reports a summary of the findings and conclusions from the meeting. The strengths and weaknesses were generally different in less-developed countries compared with developed countries. Possible improvements were suggested in six areas: human resources and responsibilities, training, safety and quality culture, regulations, funding, and tools and methods. An overall conclusion was that radiation protection requires a patient-centric approach and a transfer from purely reactive to increasingly proactive optimization, whereby the best outcome is expected from good teamwork.

The use of dedicated PET scanners is becoming more widespread throughout Australia and the world. PET imaging utilizes short-lived (approximately 108 min), high-energy (511 keV) gamma-ray emitters that could result in a high radiation dose being received by staff. As part of a larger staff and area monitoring project, this paper discusses the personal dose equivalent, H(p)(10), received by PET staff working in a dedicated PET center. The typical H(p)(10) received by staff was approximately 1 microSv per minute of close contact with patients, which resulted in an average daily dose for nuclear medicine technologists of approximately 31 microSv. The average daily administered activity to patients at Austin Health was 1,280 MBq.