On the importance of systems thinking when using the ALARP principle for risk management

Rationale and objectives Radiology personnel must have good knowledge, experience and adherence to radiation protection and infection control practices to ensure patient safety and prevent the further spread of the COVID-19 virus. This study analysed compliance and adherence to radiation protection and infection control during COVID-19 mobile radiography. Methods A cross-sectional using online survey was conducted from September to December 2021. Data on demographic characteristics, adherence to radiation protection and infection control practice were collected during mobile radiography for COVID-19 patients in the study. A random sample of the radiographers working in COVID-19 centres in the United Arab Emirates. Results Responses were received from 140 participants, with a response rate of 87.5%. Females were the predominant participants (n = 81; 58%). Participants aged ages between 18–25 years (n = 46; 33%) and 26–35 years (n = 42; 30%), (n = 57; 41%) had less than five years of experience, followed by participants who had more than 15 years (n = 38; 27%). Most participants (n = 81; 57.9%) stated that they performed approximately 1–5 suspected or confirmed COVID-19 cases daily. The participants had moderate to high adherence to radiation protection, with a mean and standard deviation of 42.3 ± 6.28. Additionally, infection control adherence was high, with 82% of the participants showing high adherence. Conclusion Continuous guidance, training and follow-up are recommended to increase adherence and compliance to radiation protection and infection control compliance. Educational institutions and professional organisations must collaborate to provide structured training programmes for radiology practitioners to overcome the practice and knowledge gap.

Infection control and radiation safety practices in the radiology department during the COVID-19 outbreak

Ectodermal dysplasia (ED) is a congenital syndrome characterized by abnormal development of ectodermal structures, such as skin, hair, nails, teeth, or salivary glands. Patients with ED demonstrate craniofacial dysmorphology, midfacial hypoplasia and hypodontia. The aim of this study is to evaluate volume and surface area of maxillary sinus and craniofacial structures in patients with ectodermal dysplasia (ED) using cone-beam computed tomography (CBCT) images. The CBCT images of 20 patients with ED (study group) and 20 healthy individuals (control) which are equal in terms of age and gender were evaluated. After a three-dimensional analysis and segmentation of each maxillary sinus, the volume and surface area were calculated. Craniofacial dimensions were measured on the sagittal planes of the CBCT images. The results of the ED and control groups were statistically compared. The right and left sinus volumes and surface areas were significantly lower in the ED group than in the control group (p   0.05). The volumes and surface areas of both maxillary sinuses were found to be smaller in patients with ED compared to healthy individuals. Class III malocclusion with maxillary retrusion is a characteristic craniofacial feature of these patients.

The effect of ectodermal dysplasia on volume and surface area of maxillary sinus.

In September 2022, the International Commission on Radiological Protection (ICRP) organised a Workshop in Estoril, Portugal, on the "Review and Revision of the System of Radiological Protection: A Focus on Research Priorities". The Workshop, which was a side event of the European Radiation Protection Week, offered an opportunity to comment on a recent paper published by ICRP on areas of research to support the System of Radiological Protection. Altogether, about 150 individuals participated in the workshop. After the workshop, 16 of the 30 organisations in formal relations with ICRP provided written feedback. All participants and organisations followed ICRP's view that further research in various areas will offer additional support in improving the System in the short, medium, and long term. In general, it was emphasized that any research should be outcome-focused in that it should improve protection of people or the environment. Many research topics mentioned by the participants were in line with those already identified by ICRP in the paper noted above. In addition, further ideas were expressed such as, for example, that lessons learned during the COVID-19 pandemic with regards to the non-radiological social, economic and environment impacts, should be analysed for their usefulness to enhance radiological protection, and that current protection strategies and application of current radiological protection principles may need to be adapted to military scenarios like those observed recently during the military conflict in the Ukraine or the detonation of a nuclear weapon. On a broader perspective, it was discussed how radiation research and radiological protection can contribute towards the Sustainable Development Goals announced by the United Nations in 2015. This paper summarises the views expressed during the Workshop and the major take home messages identified by ICRP. .

ICRP workshop on the review and revision of the system of radiological protection: A focus on research priorities - feedback from the international community.

The ALARA (an acronym for 'as low as reasonably achievable') principle, keeping the likelihood of incurring exposure, the number of people exposed and the magnitude of their individual doses 'as low as reasonably achievable, taking into account economic and societal factors', is at the core of radiation protection. For many decades the principle has been an area of continuous development, with recent work highlighting the importance of engaging not only with the decision-makers in the ALARA process but all stakeholders who may incur an exposure. This paper considers a particular case study in which the dredging of non-hazardous sediment in the United Kingdom near a now decommissioned nuclear power station raised substantial public concern about radiological exposure. This turned what was a straightforward construction activity into a complex public engagement and reassurance task, at a significant cost disproportionate to the level of radiological risk. This paper highlights the key lessons learnt from the case study, including not only the importance of engaging the public as part of the ALARA process but also of considering the societal impact arising from stress and concerns if misinformation is allowed to promulgate. A discussion is included on the need to underpin any engagement with a clear plan, including pre-engagement, implementation and reinforcement of messages. In addition, the role of the radiation protection professional is considered in ensuring that all stakeholders are informed, so that ultimately they can come to their own decision on what is safe.

Communicating radiation risk: the role of public engagement in reaching ALARA.

The principle of As Low As Reasonable Achievable (ALARA) stems from the field of radiological protection. In the UK, this principle has been incorporated into the Health and Safety at Work Act 1974 and rather than applying solely to radiological hazards, applies to all hazards in totality. Given that the current methods for assessing hazards are somewhat isolated, in that one hazard is assessed independently of another, it can be challenging to ensure a truly holistic view of the risks, and demonstrate they have been reduced to ALARA or As Low As Is Reasonably Practicable (ALARP) as required in the UK regulatory regime. The following paper presents a proposed framework for the integrated assessment of risks from multiple hazards. In addition, it presents an overview of some of the key challenges that may be encountered when producing a holistic ALARA demonstration.

https://iopscience.iop.org/article/10.1088/1361-6498/aa8e53/pdf

Integration of risks from multiple hazards into a holistic ALARA/ALARP demonstration

The practical implementation of the principle of optimisation of radiological protection (i.e., ALARA principle) was the subject of two workshops organised in Paris (France) in February 2017 and October 2018 at the initiative of SFRP within the framework of IRPA. The article summarizes the discussions and conclusions of these two workshops. The search for reasonableness was examined in three sectors: nuclear industry, medical practices and existing exposure situations. In all sectors, the optimisation remains a challenge and experience shows that this is implemented through a deliberative process to achieve a reasonable compromise with all informed parties. This issue was further investigated by three working groups − one for each sector – on the basis of cases studies. It emerges that, in complement to the use of classical tools such as cost-benefit analysis, the implementation of the optimisation principle implies a clear identification of the challenges to be met in order to achieve the best protection in the prevailing circumstances. These challenges may be specific to a type of exposure situation and in some cases to a given situation. The process should also well identify the relevant stakeholders and decision-makers to be involved and determine how they will be involved. A proactive process including development of awareness, empowerment and/or training may be needed. This reflexion deserves to be further developed.

/pdf/summary-of-sfrp-irpa-workshops-on-the-reasonableness-in-the-2rlfl7v1un.pdf

Summary of SFRP-IRPA workshops on the reasonableness in the practical implementation of the ALARA principle

Alara 原則の実用的な実装における合理性に関するフランス放射線防護学会（sfrp）と国際放射線防護学会（irpa）のワークショップの要約

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Integration of risks from multiple hazards into a holistic ALARA/ALARP demonstration

Summary of SFRP-IRPA workshops on the reasonableness in the practical implementation of the ALARA principle

Alara 原則の実用的な実装における合理性に関するフランス放射線防護学会（sfrp）と国際放射線防護学会（irpa）のワークショップの要約