BMJ  2004;328:1201 (15 May), doi:10.1136/bmj.328.7449.1201

Letter

Sustainability of medical imaging

Proposed licensing system and consent procedure are impractical

EDITOR—It is difficult to argue with Picano's premise that it would be a good thing if the doctors who referred patients for examinations using ionising radiation had a clearer idea of the risks involved.¹ However, Hardingham is right to point out that his suggested solution of a "driving licence" is completely impractical, and is based on a misunderstanding of the current legislation for the protection of patients.²

The licensing system he proposes would be bureaucratic and impossible to administer. It is also unnecessary. The legislation makes it quite clear that the referrer's responsibility is to provide the practitioner with sufficient information to decide whether the examination is justified. Whenever possible, that practitioner should be the radiologist (or nuclear medicine doctor) responsible for performing and reporting the examination, who will hopefully have the requisite knowledge of the radiation hazard and will be able to make an informed judgment.

If the licensing were an administrative nightmare then obtaining written consent for every exposure would bring radiology departments to a halt. The concept of counselling all the anxious patients referred for a chest x ray and confused and alarmed by the information that they are about to receive an exposure of 0.02 mSv, which may, or may not, cause cancer in 30 years' time hardly bears thinking about. There may be a case for this with some of the higher dose procedures, but even here we would need to give it careful thought. Simply stating the absolute level of risk (which we don't actually know with any degree of accuracy) without any attempt to put it into the context of the patient's illness and the benefits to be expected, would be unfair on them, and it would be impossible to do this adequately for more than a small minority.

Leeds General Infirmary, Leeds LS1 3EX bob.bury{at}leedsth.nhs.uk

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Competing interests: BB is a consultant radiologist with a special interest in radiation protection.

References

1. Picano E. Sustainability of medical imaging. BMJ 2004;328: 578-80. (6 March.)[Free Full Text]
2. Hardingham C. The radiologist's role in radiation protection. Electronic response to: Sustainability of medical imaging. bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/328/7439/578#52506 (accessed 28 Apr 2004).

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