Making the best use of clinical radiology

Nuclear power plant disasters capture headlines but the collective dose to the population from medical imaging is three times greater than from nuclear energy production.1 2

Perhaps the two principles of radiation protection—optimisation and justification—need reiterating and the impact of measures to support these outlined. Optimisation—the reduction of medical exposure dose to as low as reasonably achievable—is promoted in the UK through use of diagnostic reference levels and the National Patient Dose Database. Justification (legal requirement balancing benefit and risk of a medical exposure) requires guidance to referrer and radiology practitioner.

Over the past 20 years, the Royal College of Radiologists (RCR) has published guidance to help clinicians select the appropriate imaging investigation. Making the Best Use of Clinical Radiology Services (6th ed) is available through NHS networks and from the RCR.3 A 20% reduction in medical exposures has been estimated.4 Although difficult to find a surrogate for appropriate imaging, the UK has the lowest per capita collective dose in a dozen European countries, lending some weight to the value of justification.5

The forthcoming seventh edition of the NHS evidence accredited RCR imaging referral guidelines will be published this autumn and aims to be concordant with many validated clinical guidelines, such as National Institute for Health and Clinical Excellence guidance on low back pain. Although the pocket sized print version has changed little outwardly, its size belies its value for assessing justification and it bridges the gap between clinician, radiologist, and possibly patients, by promoting the best test first.