X-rays for medical imaging: Radiation protection, governance and ethics over 125 years

Abstract

Starting from Röntgen's discovery and the first radiograph of his wife's hand, the curtain was raised on a new technique with remarkable possibilities for contributing to human health. While growth in applications proceeded rapidly, it was accompanied by significant harms to those involved and by inappropriate opportunistic application. This paper places the attempts to deal with the harms and inappropriate activities side by side with the positive developments. It attempts a narrative on the development of medical radiation protection over the 125-year period and places it in the context of a commentary on governance and ethics. The substance of the narrative is based on the recommendations of ICRP as they developed and altered over time. The governance commentary is based on assessing the independence of ICRP and its attention to medical exposures. In terms of ethics, the recommendations at each stage are reviewed in the light of values that are deemed appropriate to both medical ethics and radiation protection. The paper, while celebrating Röntgen-125, also hopefully provides a perspective for discussion as ICRP's centenary in 2028 approaches. This is an important part of ensuring continued acceptance and confident use of X-Rays, and helps underwrite the possibility of further developments in the area. 'Radiological protection relies on scientific knowledge, ethical considerations, and practical experience.' (ICRP 138) 'All professions are conspiracies against the laity' (George Bernard Shaw in The Doctor's Dilemma)

Systematic literature review on the benefit of patient protection shielding during medical X-ray imaging: Towards a discontinuation of the current practice

“…Based on the current hot topic debate about the significance of patient shielding, this review not only summarizes the evidence presented in the literature, but also puts it in the context of the technical developments in the same period [54][55][56][57]. In addition, non-dose-related aspects are considered in order to evaluate whether patient protection by means of contact shielding should be maintained or discontinued.…”

A review on optimization techniques for medical image analysis

“…They are converted into photons with energies ranging from 12 to 125 keV. The development of x‐ray imaging coincided with the necessity for lab testing as a medical diagnostic method 31 . There are three basic phases in the image generation process: pre‐reading, main reading of images, and image processing.…”

Why is radiological protection different in medicine? Sievert Memorial Lecture

“…In a recent paper entitled 'X-rays for medical imaging: Radiation protection, governance and ethics over 125 years', Malone highlighted the six ethical values to be considered: (a) dignity/autonomy; (b) non-maleficence/beneficence; (c) justice; (d) prudence/precaution; (e) honesty/transparency and (f) solidarity [22]. The author considers that the notion of dignity and autonomy of the individual may be present for workers; however, it is sometimes missing for patients.…”