ISRRT Position Statement:
Radiographer/Radiological Technologist Role in Authorization and Justification
Of Medical Exposure as a Team Approach
The ISRRT considers authorization and justification of medical exposure within the scope of practice of a radiographer/radiological technologist, subject to their demonstration of appropriate education and training leading to clinical competence.
The ISRRT policy underpinning this statement was agreed at the Council meeting of October 2016 and is as follows:
The ISRRT expects all qualified radiographers/radiological technologists to be competent in the principles and practice of ionizing radiation dose optimization relevant to their clinical work.
As professionals bearing the responsibility for delivering doses of ionizing radiation to patients and in research applications, radiographers/radiological technologists must have authority to exercise their judgment in accepting a referral for exposure. This must include adjusting technique to minimize the exposure to patients, staff and the public whilst optimizing a diagnostic or therapeutic outcome.
Radiographers/Radiological Technologists play an integral part in the authorization and justification of medical exposure process by communicating the radiation risks to patients and referring clinicians using evidence based data in their daily practice.
Supporting this position statement is the Basic Safety Standards (BSS) published by the International Atomic Energy Agency (IAEA) as General Safety Requirements-Part 3, July 2014. The BSS covers four areas of responsibilities for the protection and safety of patients relating to Justification. It states that the person or organisation responsible for facilities and activities that give rise to radiation risk shall have the prime responsibility for protection and safety. BSS paragraph 2.40 and 2.41 states that other parties, such as the referring medical practitioner, medical physicist and Medical radiation technologist (MRT) (Radiographer/Radiological Technologist) shall also have specified responsibilities. The BSS states that justification can be explained as the process of weighing the expected benefits of an exposure against the possible detriment of the associated dose. The benefit versus detriment may relate to the individual and/or to society as a whole.
Justification of the medical exposure procedure for the individual patient is defined in the BSS under paragraphs 3.156 and 3.157. These two requirements of the BSS ensure that the individual medical exposure is justified in advance taking into account the specific objectives of the exposure and the characteristics of the individual involved.
The radiographer/radiological technologist as a result of their education and training obtain a thorough understanding and knowledge of justification. It is within their scope of practice to undertake authorization, commonly in collaboration with other members of the imaging or radiation therapy team.
Radiographer/Radiological Technologist authorization may be demonstrated by signing or initialing the referral in a predetermined place or by entering an electronic password. The employer’s procedure should describe clearly how authorization is to be demonstrated.
It is recognized that, in addition to radiologists, in some countries the radiographer/radiological technologist is authorized to act as a practitioner for a specific range of diagnostic procedures. The radiographers/radiological technologists have a responsibility to contribute to the imaging team to ensure that patients do not receive additional exposure due to duplicate procedures or inappropriate requests. It is not feasible for a radiologist, acting as a practitioner, to review every imaging request and therefore appropriately entitled radiographers/radiological technologists must authorize exposures using agreed guidelines.
The ISRRT promotes the scope of practice of a team approach to authorization and justification as safe and best practice for diagnostic imaging services.
www.isrrt.org, Justification and authorization of planned Medical Exposures
www.isrrt.org, Flow Chart - Summary of actions in the process of authorization and justification of medical exposure to ionizing radiation
www.isr.org, ISRQSA News, July, 2016 Web-based Decision Tool for Radiographers for the Authorization and Justification of Imaging Procedures Using Ionizing Radiation
www.isrrt.org, News and Views, Dec,2015, ISRRT response to the Bonn Call-for-Action, New International BSS calls for a team approach to justification and authorization of medical exposure – what role can the technologists/radiographer play in justification and authorization
www.iaea.org, International Basic Safety Standards (BSS), International Atomic Energy Agency (IAEA) , General Safety Requirements Part 3, July 2014.