Radiation Protection Agencies and Regulations
Radiation Protection Agencies and Regulations
In the US, each state has several organizations and multiple regulations pertaining to radiation safety and a department dedicated to enforcing those regulations. There are many more throughout the world including international organizations. To attempt to list all of the radiation agencies, policies, and laws in the US would fill volumes much larger then this book. Although the web of regulations is tangled, they are an important part of administrative controls.
The United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR)
UNSCEAR was set up by resolution of the United Nations General Assembly in 1955. The organization has no power to set radiation standards nor to make recommendations in regard to nuclear testing. It was established solely to “define precisely the present exposure of the population of the world to ionizing radiation.” UNSCEAR is an organization that evaluates human and environmental ionizing radiation exposure and derives radiation risk assessments from epidemiologic data and research conclusions, then provides information to other organizations, such as the ICRP, for evaluation.
Less frequently major public reports on Sources and Effects of Ionizing Radiation are issued, as of July 2011, there are 20 major publications from 1958 report to 2010 report. The reports are all available from the UNSCEAR website. These works are very highly regarded as sources of authoritative information and are used throughout the world as scientific basis for evaluation of radiation risk. The publications review studies undertaken separately from a range of sources. Reports from UN member states and other international organizations on data from survivors of the atomic bombings of Hiroshima and Nagasaki, the Chernobyl disaster, accidental, occupational, and medical exposure to ionizing radiation.
The International Commission on Radiological Protection (ICRP)
The ICRP is an advisory body providing recommendations and guidance on radiation protection. The ICRP evaluates information on biologic effects of radiation and provides radiation protection guidance. It is a radiation protection standards organization considered to be the international authority regarding the safe use of sources of ionizing radiation. The ICRP is responsible for providing clear and consistent radiation protection guidance through its recommendations on occupational and public dose limits. It was founded in 1928 by the International Society of Radiology (ISR) and was then called the International X-ray and Radium Protection Committee (IXRPC). Then it was restructured to better take account of uses of radiation outside the medical area, and given its present name, in 1950. ICRP is a not-for-profit organization in the United Kingdom and currently has its scientific secretariat in Ottawa, Canada. The ICRP defined the reference man in 1974.
The standard person or reference person is a theoretical individual that has perfectly “normal” characteristics. This model is used for much research into radiation safety. For many years, the standard person was called reference man because the work assumed a healthy, young adult male. In recent years, reference woman and reference child models have been created, along with variations on body size, age, sex, and race.
The International Atomic Energy Agency (IAEA)
The IAEA is an international organization that seeks to promote the peaceful use of nuclear energy, and to inhibit its use for any military purpose, including nuclear weapons. The IAEA was established as an autonomous organization on 29 July 1957. Though established independently of the United Nations through its own international treaty, the IAEA Statute, the IAEA reports to both the UN General Assembly and Security Council.
The IAEA serves as an intergovernmental forum for scientific and technical cooperation in the peaceful use of nuclear technology and nuclear power worldwide. The programs of the IAEA encourage the development of the peaceful applications of nuclear technology, provide international safeguards against misuse of nuclear technology and nuclear materials, and promote nuclear safety (including radiation protection) and nuclear security standards and their implementation.
The IAEA and its former Director General, Mohamed ElBaradei, were jointly awarded the Nobel Peace Prize on October 7, 2005. The IAEA exists to pursue the “safe, secure and peaceful uses of nuclear sciences and technology” (Pillars 2005). The IAEA executes this mission with three main functions: the inspection of existing nuclear facilities to ensure their peaceful use, providing information and developing standards to ensure the safety and security of nuclear facilities, and as a hub for the various fields of science involved in the peaceful applications of nuclear technology.
In 2004, the IAEA developed a Program of Action for Cancer Therapy (PACT). PACT responds to the needs of developing countries to establish, to improve, or to expand radiotherapy treatment programs. The IAEA is raising money to help efforts by its Member States to save lives and to reduce suffering of cancer victims.
The IAEA’s missions are guided by the interests and needs of Member States, strategic plans and the vision embodied in the IAEA Statute. Three main pillars – or areas of work – underpin the IAEA’s missions: Safety and Security; Science and Technology; and Safeguards and Verification. The IAEA is generally described as having three main missions:
- Peaceful uses: Promoting the peaceful uses of nuclear energy by its member states,
- Safeguards: Implementing safeguards to verify that nuclear energy is not used for military purposes, and
- Nuclear safety: Promoting high standards for nuclear safety.
The IAEA itself says that, beginning in 1986, in response to the nuclear reactor explosion and disaster near Chernobyl, Ukraine, the IAEA redoubled its efforts in the field of nuclear safety. The IAEA says that the same happened after the Fukushima disaster in Fukushima, Japan. In June 2011, the IAEA chief said he had “broad support for his plan to strengthen international safety checks on nuclear power plants to help avoid any repeat of Japan’s Fukushima crisis”. Peer-reviewed safety checks on reactors worldwide, organized by the IAEA, have been proposed.
North Korea was an IAEA Member State from 1974–1994, but withdrew after the Board of Governors found it in non-compliance with its safeguards agreement and suspended most technical cooperation.
The Nuclear Regulatory Commission (NRC)
The NRC is an independent agency of the United States government that was established by the Energy Reorganization Act of 1974, first beginning operations on January 19, 1975. The NRC oversees the nuclear industry in the US, enforces radiation protections standards, and works with state agencies to regulate use of radioisotopes and other radioactive materials. As one of two successor agencies to the United States Atomic Energy Commission, the NRC was charged with overseeing reactor safety and security, reactor licensing and renewal, radioactive material safety, and spent fuel management (storage, security, recycling, and disposal).
The NRC’s mission is to regulate the nation’s civilian use of byproduct, source, and special nuclear materials to ensure adequate protection of public health and safety, to promote the common defense and security, and to protect the environment. The NRC’s regulatory mission covers three main areas:
- Reactors – Commercial reactors for generating electric power and research and test reactors used for research, testing, and training
- Materials – Uses of nuclear materials in medical, industrial, and academic settings and facilities that produce nuclear fuel
- Waste – Transportation, storage, and disposal of nuclear materials and waste, and decommissioning of nuclear facilities from service
Between 2007 and 2009, 13 companies applied to the Nuclear Regulatory Commission for construction and operating licenses to build 25 new nuclear power reactors in the United States. Demand for new nuclear plant construction was weak due to abundant natural gas supplies, slow electricity demand growth in a weak U.S. economy, and lack of financing. More uncertainty has followed the Fukushima nuclear disaster. Many license applications for proposed new reactors were suspended or cancelled. Only a few new
reactors will enter service by 2020.
Title 10 of the Code of Federal Regulations, Part 20 is a document prepared and distributed by the U.S. Office of the Federal Register. The rules and regulations of the Nuclear Regulatory Commission (NRC) and fundamental radiation protection standards governing occupational radiation exposure are included in this document.
Agreement states are individual states within the US which have entered into agreements with NRC that give them the authority to license and inspect byproduct, source, or special nuclear materials used or possessed within their borders.
The National Academy of Sciences (NAS)
National Research Council Committees on The Biological Effects of Atomic Radiation (BEAR) was a national organization set up to review studies of biologic effects of radiation and risk assessment. The mission of the Committees was to provide a thorough review of all that was known at the time about the effects of atomic radiation on living organisms. The Committees on BEAR had been put together in 1955 by then-NAS president Detlev Bronk in response to the increasing but uncoordinated accumulation of data on the effects of atomic radiation.
Six committees were formed to investigate various problems arising from the release or presence of radiation in the environment. These committees were: Pathologic Effects of Atomic Radiation (with various subcommittees); Meteorological Aspects of the Effects of Atomic Radiation; Effects of Atomic Radiation on Agriculture and Food Supplies; Disposal and Dispersal of Radioactive Wastes; and Oceanography and Fisheries. A number of reports, including two summary reports, the first released in 1956 and second released in 1960, were published by the various BEAR committees and subcommittees before the study was terminated in 1964.
In 1980 a joint NAS/NRC committee released a new report. The Biological Effects of Ionizing Radiation (BEIR) report on the risks of exposure to ionizing radiation. In the report a majority of the committee endorsed a linear-quadratic1 model of radiation-induced cancer. The report included two “minority opinions,” in which one committee member supported a straightforward linear model of cancer induction and another member endorsed a purely quadratic model. This division among the committee members exemplified more general disagreement within the scientific community about the most appropriate way to characterize radiation risk at low doses. It also reflected concern over the growing practice of using dose-response models to estimate hypothetical cancer risks at doses substantially below levels where epidemiological studies have confirmed injury. 2 Two additional BEIR reports were issued after the 1980 report of the BEIR III committee. The BEIR IV report, which addressed the health risks of radon and other internally deposited radionuclides (NAS/NRC, 1988), offered several suggestions for further research that, collectively, called for intensified experimental efforts to characterize the shape of the dose-response curve for long-term health effects at low levels of exposure. The BEIR V report again considered the broad topic of adverse health effects from exposure to low levels of ionizing radiation (NAS/NRC, 1990). As in previous reports, the committee noted the failure of epidemiological studies to demonstrate hereditary effects in humans exposed to low radiation levels. Nevertheless, the committee confirmed previous estimates of radiation-induced genetic risk in humans. In 2006, NAS published BEIR VII, its most recent study, finding ionizing radiation produces about a third more cancers per unit dose than previously presumed.
The United States Occupational Safety and Health Administration (OSHA)
OSHA is an agency of the United States Department of Labor. Congress established the agency under the Occupational Safety and Health Act. OSHA functions as a monitoring agency in places of employment, predominantly in industry. OSHA regulates occupational exposure to radiation and is responsible for regulations concerning the “right to know” of employees with regard to hazards that may be present in the workplace. OSHA publishes standards, Federal Registers (rules, proposed rules, and notices), directives (instructions for compliance officers), standard interpretations (official letters of interpretation of the standards), and other federal standards related to ionizing radiation. Twenty-five states, Puerto Rico and the Virgin Islands, have OSHA-approved State Plans and have adopted their own standards and enforcement policies. For the most part, these States adopt standards that are identical to Federal OSHA. However, some States have adopted different standards applicable to this topic or may have different enforcement policies.
The Occupational Safety and Health Act is the primary federal law which governs occupational health and safety in the private sector and federal government in the United States. It was enacted by Congress in 1970 and was signed by President Richard Nixon on December 29, 1970. Its main goal is to ensure that employers provide employees with an environment free from recognized hazards, such as ionizing radiation. The Act can be found in the United States Code at title 29, chapter 15. OSHA regulates occupational exposure to radiation through 29 CFR 1910. It is responsible for regulations concerning an employee’s ‘right to know’. “Right to know”, in the context of United States workplace and community environmental law, is the legal principle that the individual has the right to know the chemicals to which they may be exposed in their daily living. It is embodied in federal law in the United States as well as in local laws in several states. “Right to Know” laws take two forms: Community Right to Know and Workplace Right to Know. Each grants certain rights to those groups. Possible exposure to ionizing radiation in the work area must be disclosed to the occupants under laws managed by OSHA. OSHA also regulates training programs in the workplace.
The American Biological Safety Association (ABSA)
The ABSA was founded in 1984 to promote biosafety as a scientific discipline and serve the growing needs of biosafety professionals throughout the world. The Association’s goals are to provide a professional association that represents the interests and needs of practitioners of biological safety, and to provide a forum for the continued and timely exchange of biosafety information. The ABSA currently allies with OSHA. The OSHA and ABSA Alliance focuses on enhancing workplace health and safety and to assist employers, including small businesses, in developing a preventive focus for biological safety issues including occupational exposure to ionizing radiation. The Alliance’s goals include:
Outreach and communication:
- Work with OSHA to provide expertise in developing information on the recognition and prevention of workplace hazards, and to provide expertise in developing ways of communicating such information (e.g. print and electronic media, electronic assistance tools and OSHA’s and ABSA’s Web sites) to employers and employees in the industry.
- Speak, exhibit or appear at OSHA’s or ABSA’s conferences, local meetings, or other events such as ABSA’s Annual Conference.
- Share information among OSHA personnel and industry safety and health professionals regarding ABSA’s best practices or effective approaches and publicize results through outreach by ABSA and through OSHA or ABSA developed materials, training programs, workshops, seminars, and lectures (or any other applicable forum).
- Promoting the national dialogue concerning biological safety in the workplace:
- Convene or participate in forums, round table discussions, or stakeholder meetings on Biosafety issues to help forge innovative solutions in the workplace or to provide input on safety and health issues.
The U.S. Food and Drug Administration (FDA)
The FDA conducts an ongoing products radiation control program, regulating the design and manufacture of electronic products, including diagnostic x-ray equipment. To determine the level of compliance with standards in a given x-ray facility, the FDA conducts onsite inspections of x-ray equipment, especially mammography units. Compliance with FDA standards ensures protection of occupationally and non-occupationally exposed persons from faulty manufacturing.
The Radiation Control for Health and Safety Act of 1968 is a law passed by the U.S. Congress to protect the public from the hazards of unnecessary radiation exposure resulting from electronic products such as microwave ovens, color televisions, and diagnostic x-ray equipment. In 1968 the U.S. Congress passed this Act. (Public Law 90-602) to protect the public from the hazards of unnecessary radiation exposure resulting from electronic products such as microwave ovens and color TVs. Diagnostic x-ray equipment also was included. The act permitted the establishment of the Center for Devices and Radiological Health (CDRH). The CDRH falls under the jurisdiction of the FDA. Essentially, it is responsible for conducting an ongoing electronic product radiation control program. This includes setting up standards for the manufacture, installation, assembly , and maintenance of machines for radiologic procedures. Further responsibilities include assessing the biologic effects of ionizing radiation, evaluating radiation emissions from electronic products in general, and conducting research to reduce radiation exposure. The code of standards for diagnostic x-ray equipment went into effect in 1974. This code applies to complete systems and major components manufactured since then. This law does not regulate the diagnostic x-ray user. It is strictly an equipment performance standard. Some provisions included in the standards for diagnostic x-ray equipment include.
- Automatic limitation of the radiographic beam to the image receptor regardless of image receptor size, a condition known as positive beam limitation.
- Appropriate minimal permanent filtration of the x-ray beam to ensure an acceptable level of beam quality. Filtration provides significant reduction in the intensity of very ‘soft’ x-rays that contribute only to added patient absorbed dose.
- Ability of x-ray units to duplicate certain radiation exposures for any given combination of kilovolts at peak value (kVp), milliamperes CmA), and time to ensure both exposure reproducibility and linearity. Reproducibility is defined as consistency in output in radiation intensity for identical generator settings from one individual exposure to other subsequent exposures.* A variance of 5% or less is acceptable. Exposure linearity is defined as consistency in output radiation intensity at a selected kVp setting when changing from one mllliamperage and time combination (mAs= mAx exposure time to another. Linearity, which is defined as the ratio of the difference in mR/mAs values between two successive generator stations to the sum of those mR/mAs values, must be less than 0.1).
- Inclusion of beam limitation devices for spot films taken during fluoroscopy. Such devices should be located between the x-ray source and the patient.
- Presence of “beam on” indicators to give visible warnings when x-ray exposures are in progress and both visual and audible signals when exposure has terminated.
- Inclusion of manual backup timers for automatic (photo-timed) exposure control to ensure the termination of the exposure if the automatic timer fails.
The Consumer-Patient Radiation Health and Safety Act of 1981 created federal legislation requiring the establishment of minimal standards for the accreditation of education programs for persons who administer radiologic procedures and the certification of such persons. The purpose of this federal act, which is under the directorship of the secretary of Health and Human Services, is to ensure that standard medical and dental radiologic procedures adhere to rigorous safety precautions and standards. Individual states are encouraged to enact similar statutes and administer certification and accreditation programs based on the standards established therein. Because no legal penalty exists for noncompliance, many states, unfortunately, have not responded with appropriate legislation. The full legislation can be found under 42 CFR 10001.
The Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy (CARE) bill.
The CARE bill is a proposed bill championed by the ASRT and an alliance of other radiologic science organizations. The goal of the bill is to protect patients from overexposure to radiation during radiologic procedures and help reduce the cost of administering health care. It intends to achieve this by clarifying and strengthening federal educational and certification standards for health care workers who administer radiologic procedures. If enacted, the CARE bill would ensure that patients undergoing all types of radiologic procedures have the same assurance of quality as those receiving mammograms under the provisions of the Mammography Quality Standards Act. The bill was conceived in concept around 1998 and was introduced to congress several times since then without passing as of 2013.
The National Council on Radiation Protection and Measurements (NCRP)
The NRCP reviews regulations formulated by the ICRP and decides how to include them in U.S. radiation protection criteria; recommendations are published in the form of various NCRP Reports. NCRP was chartered by the U.S. Congress in 1964 as the National Council on Radiation Protection and Measurements.
It’s missions are;
- collect, analyze, develop and disseminate in the public interest information and recommendations about (a) protection against radiation (referred to herein as radiation protection) and (b) radiation measurements, quantities and units, particularly those concerned with radiation protection;
- provide a means by which organizations concerned with the scientific and related aspects of radiation protection and of radiation quantities, units and measurements may cooperate for effective utilization of their combined resources, and to stimulate the work of such organizations;
- develop basic concepts about radiation quantities, units and measurements, about the application of these concepts, and about radiation protection;
- cooperate with the International Commission on Radiological Protection, the Federal Radiation Council, the International Commission on Radiation Units and Measurements, and other national and international organizations, governmental and private, concerned with radiation quantities, units and measurements and with radiation protection.”
The United States Environmental Protection Agency (EPA or sometimes USEPA)
The EPA is a U.S. government agency that facilitates the development and enforcement of regulations pertaining to the control of radiation in the environment. This agency sets limits for radioactive contamination that assume that a risk of one in ten thousand of causing a fatal cancer is unacceptable. The EPA was created for the purpose of protecting human health and the environment by writing and enforcing regulations based on laws passed by Congress. The EPA was proposed by President Richard Nixon and began operation on December 2, 1970, after Nixon signed an executive order.
EPA has following several groups of projects to protect public from nuclear contamination.
- Waste Management Programs
- Emergency Preparedness and Response Programs
- Protective Action Guide
- EPA developed the manual to provide guideline for local and state governments to protect public from nuclear accident.
- EPA Cleanup and Multi-Agency Programs
- Risk Assessment and Federal Guidance Programs
- Naturally-Occurring Radioactive Materials Program
- Air and Water Programs
- Radiation Source Reduction and Management
EPA’s nationwide radiation monitoring system, RadNet, consists of two components. First, stationary and deployable air monitors measure radiation 24 hours a day, 7 days a week. The map below provides monitoring results as graphs that are updated several times daily. You can also search the RadNet database in EPA’s Central Data Exchange (CDX) to find monitoring data. Second, EPA samples precipitation, drinking water, and milk on a routine schedule and tests them for radiation in a laboratory.
The EPA is also the main organization charged with preparing to aid the public during radiation emergencies. Radiation emergencies include lost radiation sources, nuclear power plant accidents, transportation accidents, terrorist acts, and accidents involving satellites containing radioactive materials. For example, the EPA responded to nuclear power plant accidents at Three Mile Island and Chernobyl.
The International Commission on Radiation Units and Measurements (ICRU)
The ICRU is a standardization body set up in 1925 by the International Congress of Radiology, originally as the X-ray Unit Committee until 1950. Its objective “is to develop concepts, definitions and recommendations for the use of quantities and their units for ionizing radiation and its interaction with matter, in particular with respect to the biological effects induced by radiation”.
The commission has been responsible for defining and introducing the following units of measure on behalf of the industry. The number of different units for various quantities is indicative of changes of thinking in world metrology, especially the movement to SI units.
The National Institute of Standards and Technology (NIST)
The NIST is a measurement standards laboratory which is a non-regulatory agency of the United States Department of Commerce. The institute’s official mission is to promote U.S. innovation and industrial competitiveness by advancing measurement science, standards, and technology in ways that enhance economic security and improve our quality of life. NIST is the professional organization responsible for accrediting calibration laboratories that measure radiation exposure in medical radiography.
The American Association of Physicists in Medicine (AAPM)
The AAPM is a scientific, educational, and professional organization of medical physicists. The purposes of the American Association of Physicists in Medicine are to promote the application of physics to medicine and biology and to encourage interest and training in Medical Physics and related fields. The AAPM has established Medical Physics as its primary scientific and informational journal. The AAPM is a Member of the American Institute of Physics . The AAPM is the primary scientific and educational body for medical physicists and is also responsible for accrediting calibration laboratories that measure radiation exposure in medical radiology.
The American College of Radiology (ACR)
The ACR was founded in 1923, is a non-profit professional medical association composed of diagnostic radiologists, radiation oncologists, interventional radiologists, nuclear medicine physicians, and medical physicists. The college publishes The Journal of the American College of Radiology (JACR) and The ACR Bulletin. The mission of the ACR is to serve patients and society by maximizing the value of radiology, radiation oncology, interventional radiology, nuclear medicine and medical physics by advancing the science of radiology, improving the quality of patient care, positively influencing the socio-economics of the practice of radiology, providing continuing education for radiology and allied health professions and conducting research for the future of radiology. The ACR accredits facilities to perform diagnostic imaging procedures.
The Armed Forces Radiobiology Research Institute (AFRRI)
The Armed Forces Radiobiology Research Institute (AFRRI) is a laboratory in Bethesda, Maryland, USA, chartered by the U.S. Congress in 1961. It conducts research in the field of radiobiology and related matters which are essential to the operational and medical support of the U.S. Department of Defense (DoD) and the U.S. military services. AFRRI provides services and performs cooperative research with other federal and civilian agencies and institutions.
AFRRI is charged with executing DoD’s Medical Radiological Defense Research Program. Its civilian and active duty military personnel conduct exploratory and developmental research to identify and develop medical countermeasures against ionizing radiation. Core areas of study include prevention, assessment, and treatment of radiological injuries. The program seeks to develop prophylactic and therapeutic drugs that prevent and treat radiation injuries and to develop rapid high-precision analytical methods that assess radiation exposure doses from clinical samples and thus aid in the triage and medical management of radiological casualties. New drug candidates and biological dose assessment technologies are developed up to and through preclinical testing and evaluation.
The Joint Commission (TJC)
The Joint Commission (TJC), formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), is a United States-based nonprofit tax-exempt organization that accredits more than 20,000 health care organizations and programs in the United States. A majority of state governments have come to recognize Joint Commission accreditation as a condition of licensure and the receipt of Medicaid reimbursement. he declared mission of the organization is ‘To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.”
The Joint Commission is not a complete monopoly and while many states in the U.S. make use of their services, not all do. Some states have set up their own alternative assessment procedures; the Joint Commission is not recognized for state licensure in the states of Oklahoma (except for hospital-based outpatient mental health services), Pennsylvania, and Wisconsin. In California, The Joint Commission is part of a joint survey process with state authorities. However some sort of accreditation is universally required for reimbursement from Medicare as well as private insurance companies.
This organization affects Radiologic Technologists in that it keeps hospitals and ambulatory care facilities who employ them in check to keep current documentation in regards to technologist and equipment licensure. They ensure that certain safety standards are observed.
Integrating the Healthcare Enterprise (IHE)
Integrating the Healthcare Enterprise (IHE) is a non-profit organization based in the US state of Illinois. It sponsors an initiative by the healthcare industry to improve the way computer systems share information. IHE was established, in 1998, by a consortium of radiologists and information technology (IT) experts. IHE “Integration Profiles” help make systems easier to implement and integrate, and help care providers use information more effectively. The ultimate goal is more efficient delivery of optimal patient care. IHE integration profiles describe a clinical information need or workflow scenario and document how to use established standards to accomplish it. IHE integration profiles describe clinical information management use cases and specify how to use existing standards. A group of systems that implement the same integration profile address the need/scenario in a mutually compatible way. For example, the Digital Imaging and Communications in Medicine (DICOM) standards specify many different formats for image data. A given set a images that might comply with some optional parts of the standards might still not be accepted by an application in use by a particular radiologist. Profiles reduce the chances of these incompatibilities. For equipment vendors, Integration Profiles are implementation guides. For healthcare providers, Integration Profiles are shorthand for integration requirements in purchasing documents. Integration Statements tell customers the IHE Profiles supported by a specific release of a specific product.
The American Registry of Radiologic Technologists (ARRT)
The ARRT is the world’s largest credentialing organization of radiologic technologists. They test and certify technologists and administer continuing education and ethics requirements for their annual registration. The ARRT promotes high standards of patient care by recognizing qualified individuals in medical imaging, interventional procedures, and radiation therapy. Their mission is promoting high standards of patient care by recognizing qualified individuals in medical imaging, interventional procedures, and radiation therapy. In support of this mission, the ARRT: Adopts and upholds standards for educational preparation for entry into the profession; Adopts and upholds standards of professional behavior consistent with the level of responsibility required by professional practice; and develops and administers examinations which assess the knowledge and skills underlying the intelligent performance of the tasks typically required by professional practice in the discipline.
In addition to initial recognition, ARRT provides a mechanism to recognize individuals who continue to demonstrate their qualifications through adherence to the standards of professional behavior and compliance with continuing education requirements.
The American Society of Radiologic Technologists (ASRT)
The American Society of Radiologic Technologists is the world’s largest and oldest membership association for medical imaging technologists and radiation therapists. ASRT members are the health care personnel who perform diagnostic imaging examinations and who deliver radiation therapy treatments. They may specialize in a specific area of radiologic technology, such as computed tomography, mammography, magnetic resonance imaging or nuclear medicine. The ASRT provides its members with educational opportunities, promotes radiologic technology as a career, and monitors state and federal legislation that affects the profession. It also is responsible for establishing standards of practice for the radiologic science profession and developing educational curricula. The ASRT’s mission is to give radiologic technologists the knowledge, resources and support they need to provide quality patient care.
The Image Gently and Image Wisely Campaigns
Also known as the Image Gently Alliance, the Alliance for Radiation Safety in Pediatric Imaging was formed in 2006. It is a coalition of 44 health care organizations serving more than 500,000 health care providers worldwide including the Society for Pediatric Radiology, The American Society of Radiologic Technologists, The American College of Radiology and The American Association of Physicists in Medicine, and the Society for Pediatric Radiology. The primary objective of the Alliance is to raise awareness in the imaging community of the need to adjust radiation dose when imaging children. The ultimate goal of the Alliance is to change practice in response to increased concern by the public and the ongoing progress of best practices. In 2008 the Alliance launched the Image Gently Campaign which is designed to maintain high quality imaging studies while using the lowest doses and best radiation safety practices available on pediatric patients. This initiative has been endorsed and applied by a growing list of various professional medical organizations around the world and has received support and assistance from companies that manufacture equipment used in Radiology.
The Alliance chose to focus first on computed tomography (CT) scans. The dramatic increase in the number of pediatric CT scans performed in the United States in the past five years and the rapid evolution, change and availability of CT technology and equipment well justify this Alliance strategy. The campaign has grown to include: parent information, Fluoroscopy, Interventional Radiology, Nuclear Medicine, and Digital Radiography. The Step Lightly campaign was later launched to focus primarily on interventional radiology.
Following upon the success of the Image Gently campaign, the American College of Radiology, the Radiological Society of North America, the American Association of Physicists in Medicine and the American Society of Radiologic Technologists have launched a similar campaign to address this issue in the adult population called Image Wisely. The World Health Organization and International Atomic Energy Agency (IAEA) of the United Nations have also been working in this area and have ongoing projects designed to broaden best practices and lower patient radiation dose.
The Mammography Quality Standards Act (MQSA)
The Mammography Quality Standards Act (MQSA) was enacted by the United States Congress to regulate the quality of care in mammography. MQSA is intended to maintain high quality mammography in the United States and its territories.
Congress enacted MQSA to ensure that all women have access to quality mammography for the detection of breast cancer in its earliest, most treatable stages. The Mammography Quality Standards Act requires mammography facilities across the nation to meet uniform quality standards. Congress passed this law in 1992 to assure high-quality mammography for early breast cancer detection, which can lead to early treatment, a range of treatment options leading to an increased chance of survival. Under the law, all mammography facilities must: 1) be accredited by an FDA-approved accreditation body, 2) be certified by FDA, or its State, as meeting the standards, 3) undergo an annual MQSA inspection, and 4) prominently display the certificate issued by the agency.
Congress tasked the FDA with developing and implementing MQSA regulations. As a result of MQSA, mammography facilities are required to provide patients with written results of their mammograms in language that is easy to understand. Also known as a “lay report.” A consumer complaint mechanism is required to be established in mammography facilities to provide patients with a process for addressing their concerns. Patients can obtain their original mammograms, not copies, when they are needed. For cases in which a facility’s mammograms are determined to be substandard and a risk to public health, facilities will notify the patients and their doctors and suggest an appropriate plan of action.