title: Justification of diagnostic medical exposures: some practical issues. Report of an International Atomic Energy Agency Consultation.
abstract: OBJECTIVE
  The Radiation Protection of Patients Unit of the International Atomic Energy Agency (IAEA) is concerned about the effectiveness of justification of diagnostic medical exposures. Recent published work and the report of an initial IAEA consultation in the area gave grounds for such concerns. There is a significant level of inappropriate usage, and, in some cases, a poor level of awareness of dose and risk among some key groups involved. This article aims to address this.
  
  
  METHODS
  The IAEA convened a second group of experts in November 2008 to review practical and achievable actions that might lead to more effective justification.
  
  
  RESULTS
  This report summarises the matters that this group considered and the outcome of their deliberations. There is a need for improved communication, both within professions and between professionals on one hand, and between professionals and the patients/public on the other. Coupled with this, the issue of consent to imaging procedures was revisited. The need for good evidence-based referral guidelines or criteria of acceptability was emphasised, as was the need for their global adaptation and dissemination.
  
  
  CONCLUSIONS
  Clinical audit was regarded as a key tool in ensuring that justification becomes an effective, transparent and accountable part of normal radiological practice. In summary, justification would be facilitated by the "3 As": awareness, appropriateness and audit.
authors.affiliation: Radiation Protection of Patients Unit, Radiation Safety and Monitoring Section, NSRW, International Atomic Energy Agency, Vienna, Austria. jfmalone@tcd.ie
authors.forename: J
authors.initials: J
authors.lastname: Malone
authors.forename: R
authors.initials: R
authors.lastname: Guleria
authors.forename: C
authors.initials: C
authors.lastname: Craven
authors.forename: P
authors.initials: P
authors.lastname: Horton
authors.forename: H
authors.initials: H
authors.lastname: Järvinen
authors.forename: J
authors.initials: J
authors.lastname: Mayo
authors.forename: G
authors.initials: G
authors.lastname: O'reilly
authors.forename: E
authors.initials: E
authors.lastname: Picano
authors.forename: D
authors.initials: D
authors.lastname: Remedios
authors.forename: J
authors.initials: J
authors.lastname: Le Heron
authors.forename: M
authors.initials: M
authors.lastname: Rehani
authors.forename: O
authors.initials: O
authors.lastname: Holmberg
authors.forename: R
authors.initials: R
authors.lastname: Czarwinski
mesh_terms: D000369:Aged, 80 and over; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006287:Health Planning Guidelines; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007390:International Agencies; D008297:Male; D008875:Middle Aged; D011835:Radiation Protection / Q000379:methods*; D011871:Radiology / Q000379:methods* / Q000592:standards; D012017:Referral and Consultation; D058028:Research Report; D012306:Risk