1. CURRENT TRENDS IN RADIATION PROTECTION AND THE CHALLENGE OF STRENGTHENING RADIATION PROTECTION IN MEDICINE IN THE NEXT DECADE: Focus on Paediatric Radiation Protection BY NKUBLI BOBUIN FLAVIOUS Dept. of Medical Radiography University of Maiduguri 8 th November, 2015 World Radiography Day Celebration

2. OUTLINE Timeline of radiation protection Current trends in radiation protection Challenges of paediatric radiation protection in crisis and resource-limited setting

3. LEARNING OBJECTIVES To keep the audience abreast of the trends in radiation protection over the years (Timeline to- date) To explore the current trends in radiation protection with a view to increase awareness among patients and health professionals To highlight the challenges of paediatric radiation protection in crisis and resource-limited settings and the way forward.

4. TIMELINE OF RADIATION PROTECTION  Early 20 th century before the advent of radiation protection measures; marked by skin injuries  1920’s-1980’s : Skin injuries largely decreased  1990’s: resurgence of skin injury in patients undergoing interventional procedures  Presently in an era of increased and increasing patient radiation exposure (Rehani, 2009)

5. CURRENT TRENDS IN RADIATION PROTECTION  Radiation protection of patients advocacy campaigns (Image gently campaigns, Referral guidelines, DRLs)  Patient radiation dose tracking (CR/DR advanced dose saving techniques & radiation smart cards)  Mechanistic and Orthomolecular approaches to radiation protection

6. Radiation protection of patients advocacy campaigns There is a recent global call “Bonn Call for Action” to strengthen paediatric radiation protection worldwide (IAEA, 2015). Relevant stake holders such as image gently, ISRRT, IAEA, ESR,WHO EUROSAFE, etc are all involved Emphasis is laid on justification of individual medical exposures. Others are; – Use of referral guidelines – Establishment of Paediatric Dose Reference Levels

7. Patient radiation dose tracking Current researches are tending towards patient exposure dose tracking with the recent IAEA radiation smart card project that is on-going (Rehani,2009: Rehani & Frush, 2011) Manufacturers of CR/DR on their part are also coming up with advanced dose saving techniques to protect the paediatric patient

8. Specimen of radiation smart card by IAEA

9. Mechanistic and orthomolecular approaches to radiation protection  While most of the approaches to radiation protection over the years have been mechanistic, current approaches tend towards orthomolecular (Yamamoto et al, 2010; Yanagisawa et al, 2011; Brink & Boice, 2012).

10. CHALLENGES OF PAEDIATRIC RADIATION PROTECTION IN CRISIS & RESOURCE -LIMITED SETTING  Awareness and utilization of ionizing radiation among health professionals  Awareness of risks and benefits of ionizing radiation on the part of the patients and parents  Paediatric- friendly radiological equipment and specialized staff training

11. Awareness and utilization of ionizing radiation among health professionals Low awareness results in under- or over- utilization of ionizing radiation which results in; – Unjustified patient exposure – Increased radiation dose to the patient – Poor communication of risks and benefit to the patient or relations

12. Awareness of risks and benefit of radiation on the part of patients Low awareness of the risks and benefits of radiation result in apathy on the part of patients This is further complicated by the influence of social media and exaggerated media reportage on radiation risks and hazards

13. Paediatric-friendly radiological equipment and specialized staff training Apparent lack of dedicated paediatric radiological equipment affects patient dose Inadequate paediatric positioning aids and immobilization devices lead to poor quality images and increased radiation dose Absence of specialized training in paediatric radiography and by extension radiation protection results in sub-optimal practice

14. Recommended way forward The following are suggested ways forward to overcome the challenges of paediatric radiation protection in resource- limited settings; Increase Awareness, Appropriateness and Audit of ionizing radiation in paediatric medicine Management of hospitals should include paediatric equipment in their procurements Specialized education and training on paediatric radiography is recommended

15. Conclusion As we celebrate the discovery x-rays today with paediatric radiation protection in focus. Three things we must take home are; A lot has happened in the field of radiation protection and there is need to strengthen radiation protection in the next decade There are challenges in resource- limited settings but these challenges are surmountable To have a healthy population that will succeed us in the next decades, we must promote; Awareness, Appropriateness & Audit of ionizing radiation in paediatric medicine.

16. REFERENCES Brink AJ, Boice DJ (2012) Science to Practice: Can Antioxidant Supplements Protect against the Possible Harmful Effects of Ionizing Radiation from Medical Imaging? Radiology 264 (1) pp 1-2 IAEA (2015) Radiation protection in medicine: Setting the scene for the next decade. Proceedings of an international conference Organized by the International atomic energy agency, Hosted by the government of Germany, Co-sponsored by the World Health Organization And held in Bonn, Germany, 3–7 December 2012 Rhani MM (2009) Smart Protection An electronic smart card could serve as a digital medical record of radiation exposure for patients who want one. IAEA Bulletin 50(2); pp37

17. REFERENCES Rehani MM Frush DP (2010) Patient exposure tracking – the IAEA smart card project. Radiat Prot Dosimetry 2011 http://www.ncbi.nlm.nih.gov/pubmed/21778155 Yamamoto et al, (2010) Pretreatment with Ascorbic acid prevents gastrointestinal syndrome in Mice receiving a massive amount of radiation. J Institute of Intravenous therapy 51;145-15 Yanagisawa A, Iwata M, Akiyama S (2011) Effect of Vitamin C and anti-oxidative nutrition on radiation-induced gene expression in Fukushima nuclear plant workers - A pilot study J Radiat Res 51;145-156

18. THANK YOU!