Abstract
In recent years the concept of Justification has increasingly come to the fore of the minds of legislators, users of radioactive materials and radiation protection specialists alike. Perhaps the most well known manifestation of this was the lengthy debate, ending in judicial review, about the Justification for the operation of the Thermal Oxide Reprocessing Plant (Thorp) at Sellafield and, more generally, about the nuclear industry in toto. Nevertheless, it is important to remember that all practices involving the use of radiation or radioactive materials have to be justified, not just the obvious ones, including their use in research and medicine, as well as in industry. This collection of papers discusses, for the most part, the application of the concept to medical exposures, but also has contributions on research and theft detection.
The need for Justification of Medical Exposures has recently been revised and expanded in two different, but complementary, European Directives - The Medical Exposure Directive and the Basic Safety Standards Directive. The basic provisions in these two Directives are covered, as are some of the requirements that may be needed to implement them into UK law.
Other papers consider in some detail a wide variety of issues related to how, in practice, the Justification requirement can be satisfied with regard to medical exposures. It was evident to me, as someone not directly involved in the medical uses of radiation, that a `quiet revolution' is taking place with regard to the use of radiation in medicine. The various procedures that are used will not be able to be undertaken without prior consideration of a wide variety of inputs, from the most generic level to the most specific. With regard to the generic, the justification of new medical practices will have to be undertaken prior to their introduction whilst, with regard to the individual, the justification, or value, of individual treatments from a number of different points of view may also need to be considered. Quite apart from these subject-related considerations, a range of issues not directly related to the dose that patients receive, such as the design of a radiation facility (room) are discussed in some detail, even as far as noting that there may be an optimal way to hang a door.
In addition to summarising the basis of the Justification Requirements and the considerations relating to the doses that patients, staff and even members of the public rnight receive, other papers consider issues such as the number of, and justification for, repeat x-rays, and the implications of the use of new procedures, such as interventional radiology which could lead, against the trend, to increases in the doses received from medical exposures. I found the former of these to be particularly interesting, especially the impact that new technology (in particular, the use of digital imaging) can have in reducing the need for repeat examinations and therefore further doses.
Two papers that are not directly related to the medical uses of radiation cover theft detection and use in research. The former focuses on the justification for the use of x-ray examinations to maintain security, and uses the prevention of diamond theft in the South African Mining Industry as an example. This poses an interesting question, in that the individual does not necessarily receive a (direct) benefit, and may potentially receive rather more than just the associated radiation dose! I won't give the answer, but it is an interesting use of the `overall benefit' argument. The latter paper essentially discusses the necessary precautions and requirements that must be in place before any sort of research involving the use of radioactive substances and volunteers is undertaken.
Perhaps above all, the message that one comes away from this book with is the need for a wide variety of disciplines to work together to achieve an optimal outcome, and the need for all of those involved to be educated in, and fully aware of, the implications and responsibilities placed upon them.
You might get the impression from the above that the content is somewhat `dry', but this is far from the truth. Even from the point of view of someone not directly involved in the medical uses of radiation, I found the discussions contained in this book fascinating and thought-provoking. I feel sure that those directly involved in such uses will find much food for thought, and many pointers to the kinds of issues that need to be considered in order for both legal and moral obligations to be satisfied.