Izradilo Hrvatsko stomatološko društvo Hrvatskog liječničkog zbora , studeni 2020. godine
Developed by the Croatian Dental Society of the Croatian Medical Association, November 2020
Medical exposure means exposure to ionizing radiation of patient or individuals without symptoms of illness during the diagnostic examination, intervention or therapy in medicine or dental medicine for the purposes of improving their health. In addition to these groups of individuals, medical exposure also means exposure to ionizing radiation of carers and comforters who support the patients and help them during that diagnostic examination, intervention or therapy as well as individuals who voluntarily take part in a medical and biomedical research that includes the use of ionizing radiation.
Carers and comforters
For some patients, having an X-ray examination is difficult or impossible due to practical difficulties in positioning, or because of a lack of cooperation due to physical or intellectual disability. Radiography of young children may also present significant challenges to the dentist who needs an X-ray image for diagnosis. In such cases, the patient needs support and help. Since applicable regulations do not allow individuals who are exposed to ionizing radiation as part of their profession (dentists or X-ray technicians) to hold and help such patients at their workplace, help and support to the patient may be provided by the persons accompanying them. A dentist or an X-ray technician may ask a third party to support the patient or remain with the patient in the controlled area during the exposure, provided that this type of help and support is not provided by pregnant women, women who are likely to be pregnant and persons under the age of 18.
Exposure to radiation of persons who knowingly and willingly support and help the patient during an X-ray examination must balance the possible benefit to them, the detriment that the X-ray exposure might cause and the direct benefit to the patient’s health. In the context of dental medicine, it is straightforward to see a benefit to a parent acting as a carer/ comforter of their child having a successful X-ray examination, which in turn would facilitate successful treatment. A benefit would not, however, be apparent to someone who is not a family member or close friend acting as a carer/ comforter in this situation.
Moreover, whenever possible, a clinically responsible healthcare worker shall ensure that, prior to the medical X-ray examination, the persons who knowingly and wilfully support and help the patient during the medical X-ray examination are provided with adequate information on the benefits and risks related to the patient’s dose as a result of exposure, of which a written record shall be made.
The recommended dose constraint for persons who knowingly and wilfully support and help the patient during an X-ray examination is 5 mSv (effective dose) per individual examination, and the legal entity or natural person carrying out the X-ray examination must assess the effective dose for a particular type of procedure on the basis of data from literature and/or by measuring the exposure of persons undergoing the examination using a personal dosimeter with direct or deferred reading.
The persons who knowingly and wilfully support and help the patient during an X-ray examination must be protected by adequate personal protective equipment with stipulated protective effect, and their exposure to radiation must be optimized.
Exposures of volunteers in medical or biomedical research
The availability of volunteers to take part in research is essential. Their involvement must follow the highest ethical standards. Exposure to radiation of patients for the purposes of medical or biomedical research must be approved by a relevant ethical committee in accordance with special regulations. The persons who voluntarily take part in medical or biomedical research involving exposure to radiation must participate of their own will and must be informed about the risk related to exposure to radiation. A person referring the patient or a clinically responsible healthcare worker must assess, prior to an X-ray examination, the dose to be received by each person who voluntarily agrees to experimental medical imaging and for which a diagnostic or treatment benefit from that imaging is expected. The persons who voluntarily take part in medical and biomedical, diagnostic or therapy research programmes using sources of ionizing radiation, for whom no direct medical benefit from exposure to radiation is expected, may not receive an effective annual dose higher than 0,1 mSv.