ESR News February 2016

Education and training in radiation protection for healthcare personnel involved in multi-modality procedures

John Damilakis, Professor of Medical Physics

Multimodality systems such as SPECT/CT, PET/CT bring together anatomical and molecular information. The number of procedures carried out in these systems is continuously increasing all over the world. This is mainly due to the availability of more equipment and the continuous and rapid development of technology. Properly structured and comprehensive education and training in both radiology radiation protection and nuclear medicine radiation protection is needed to provide trainees the necessary knowledge, skills and competences.

Training and education in physics, technology, radio-pharmacy and radiation protection of multimodality systems should meet the different needs of six groups of professionals.

  1. Referral physicians requesting a multimodality examination. This group is involved in justification of examinations and requires knowledge about the expected benefits from multi-modality procedures and possible risks related to radiation.
  2. Radiologists may need to acquire knowledge, skills and competences related to nuclear medicine radiation protection and nuclear medicine physicians may need to acquire knowledge, skills and competences related to diagnostic x-ray radiation protection. Training should incorporate the physical and technological principles to allow the trainee to acquire a full understanding of the possibilities and difficulties of each technique. Training should also provide the basis for participating in the radiation dose optimisation processes.
  3. Medical physicists who define and optimise the set of standard protocols on a specific system. For this team of specialists, besides radiation protection topics, training should include detailed information associated with the physics and technology of multimodality systems, scan parameters and how to optimise them in order to obtain the best diagnostic image at the lowest possible dose.
  4. Radio-chemists and radio-pharmacists who make informed decisions regarding supply and proper use of radiopharmaceuticals.
  5. Radiographers who perform the examination may need to be able to perform both CT and nuclear medicine examinations safely. They require knowledge about adaptations required for each patient, proper centring of patients and proper use of dose reduction tools.
  6. Biomedical engineers and physicists involved in the development of hardware and software.


To establish a safety culture and healthcare best practice in the field of multimodality imaging, it is necessary to promote the ‘team concept’ in education and training. Training programmes to improve knowledge, skills and competences should be offered to all ‘members of the team’. The term ‘members of the team’ should include not only referring physicians, practitioners (radiologists and nuclear medicine physicians), medical physicists, other scientists and radiographers but also, physicists and engineers working in the industry. This approach will bring together scientists from different disciplines and sectors (public and private) to foster cooperation in multimodality imaging.

The European Union, the International Atomic Energy Agency (IAEA), the International Commission on Radiological Protection (ICRP), the World Health Organization (WHO) and other organisations have published recommendations and guidelines related to education and training of healthcare professionals in medical radiation protection (1-3). It is generally accepted that radiation protection education and training is problematic in many countries all over the world for almost all medical specialists requesting or performing diagnostic and interventional procedures. This issue is greater for multi-modality imaging education and training because it should incorporate the principles of radiation protection of both modalities to allow the trainee to acquire a full understanding of the subject. Improved education and training of personnel involved in multi-modality imaging on dose saving strategies is needed to ensure radiation safety for both patients and staff.



  1. European Commission, RP 175 ‘Guidelines on radiation protection education and training of medical professionals in the European Union’, Directorate-General for Energy, Luxembourg (2014)
  2. International Commission on Radiological Protection (ICRP), ‘Education and training in radiological protection for diagnostic and interventional procedures’, Publication 113, Pergamon Press, Oxford and New York (2009)
  3. International Atomic Energy Agency (IAEA), Training courses series No. 18, Postgraduate educational course in radiation protection and the safety of radiation sources, Standard Syllabus, Vienna (2002)