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German regulations require a license for using ionizing radiation in medicine. This license-called "Fachkunde"-varies for different medical procedures such as CT, fluoroscopy, radiography, or mammography. The required frequencies and training times also vary for different medical disciplines such as radiology, cardiology, vascular surgery, traumatology, nuclear medicine, and radiotherapy, among others. The quality criteria for a specific license require a minimum training time under supervision and a minimum frequency of a wide range of procedures. Depending on the radiation doses used and the complexity of procedures performed, this may go up to 5000 examinations and 36 months for a radiology resident. A refresher course is mandatory every 5 years.

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The application of ionizing radiation in medicine seems to be a safe procedure for patients as well as for occupational exposition to personnel. The developments in interventional radiology with fluoroscopy and dose-intensive interventions require intensified radiation protection. It is recommended that all available tools should be used for this purpose. Besides the options for instruments, x­ray protection at the intervention table must be intensively practiced with lead aprons and mounted lead glass. A special focus on eye protection to prevent cataracts is also recommended. The development of cataracts might no longer be deterministic, as confirmed by new data; therefore, the International Commission on Radiological Protection (ICRP) has lowered the threshold dose value for eyes from 150 mSv/year to 20 mSv/year. Measurements show that the new values can be achieved by applying all X­ray protection measures plus lead-containing eyeglasses.

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This is the third of a series of articles targeted at biomedical physicists providing educational services to other healthcare professions, whether in a university faculty of medicine/health sciences or otherwise (e.g., faculty of science, hospital-based medical physics department). The first paper identified the past and present role of the biomedical physicist in the education of the healthcare professions and highlighted issues of concern. The second paper reported the results of a comprehensive SWOT (strengths, weaknesses, opportunities, threats) audit of that role. In this paper we present a strategy for the development of the role based on the outcomes of the SWOT audit. The research methods adopted focus on the importance of strategic planning at all levels in the provision of educational services. The analytical process used in the study was a pragmatic blend of the various theoretical frameworks described in the literature on strategic planning research as adapted for use in academic role development. Important results included identification of the core competences of the biomedical physicist in this context; specification of benchmarking schemes based on experiences of other biomedical disciplines; formulation of detailed mission and vision statements; gap analysis for the role. The paper concludes with a set of strategies and specific actions for gap reduction.

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PURPOSE: The medical X-ray exposure was determined in a 2400-bed hospital. The radiation-related risk was compared with the severity of disease (ICD) to verify the justification for X-ray procedures. A model to estimate radiation and disease-related "loss of lifetime" was applied. MATERIALS AND METHODS: X-ray exposure from radiography, fluoroscopy and CT was determined for diagnostic and interventional procedures during one hospital stay of 403 patients (0.5 % of all 80 000 patients/year). CTDI and DLP in CT, DAP in fluoroscopy or SED in radiography were used to calculate the effective dose (ED). The disease and radiation-related risk were compared with a simple "loss of lifetime" model. RESULTS: The mean age of all patients was 60. Only a subgroup of 170 patients (42 %) with a mean age of 67.6 had one or more X-ray procedures. The average ED of these exposed patients was 5.12 mSv. 14.4 % CT examinations had a dose contribution of 52.5 % followed by 5.3 % radiology and cardiology procedures at 37.2 %. 90 % of ED was applied to only 44 patients (11 %) and 50 % of ED was applied to only 10 patients (2.5 %) with a mean age of 71.2. 4 of these 10 patients had malignant tumors, the other 6 suffered from pulmonary embolism, pneumonia, stent-graft infection, CAD, Crohn's disease and severe hypertension. The ratio of disease vs. radiation-related risk was between 2.1 : 1 and 1800 : 1. CONCLUSION: In this study referral for justified X-ray procedures in a large hospital with high level medical care offers a significant patient benefit.

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Although biomedical physicists provide educational services to the healthcare professions in the majority of universities in Europe, their precise role with respect to the education of the healthcare professions has not been studied systematically. To address this issue we are conducting a research project to produce a strategic development model for the role using the well-established SWOT (Strengths, Weaknesses, Opportunities, Threats) methodology. SWOT based strategic planning is a two-step process: one first carries out a SWOT position audit and then uses the identified SWOT themes to construct the strategic development model. This paper reports the results of a SWOT audit for the role of the biomedical physicist in the education of the healthcare professions in Europe. Internal Strengths and Weaknesses of the role were identified through a qualitative survey of biomedical physics departments and biomedical physics curricula delivered to healthcare professionals across Europe. External environmental Opportunities and Threats were identified through a systematic survey of the healthcare, healthcare professional education and higher education literature and categorized under standard PEST (Political, Economic, Social-Psychological, Technological-Scientific) categories. The paper includes an appendix of terminology. Defined terms are marked with an asterisk in the text.

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The role of the biomedical physicist in the education of the healthcare professions has not yet been studied in a systematic manner. This article presents the first results of an EFOMP project aimed at researching and developing this important component of the role of the biomedical physicist. A background to the study expands on the reasons that led to the need for the project. This is followed by an extensive review of the published literature regarding the role. This focuses mainly on the teaching contributions within programmes for physicians, diagnostic radiographers, radiation therapists, and the postgraduate medical specializations of radiology, radiotherapy, interventional radiology and cardiology. Finally a summary list of the specific research objectives that need to be immediately addressed is presented. These are the carrying out of a Europe-wide position audit for the role, the construction of a strategic role development model and the design of a curriculum development model suitable for modern healthcare professional education.

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PURPOSE: Recommendations for lossy compression of digital radiological DICOM images in Germany by means of a consensus conference. The compression of digital radiological images was evaluated in many studies . Even though the results demonstrate full diagnostic image quality of modality-dependent compression between 1:5 and 1:200, there are only a few clinical applications. MATERIALS AND METHODS: A consensus conference with approx. 80 interested participants (radiology, industry, physics, and agencies) without individual invitation was organized by the working groups AGIT and APT of the German Roentgen Society DRG to determine compression factors without loss of diagnostic image quality for different anatomical regions for CT, CR/DR, MR, RF/XA examinations. The consent level was specified as at least 66 %. RESULTS: For individual modalities the following compression factors were recommended: CT (brain) 1:5, CT (all other applications) 1:8, CR/DR (all applications except mammography) 1:10, CR/DR (mammography) 1:15, MR (all applications) 1:7, RF/XA (fluoroscopy, DSA, cardiac angio) 1: 6. The recommended compression ratios are valid for JPEG and JPEG 2000 /Wavelet compressions. CONCLUSION: The results may be understood as recommendations and indicate limits of compression factors with no expected reduction of diagnostic image quality. They are similar to the current national recommendations for Canada and England .

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Since the discovery of X-rays, over exposures and radiation in juries have been reported in both patients and persons exposed in the course of their professional duties. Each year, more than 2,500 million diagnostic radiological examinations, 32 million nuclear medicine examinations or treatment procedures and 5.5 million radiotherapy sessions are performed world wide. Despite all precautions, avoidable incidents and accidents occur through out the world every year, albeit with low frequency. Where as diagnostic radiology is generally safe for patients and staff, intervention al procedures (e.g. coronary artery dilatations) involve the risks of occupational over exposure and of skin injuries to patients. In nuclear medicine, radiation protection is focused on the introduction of new procedures with beta-emitters, for example. The increasing frequency of positron emission tomography (PET) requires a special focus on shielding measures. In radiotherapy, occupational over exposure caused by mal functions and accidents is relatively rare.

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For 110 years, x-rays and special x-ray films have been used in medical diagnostics. New developments in the field of x-ray techniques, and especially new computer applications, have led to new imaging techniques which have substantially expanded the spectrum of radiological examinations. In spite of significant technological and medical advances in the field of MRI and multidetector-CT, radiographic images of the lungs, skeleton and organs still comprise up to 80% of the routine radiological workload. The increasing availability of digital detectors has led to the continual replacement of conventional film/screen systems. The inclusion of digital mammography was delayed due to the higher requirements for spatial resolution. For about 2 years, dynamic flat panel detectors have started to replace the image intensifier which has been used in fluoroscopy for 40 years.

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Since the discovery of X-rays , overexposures and radiation injuries have been reported in both patients and persons exposed in the course of their professional duties. Each year, more than 2,500 million diagnostic radiological examinations, 32 million nuclear medicine examinations or treatment procedures and 5.5 million radiotherapy sessions are performed worldwide. Despite all precautions, avoidable incidents and accidents occur throughout the world every year , albeit with low frequency. Whereas diagnostic radiology is generally safe for patients and staff, interventional procedures (e.g. coronary artery dilatations) involve the risks of occupational overexposure and of skin injuries to patients. In nuclear medicine, radiation protection is focused on the introduction of new procedures with beta-emitters, for example. The increasing frequency of positron emission tomography (PET) requires a special focus on shielding measures. In radiotherapy, occupational overexposure caused by malfunctions and accidents is relatively rare.

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In May 1998, the German "Concerted Action Dose Reduction in CT" was founded by all parties involved in CT. Its intention was to achieve a significant reduction of the radiation exposure caused by CT, a matter that has increasingly been considered a major challenge since the early nineties. As a result of a number of joint efforts, the essential preconditions have been established by now. The fifth anniversary of the Concerted Action gave rise for both retrospection and outlook on the tasks that have already been accomplished and those that still need to be done. For this purpose, a one-day symposium took place in Berlin on November 4, 2003. The contents of a total of 18 contributions will be outlined here in brief.

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The suitability of a three-color fluorescence in situ suppression hybridization technique was examined for monitoring five different groups of individuals: 30 occupied in radiology, 26 occupied in nuclear medicine or radiation physics, 32 patients with breast cancer, 26 occupied with military waste disposal, all presumably exposed to low doses of radiation or chemical mutagens and a non-exposed control group (N=29). The average frequency of breaks constituting the various aberrations did not significantly differ between the groups of medical radiation appliers and the control group. However, breast tumor patients and military waste disposers, as groups, showed a higher aberration rate than did healthy controls. Stable rearrangements mainly characterized the groups of controls, tumor patients, and radiation appliers, while a higher proportion of unstable aberrations was found in the chemically exposed individuals. Individuals with an increased frequency of aberrations could be detected within each examined group, which clearly determined the average values of the whole group. With respect to interchromosomal distribution of the breakpoints constituting the found aberrations and the involvement of the labeled chromosomes in rearrangements, the observed values were very close to the expected ones in the controls. A rather similar trend of deviations from expectation was observed in all other groups. Chromosome 4 was slightly over-affected, while chromosome 2 was slightly underrepresented in all analyzed groups (except tumor patients). Rearrangements of the labeled chromosomes with the unlabeled ones exceeded expectation. In conclusion, chromosome painting if included in further attempts of human population monitoring will broaden the basis of argumentation with respect to health risks introduced by mutagen exposure.

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Interventional procedures undoubtedly involve a high radiation exposure, for the patient. For some interventional procedures the frequencies of procedures, radiation exposures and considerations to the radiation risk are shown and discussed. Radiation risk is calculated with the currently common assumptions but always in consideration of the age and expectation of life of the patient. The risk coefficient used for the age-distribution of the common population is 5% per Sv, but for the risk coefficient for, e.g., the group of PTA patients 1.0% per Sv can be derived. That's why the risk of cancer increases in this patient group by 5/100,000. This risk must be balanced with the immediate benefit and the risk of alternative procedures.

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