Radiation protection and dosimetry issues in the medical applications of ionizing radiation

• The robustness and shortcomings of the system of radiation protection are discussed.
• Pediatric exposures to ionizing radiation are identified as a major cause of concern.
• Routine sub-mSv (below 1 mSv) CT exams are at reach during this decade.
• Significant progress in the justification of medical exams is mandatory.
• The future relies on computational dosimetry, using MC simulations and voxel phantoms.

The technological advances that occurred during the last few decades paved the way to the dissemination of CT-based procedures in radiology, to an increasing number of procedures in interventional radiology and cardiology as well as to new techniques and hybrid modalities in nuclear medicine and in radiotherapy. These technological advances encompass the exposure of patients and medical staff to unprecedentedly high dose values that are a cause for concern due to the potential detrimental effects of ionizing radiation to the human health. As a consequence, new issues and challenges in radiological protection and dosimetry in the medical applications of ionizing radiation have emerged.The scientific knowledge of the radiosensitivity of individuals as a function of age, gender and other factors has also contributed to raising the awareness of scientists, medical staff, regulators, decision makers and other stakeholders (including the patients and the public) for the need to correctly and accurately assess the radiation induced long-term health effects after medical exposure. Pediatric exposures and their late effects became a cause of great concern.The scientific communities of experts involved in the study of the biological effects of ionizing radiation have made a strong case about the need to undertake low dose radiation research and the International System of Radiological Protection is being challenged to address and incorporate issues such as the individual sensitivities, the shape of dose–response relationship and tissue sensitivity for cancer and non-cancer effects.Some of the answers to the radiation protection and dosimetry issues and challenges in the medical applications of ionizing radiation lie in computational studies using Monte Carlo or hybrid methods to model and simulate particle transport in the organs and tissues of the human body. The development of sophisticated Monte Carlo computer programs and voxel phantoms paves the way to an accurate dosimetric assessment of the medical applications of ionizing radiation.In this paper, the aforementioned topics will be reviewed. The current status and the future trends in the implementation of the justification and optimization principles, pillars of the International System of Radiological Protection, in the medical applications of ionizing radiation will be discussed. Prospective views will be provided on the future of the system of radiological protection and on dosimetry issues in the medical applications of ionizing radiation.