ICRP TG109: Ethics in Radiological Protection for Medical Diagnosis and Treatment

The International Commission on Radiological Protection (ICRP) established a joint Task Group (TG) of committees 3 and 4 to prepare a publication on ethics in radiological protection for medical diagnosis and treatment. The TG was chaired by Francois Bouchod and the members were Kimberley Applegage, Marie-Claire Cantone, Mary Coffey, John Damilakis, Fred Fahey, Chieko Kurihara-Saio, Bernard Le Guen, Jim Malone, Maria del Rosario Perez, Lynette Reid and Friedo Zolzer. The membership included radiologists, medical physicists, an ethicist, a radiation oncologist and a radiation therapist.

The report is divided into eight chapters: Introduction and Goals; Ethics in Radiological Protection; The Practical Implementation of Biomedical Ethics; Medical Use of Ionising Radiation and Ethical Decision Making; Reviewing Practice from an Ethical Perspective; Case-based Examples of Imaging Procedures; Case-based Examples in Therapy; and Education and Training in Ethics. Each chapter contains key messages to highlight the important points. The aims of the publication are:

• to clarify the ethical aspects of the use of radiation in medicine for the protection of patients. This section is aimed at radiological/medical professionals, managers/administrators, vendors, authorities, patients and the general public. It is intended to introduce core and procedure values in the context of diagnostic radiology and radiation therapy in order to increase professionals’ familiarity with the ethical foundations of radiation protection;
• to integrate ethical considerations in radiation protection in medicine into scenarios in which these ethical values may be practical and useful, such as when there is a lack of scientific evidence for the individual case, where there is disagreement between the patient/family and the care team, and where there is disagreement within the care team;
• to promote an evaluation method that enables teams to analyse clinical situations from an ethical perspective;
• to provide teaching scenarios; and
• to endorse education in ethics in radiation protection in formal and continuing education programmes.

The core values defined in the publication are based on those defined in ICRP 138, which was published in 2018, and they relate to the three principles of justification, optimisation and limitation. The values that are defined are dignity/autonomy, beneficence/non-maleficence, prudence/precaution, justice/solidarity, accountability/transparency/honesty, and inclusiveness/empathy, which are considered from the perspective of the paired values of compliance /non-compliance. The values are clearly articulated and are accompanied by a series of sensitising questions that help with the consideration of compliance or non-compliance.

The paired values are presented in tale form and are illustrated with the emoji for smiling or frowning (:) / :().

Ten scenarios for diagnostic imaging and radiotherapy are given as examples. The radiotherapy examples cover the journey of a patient from diagnosis to follow-up and consider the individual together with the community benefit, appropriate referral and multidisciplinary decision-making, technology and technique considerations, and recruitment for clinical trials.

The final draft was made available early in 2023 for public consultation and comment. Amendments were made based on submissions supplied. The report has now been published and is available on the ICRP website.

Mary Coffey

Adjunct associate professor in radiation therapy
Department of Medicine
Trinity College Dublin
Dublin, Ireland