Synthesis of the european alara network 20th workshop "alara for interventional radiology and nuclear medicine".

The European ALARA Network regularly organises workshops on topical issues in radiation protection. The topic of the 20th workshop was: "ALARA for interventional radiology (IR) and nuclear medicine (NM)". The main objective was to examine the challenges faced when applying the optimisation principle (ALARA) in IR and NM and to consider how ALARA could be better implemented for patient and staff exposures. This memorandum provides a synthesis of the workshop sessions and recommendations arising from the working groups discussion. Parallels are drawn with the recommendations coming from the 13th EAN workshop on "ALARA and the medical sector" (2011) to consider how the optimisation challenges in IR and NM have evolved over the past decade.
Current levels of exposure are presented along with operational practice and the challenges and opportunities for improvement, both in monitoring and practice. Whilst RP challenges remain, the application of ALARA appears more established in IR compared with experiences reported in 2011. The application of ALARA to emerging technologies in the NM setting is in need of further development to ensure that radiation protection is considered at all stages in the development process of new radiopharmaceuticals. Besides technical and operational aspects, the importance of education and training, human factors and , broadly, the radiation protection 'culture' were deemed fundamental to the success of the application of ALARA and where further emphasis is needed. All concerned parties, MPEs, RPEs, medical staff, manufacturers and regulators have a role to play in the application of ALARA and this is discussed in the memorandum. 
Many of the recommendations from the 13th EAN workshop remain applicable today and overlap with the recommendations arising from the 20th workshop. This should prompt attention given that the use of IR and the development of novel radiopharmaceuticals for NM is only anticipated to increase with time.

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