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Royal Decree Medical Exposure: Information Obligation Towards the Patient in Practice


Patrik Aerts

OLV Hospitals Aalst-Asse-Ninove, BE
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How to Cite: Aerts P. Royal Decree Medical Exposure: Information Obligation Towards the Patient in Practice. Journal of the Belgian Society of Radiology. 2019;103(1):63. DOI:
  Published on 18 Nov 2019
 Accepted on 06 Sep 2019            Submitted on 02 Sep 2019

The Euratom Directive 2013/59 of 5 December 2013 defines basic safety standards for protection against the dangers arising from exposure to ionizing radiation. All members states have to adjust their legislation to comply with the Euratom Directive. In Belgium the Royal Decree is prepared by the Federal Agency of Nuclear Control (FANC) in collaboration with stakeholders like the Belgian Society of Radiology (BSR). The Patient Rights Law already obliged to provide information to patients before a medical procedure since 2002. However the new Royal Decree is more specific and more extensive.

The OLV Hospital Aalst-Asse-Ninove has collaborated with BSR and FANC to propose a useful toolkit for all radiology services to comply with this new legislation. The information brochure for all patients that undergo an examination with ionizing radiation is based on the information brochure of the International Atomic Energy Agency. This brochure will be given to all patients prior to the examination. Several posters are proposed for waiting room areas or reception desks to draw extra attention to the subject. The nurse/technologist needs to check if the patient or companion received the necessary information and should be able to answer questions regarding radioprotection. Although all co-workers and radiologists completed a radioprotection training, taking care of these specific radioprotection questions will need additional training. Therefore we prepared a “first aid kit” including the most frequent questions a patient might ask together with the proposed answer. This part is based on information provided by international organisations like the American College of Radiology (ACR), Eurosafe Imaging by European Society of Radiology (ESR), Radiological Society of North America (RSNA), Heads of the European Radiological Protection Competent Authorities (HERCA), the World Health Organisation (WHO) and of course the Belgian FANC.

Special attention is paid for paediatric patients. The WHO publication “Communicating Radiation Risks in Paediatric Imaging” aims to help health care providers communicate known or potential radiation risks associated with paediatric imaging procedures and will improve the communication to ensure an effective and balanced benefit-risk dialogue between health care providers, families and patients. Furthermore special attention is paid for pregnant or potential pregnant patients and for examination with a potential higher radiation exposure like computed tomography. Communication of radiation risks in interventional radiology is addressed in a separate lecture.

The different patient flows in a radiology department require a different approach. Patients in ambulatory setting will receive their information brochure at the reception desk or by the physician who prescribes the examination. In the new legislation the prescribing physician has a shared responsibility concerning information to patients about radioprotection and the risk-benefit dialogue. In most hospitals patients from the emergency department don’t go to the radiology reception desk, but follow a different pathway. Radiology co-workers should be vigilant to hand over the radioprotection information brochure if possible or to give the necessary information at least orally to patient or companion in emergency situations. The emergency room physicians should take special care of children or women of childbearing age when ordering examinations with ionizing radiation. Third pathway is the hospitalized patient. Information can be given before the arrival in the radiology department in the hospital ward with special attention to paediatric patients, young women or patients in the intensive care unit. The prescribing physician and family or companions will play an important role in specific situations.

Competing Interests

(No information provided)

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