{"id":1835,"date":"2020-01-22T19:05:37","date_gmt":"2020-01-23T01:05:37","guid":{"rendered":"https:\/\/www.crpa-acrp-bulletin.ca\/?p=1835"},"modified":"2020-02-18T14:46:17","modified_gmt":"2020-02-18T20:46:17","slug":"alara-how-low-is-low-enough-be-reasonable-lalara-quel-taux-est-raisonnablement-faible","status":"publish","type":"post","link":"https:\/\/www.crpa-acrp-bulletin.ca\/fr\/2020\/01\/22\/alara-how-low-is-low-enough-be-reasonable-lalara-quel-taux-est-raisonnablement-faible\/","title":{"rendered":"ALARA \u2013 How Low Is Low Enough? Be Reasonable! \/ L\u2019ALARA \u2013 Quel niveau est suffisamment faible? Il suffit d\u2019\u00eatre raisonnable!"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-1838\" src=\"https:\/\/www.crpa-acrp-bulletin.ca\/wp-content\/uploads\/2020\/01\/SFRP-IRPA-workshop-attendees-2018_POST.jpg\" alt=\"\" width=\"1200\" height=\"414\" srcset=\"https:\/\/www.crpa-acrp-bulletin.ca\/wp-content\/uploads\/2020\/01\/SFRP-IRPA-workshop-attendees-2018_POST.jpg 1200w, https:\/\/www.crpa-acrp-bulletin.ca\/wp-content\/uploads\/2020\/01\/SFRP-IRPA-workshop-attendees-2018_POST-300x104.jpg 300w, https:\/\/www.crpa-acrp-bulletin.ca\/wp-content\/uploads\/2020\/01\/SFRP-IRPA-workshop-attendees-2018_POST-1024x353.jpg 1024w, https:\/\/www.crpa-acrp-bulletin.ca\/wp-content\/uploads\/2020\/01\/SFRP-IRPA-workshop-attendees-2018_POST-768x265.jpg 768w, https:\/\/www.crpa-acrp-bulletin.ca\/wp-content\/uploads\/2020\/01\/SFRP-IRPA-workshop-attendees-2018_POST-520x179.jpg 520w\" sizes=\"auto, (max-width: 1200px) 100vw, 1200px\" \/><br \/>\n<span style=\"font-size: 85%;\">Attendees at the second SFRP\/IRPA workshop on reasonableness in the implementation of the ALARA principle, which took place in Paris, France, in October 2018. \/ Les participants au second atelier de la\u00a0SFRP\/IRPA portant sur le caract\u00e8re raisonnable de la mise en application du principe ALARA, qui avait lieu \u00e0 Paris, France, en octobre 2018.<\/span><\/p>\n<div class='content-column one_third'><div style=\"padding-right:10px;\"><div style=\"padding: 8px 5px 5px 5px; background-color: #eeeeee; border: #dddddd 2px solid;\">\n<h4>R\u00e9sum\u00e9<\/h4>\n<p>Avec la Soci\u00e9t\u00e9 Fran\u00e7aise de radioprotection (SFRP), l\u2019\u00e9quivalent fran\u00e7ais de l\u2019Association canadienne de la radioprotection, l\u2019Association internationale pour la protection contre les radiations a coanim\u00e9 deux ateliers sur la mise en pratique du principe ALARA. L\u2019objectif principal \u00e9tait de r\u00e9pondre \u00e0 la question que se pose tout professionnel de la radioprotection devant appliquer le principe ALARA de fa\u00e7on pratique : Quel niveau est suffisamment faible? Dans cet article, St\u00e9phane Jean-Fran\u00e7ois fait \u00e9tat des avantages d\u2019\u00eatre raisonnable.<\/p>\n<\/div><\/div><\/div>\n<div class='content-column two_third last_column'><div style=\"padding-left:10px;\"><p>\u201cBe reasonable!\u201d Say this title out loud using the same tone of voice a parent would use with an exasperating kid. I see you smiling a bit, even if you\u2019re not a parent!<\/p>\n<p>\u201cBe reasonable\u201d is a universal order, an ultimatum, or at the very least a strong recommendation. You\u2019ve been there (you\u2019ve either uttered or heard this statement), and you know exactly what it means\u2014behave, calm down, lower your expectations.<\/p>\n<p>Did you ever ask yourself if you\u2019re worthy of the great responsibility associated with being reasonable? Whether you are a five-year-old waiting to arrive at your final destination (Are we there yet?) or a \u201cgrown-up\u201d radiation safety professional who wants to reduce a dose \u201cALARA-style,\u201d we are asking you to use \u201creason,\u201d a major philosophical concept explored by Aristotle. Reason in philosophy is used to establish criteria for what is true or false, good or bad, or to implement programs to reach an objective. Wow! Reason is meant to establish criteria for good or bad . . . but there are no clear right or wrong answers where ALARA is concerned. No wonder we\u2019re still debating what is \u201creasonable\u201d more than 2,000 years after Aristotle!<\/p>\n<p>The <a href=\"https:\/\/www.sfrp.asso.fr\" target=\"_blank\" rel=\"noopener noreferrer\">Soci\u00e9t\u00e9 Fran\u00e7aise de radioprotection (SFRP)<\/a>, the French equivalent to the Canadian Radiation Protection Association, with the International Radiation Protection Association (IRPA), co-hosted two workshops on the practical implementation of the ALARA principle. A summary of these two workshops was presented at the Health Physics Society annual meeting, July 2019, in Orlando, FL, as part of the<a href=\"http:\/\/hps.org\/documents\/2019_annual_meeting_program.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"> International Commission on Radiological Protection (ICRP)\/International Radiation Protection Association (IRPA) special session on tolerance and reasonableness<\/a>. But it all started two years ago.<\/p>\n<p>In February 2017, an <a href=\"https:\/\/www.sfrp.asso.fr\/manifestations\/manifestations\/irpa-workshop-on-reasonableness-in-the-implementation-on-the-alara-principle-.html,9,38,0,0,2823\" target=\"_blank\" rel=\"noopener noreferrer\">SFRP\/IRPA workshop on reasonableness in the implementation of the ALARA principle<\/a> in Paris, France, brought together about 30 attendees from radiation protection societies in Europe, Japan, and Korea, as well as international societies like the ICRP, World Health Organization (WHO), and IRPA. Their key objective was to answer the question we have all asked ourselves as radiation safety professionals dealing with ALARA in a practical way\u2014How low is low enough?<\/p>\n<p>The second <a href=\"https:\/\/www.sfrp.asso.fr\/manifestations\/manifestations\/2nd-irpa-workshop-on-reasonableness-in-the-implementation-on-the-alara-principle-.html,9,38,0,0,3102\" target=\"_blank\" rel=\"noopener noreferrer\">SFRP\/IRPA workshop on reasonableness in the implementation of the ALARA principle<\/a> took place in Paris, France, in October 2018.<\/p>\n<p>For both workshops, the approach was the same\u2014attendees formed three teams representing three sectors:<\/p>\n<ul>\n<li>Nuclear industry<\/li>\n<li>Medical field<\/li>\n<li>Existing exposure situations (radon, radium cleanup, post-accident, etc.)<\/li>\n<\/ul>\n<p>The focus of the first SFRP\/IRPA workshop was on actual ALARA application, and a few common points united the three sectors: education, information, training, and building radiation protection culture through stakeholder involvement.<\/p>\n<p>The second workshop used practical case studies to refine findings from the first workshop. As a participant and representative of our part of the world at the second SFRP\/IRPA workshop, I would like to share a summary of the second workshop.<\/p>\n<p>On the first day, Jean-Fran\u00e7ois Lecomte (SFRP\/Institute for Radiological Protection and Nuclear Safety {IRSN} representative) presented the results of the first workshop. Roger Coates (IRPA) and Bernard Le Guen (SFRP) introduced the goals and expectations of the second workshop. Then, nine practical cases (three cases per sector) were presented in a plenary session.<\/p>\n<p>Our very own Manon Rouleau presented one of the three medical cases: \u201c<a href=\"https:\/\/www.sfrp.asso.fr\/medias\/sfrp\/documents\/manifestations\/Tables_rondes\/2018_10_23_24\/M-ROULLEAU.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Province-wide dose optimisation in CT and PET-CT through a collaborative and multidisciplinary approach, in Canada<\/a>.\u201d She talked about the optimization of dose in imaging in Quebec through the collaboration of a multidisciplinary team. (This was also the topic of her well-received case presentation at the 2018 CRPA conference.)<\/p>\n<p>The next day, we broke out into three working groups to discuss the case studies and, at the end of the day, summarize our discussions and recommendations to IRPA. Following is a summary of our discussions.<\/p>\n<h3><strong>Nuclear Working Group<\/strong><\/h3>\n<p>Chair: Caroline Schieber<\/p>\n<p><u>Topics<\/u><\/p>\n<ul>\n<li>Replacement of heaters (France)<\/li>\n<li>Operation of nuclear plants (Spain)<\/li>\n<li>Operation of nuclear plants (United Kingdom)<\/li>\n<\/ul>\n<p><u>Findings<\/u><\/p>\n<ul>\n<li>ALARA is a holistic approach.<\/li>\n<li>Optimization is based on experience.<\/li>\n<li>Stakeholder involvement is essential. We need more communication between industry and regulators.<\/li>\n<li>Education of workers and stakeholders is crucial.<\/li>\n<li>Optimization should find a balance between the different hazards.<\/li>\n<\/ul>\n<h3><strong>Medical Working Group<\/strong><\/h3>\n<p>Chair: St\u00e9phane Jean-Fran\u00e7ois<\/p>\n<p><u>Topics<\/u><\/p>\n<ul>\n<li>Collaborative approach, dose and image (Canada)<\/li>\n<li>Operation of a public hospital (Greece)<\/li>\n<li>Image quality and dose (Italy)<\/li>\n<\/ul>\n<p><u>Findings<\/u><\/p>\n<ul>\n<li>The tools used to establish reasonableness are training and radiation protection safety culture.<\/li>\n<li>We need to share the knowledge (IRPA, ICRP, WHO).<\/li>\n<li>We need to promote ALADA (as low as diagnostically achievable) with the equipment available; we can\u2019t always have access to state-of-the-art technology (public sector).<\/li>\n<li>We need more awareness regarding medical ethics.<\/li>\n<li>We need to optimize using a multidisciplinary approach that involves patients.<\/li>\n<\/ul>\n<h3><strong>Existing Exposure Situations Working Group<\/strong><\/h3>\n<p>Chair: Amber Bannon<\/p>\n<p><u>Topics<\/u><\/p>\n<ul>\n<li>Watch industry (Switzerland)<\/li>\n<li>Radon action plan (Czech Republic)<\/li>\n<li>Drinking water survey (Belgium)<\/li>\n<\/ul>\n<p><u>Findings<\/u><\/p>\n<ul>\n<li>Public acceptance is required.<\/li>\n<li>The public accepts natural sources better than artificial sources.<\/li>\n<li>For pollution, there are no safe or acceptable levels.<\/li>\n<li>Peacetime should be used to inform the public before a crisis occurs.<\/li>\n<li>Authorities need to be clear about the rules (application, resources, etc.)<\/li>\n<\/ul>\n<p>Some \u201cavant-garde\u201d radiation protection professionals may already know the variations of ALARA, where \u201creasonably\u201d changes to account for the various stakeholders:<\/p>\n<ul>\n<li>ALA<span style=\"color: #ff9900;\"><strong>H<\/strong><\/span>A (holistically; nuclear)<\/li>\n<li>ALA<span style=\"color: #ff9900;\"><strong>D<\/strong><\/span>A (diagnostically; medical)<\/li>\n<li>ALA<span style=\"color: #ff9900;\"><strong>Q<\/strong><\/span>A (qualitatively, quality of life; post-accident)<\/li>\n<li>ALA<span style=\"color: #ff9900;\"><strong>Thec<\/strong><\/span>A (technically; non-ionizing)<\/li>\n<\/ul>\n<p>We can discuss reason here, but reason is not enough and we cannot discuss it alone. We also need to identify, engage, and empower targeted stakeholders.<\/p>\n<p>Needless to say, optimization is a challenge in all sectors. This was restated as a common point in the conclusion of a presentation titled \u201cIRPA\/SFRP workshops on the practical implementation of the ALARA principle\u201d that Jean-Fran\u00e7ois Lecomte gave (based on the paper he coauthored with me, Thierry Schneider, Caroline Schieber, and Yann Billarand) at the 2019 HPS annual meeting in Orlando, FL. He said, \u201cOptimization is a deliberative process to achieve a reasonable compromise with all informed stakeholders.\u201d<\/p>\n<p>So, CRPA members, how can we practically implement ALARA? Let\u2019s discuss.<\/p>\n<p>For our medical CRPA members, the American Association of Physicists in Medicine (AAPM) has started a conversation with an <a href=\"https:\/\/w3.aapm.org\/media\/documents\/2019_08_19-Open_Letter_Re_Gonadal_Shielding.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">open letter to the imaging community<\/a> in August 2019. The topic was the use of gonadal and fetal lead aprons for X-rays as good ALARA practice. In essence, AAPM says these aprons, once a mainstay for patient radiation protection, will no longer be used routinely as they provide negligible or no benefit to patient health.<\/p>\n<p>According to AAPM, the practice (and in many cases, regulatory obligation) of using gonadal and fetal lead aprons for X-rays should now be thrown out. Hopefully all stakeholders will be informed and the discussion will include them; it\u2019s always an important human issue to remove something that one would consider \u201cprotection.\u201d<\/p>\n<p>My reasonable two cents is this\u2014we know shielding is useless for internal scattering and technology is evolving, but this letter does not mention justification and optimization. Shall we start there first?<\/p>\n<p>Mom, Dad, more than ever I understand; being reasonable is not that easy!<\/p>\n<div style=\"padding: 10px 10px 0 10px; background-color: #eeeeee; border: #dddddd 2px solid;\">\n<h2><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1855 alignright\" src=\"https:\/\/www.crpa-acrp-bulletin.ca\/wp-content\/uploads\/2020\/01\/SJF_CROPPED.jpg\" alt=\"\" width=\"125\" height=\"125\" \/><\/h2>\n<h2 class=\"\">St\u00e9phane Jean-Fran\u00e7ois<\/h2>\n<p>St\u00e9phane Jean-Fran\u00e7ois is a certified health physicist at Radioprotection Inc. Having studied engineering physics, he received his professional certification from the American Board of Health Physics in 1998 and has renewed that certification five times since. He has worked in the field of radiation protection for the past 28 years, including 25 years as radiation safety officer. He has been a CRPA member since 1996.<\/p>\n<p>St\u00e9phane Jean-Fran\u00e7ois est sp\u00e9cialiste certifi\u00e9 en radioprotection \u00e0 Radioprotection Inc. Ing\u00e9nieur-physicien de formation, il a obtenu sa certification professionnelle en radioprotection aupr\u00e8s de l\u2019American Board of Health Physics en 1998, certification renouvel\u00e9e 5 fois depuis. Il compte 28 ans d\u2019exp\u00e9rience dans le domaine pratique de la radioprotection, dont 25 ans comme RRP. Il est membre de l\u2019ACRP depuis 1996.<\/p>\n<\/div><\/div><\/div><div class='clear_column'><\/div>\n","protected":false},"excerpt":{"rendered":"<p>The Soci\u00e9t\u00e9 Fran\u00e7aise de radioprotection (SFRP), the French equivalent to the Canadian Radiation Protection Association, with the International Radiation Protection Association (IRPA), co-hosted two workshops on the practical implementation of the ALARA principle. \/ Avec la Soci\u00e9t\u00e9 Fran\u00e7aise de radioprotection (SFRP), l\u2019\u00e9quivalent fran\u00e7ais de l\u2019Association canadienne de la radioprotection, l\u2019Association internationale pour la protection contre les radiations a coanim\u00e9 deux ateliers sur la mise en pratique du principe ALARA.<\/p>\n","protected":false},"author":52,"featured_media":1840,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[3,2],"tags":[],"class_list":["post-1835","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles","category-features"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ALARA \u2013 How Low Is Low Enough? 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