AI and the need for justification (to the patient)

This paper argues that one problem that besets black-box AI is that it lacks algorithmic justifiability. We argue that the norm of shared decision making in medical care presupposes that treatment decisions ought to be justifiable to the patient. Medical decisions are justifiable to the patient only if they are compatible with the patient's values and preferences and the patient is able to see that this is so. Patient-directed justifiability is threatened by black-box AIs because the lack of rationale provided for the decision makes it difficult for patients to ascertain whether there is adequate fit between the decision and the patient's values. This paper argues that achieving algorithmic transparency does not help patients bridge the gap between their medical decisions and values. We introduce a hypothetical model we call Justifiable AI to illustrate this argument. Justifiable AI aims at modelling normative and evaluative considerations in an explicit way so as to provide a stepping stone for patient and physician to jointly decide on a course of treatment. If our argument succeeds, we should prefer these justifiable models over alternatives if the former are available and aim to develop said models if not.

Radiographers' role in justification of medical imaging examinations

INTRODUCTION

Justification is one of the fundamental principles in radiation protection and according to the ICRP, justification means that any decision that alters the radiation exposure situation should do more good than harm. The purpose of this study was to explore diagnostic radiographers' attitude towards their role in justification, and to assess the perceived need for justification discussions with peers and the ability to reject unjustified referrals during day, evening, and night shifts.

METHODS

This study was conducted in Norway and Denmark. A questionnaire was developed in Norwegian and translated into Danish, and two experienced radiographers assessed content validity. A secure online data capture solution was used, and the questionnaire was distributed to radiographers working in clinical settings in March and April 2022 (n = 1215).

RESULTS

A total of 202 radiographers were included in the study, 93 from Norway and 109 from Denmark, respectively. Seventy-nine per cent of the radiographers reported that they had a duty to assess justification and 86 % did so daily. Their role in justification assessment was reported as relatively important, where CT and MRI had significantly different results than the total respondents. Radiologists were designated as being most responsible in the assessment, closely followed by referring doctors and radiographers. The most important criterion for justification assessment was the referring doctor's clinical assessment. The need to confer was highest during daytime when there were also more opportunities to confer.

CONCLUSION

The need to discuss justification of examinations is greater during daytime when access to radiologists is also high, while both access and need are low during night shifts. Further research is needed to explain the latter finding. Radiographers who engage in daily justification assessments, and perceive it as a duty, find justification important and report having sufficient knowledge to carry out these assessments.

The radiographers' opinion on assessing radiological referrals

INTRODUCTION

Radiographers have a fundamental duty to assess radiological referrals and ensure imaging is justified. This study constitutes the third part of a broader research on radiographers' assessment of referrals. The study examines the opinions of radiographers on the matter, as articulated in their own words.

METHODS

A questionnaire with closed and open-ended questions was designed, validated, and distributed to radiographers following activities organised by the International Society of Radiographers and Radiological Technologists (ISRRT). This third part covers the participants' free-text comments about radiographers' assessment of referrals. Qualitative, inductive content analysis was used to report findings involving three phases: 1) Preparation, 2) Organisation where two authors individually coded and categorised the emerged themes, and 3) Reporting, were the authors compared, reviewed, and defined the meanings of the themes and sub-themes.

RESULTS

Five main themes Opportunity, Competency, Work environment, Role perception and Significance emerged, shaped as descriptive, normative, and prospective statements. In opportunities the respondents (descriptively) depicted the importance of their position and challenges faced, including lack of adequate clinical information in referrals. Competencies concerned whether they have the required knowledge and skills for the task. In work environment the respondents viewed themselves as partners and collaborators with radiologists and referrers but expressed that unclear regulations could challenge their task. In role perception, the respondents expressed (normatively) that assessing referrals is vital for professional self-esteem and radiographers' responsibility. Significance covers the importance of assessing referrals for different aspects relating to quality of services.

CONCLUSION

Radiographers expressed high engagement towards tasks of assessing referrals. To support radiographers in this role, it is crucial to establish clear regulations, better organisation of departmental processes and provide adequate training.

IMPLICATIONS FOR PRACTICE

Radiology departments should actively explore strategies of incorporating the radiographers' resources and core position in the process of assessing referrals, in a consistent and effective manner.

Distinct Profiles for Beliefs About Religion Versus Science

A growing body of research suggests that scientific and religious beliefs are often held and justified in different ways. In three studies with 707 participants, we examine the distinctive profiles of beliefs in these domains. In Study 1, we find that participants report evidence and explanatory considerations (making sense of things) as dominant reasons for beliefs across domains. However, cuing the religious domain elevates endorsement of nonscientific justifications for belief, such as ethical considerations (e.g., believing it encourages people to be good), affiliation (what loved ones believe), and intuition (what feels true in one's heart). Study 2 replicates these differences with specific scientific and religious beliefs held with equal confidence, and documents further domain differences in beliefs' personal importance, openness to revision, and perceived objectivity. Study 3 replicates these differences, further finding that counter-consensus beliefs about contentious science topics (such as climate change and vaccination) often have properties resembling religious beliefs, while counter-religious beliefs about religion (e.g., "There is no God") have properties that more closely resemble beliefs about science. We suggest that beliefs are held and justified within coherent epistemic frameworks, with individuals using different frameworks in different contexts and domains.

How to activate intuitive and reflective thinking in behavior research? A comprehensive examination of experimental techniques

Experiments comparing intuitive and reflective decisions provide insights into the cognitive foundations of human behavior. However, the relative strengths and weaknesses of the frequently used experimental techniques for activating intuition and reflection remain unknown. In a large-scale preregistered online experiment (N = 3667), we compared the effects of eight reflection, six intuition, and two within-subjects manipulations on actual and self-reported measures of cognitive performance. Compared to the overall control, the long debiasing training was the most effective technique for increasing actual reflection scores, and the emotion induction was the most effective technique for increasing actual intuition scores. In contrast, the reason and the intuition recall, the reason induction, and the brief time delay conditions failed to achieve the intended effects. We recommend using the debiasing training, the decision justification, or the monetary incentives technique to activate reflection, and the emotion induction, the cognitive load, or the time pressure technique to activate intuition.

CT and MRI imaging in Sweden: retrospective appropriateness analysis of large referral samples

OBJECTIVES

The numbers of computed tomography (CT) and magnetic resonance imaging (MRI) examinations per capita continue to increase in Sweden and in other parts of Europe. The appropriateness of CT and MRI examinations was audited using established European appropriateness criteria. Alternative modalities were also explored. The results were compared with those of a previous study performed in Sweden.

METHODS

A semi-automatic retrospective evaluation of referrals from examinations performed in four healthcare regions using the European appropriateness criteria in ESR iGuide was undertaken. The clinical indications from a total of 13,075 referrals were assessed against these criteria. The ESR iGuide was used to identify alternative modalities resulting in a higher degree of appropriateness. A qualitative comparison with re-evaluated results from the previous study was made.

RESULTS

The appropriateness was higher for MRI examinations than for CT examinations with procedures classed as usually appropriate for 76% and 63% of the examinations, respectively. The degree of appropriateness for CT was higher for referrals from hospitals compared to those from primary care centres. The opposite was found for MRI examinations. The alternative modalities that would result in higher appropriateness included all main imaging modalities. The result for CT did not show improvement compared with the former study.

CONCLUSIONS

A high proportion of both CT and MRI examinations were inappropriate. The study indicates that 37% of CT examinations and 24% of MRI examinations were inappropriate and that the appropriateness for CT has not improved in the last 15 years.

CRITICAL RELEVANCE STATEMENT

A high proportion of CT and MRI examinations in this retrospective study using evidence-based referral guidelines were inappropriate.

KEY POINTS

∙ A high proportion of CT and MRI examinations were inappropriate. ∙ The CT referrals from general practitioners were less appropriate that those from hospital specialists. ∙ The MRI referrals from hospital specialists were less appropriate that those from general practitioners. ∙ Adherence to radiological appropriateness guidelines may improve the appropriateness of conducted examinations.

Vetting of medical imaging referrals: A scoping review of the radiographers' role

INTRODUCTION

Vetting and treatment verification, are now an expectation of threshold radiography competencies at qualification. Radiographer-led vetting contributes to the expedition of patients' treatment and management. However, the current state and the role of the radiographer in vetting medical imaging referrals remains unclear. This review aims to explore the current state and associated challenges to a radiographer-led vetting and offer directions for future research by addressing knowledge gaps.

METHOD

The Arksey and O'Malley methodological framework was employed for this review. This includes a comprehensive search using key terms relating to radiographer-led vetting across relevant databases: Medline, PubMed, AMED and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Articles were screened for eligibility and information extracted and analysed descriptively to map the available evidence.

RESULTS

1149 studies were identified with 12 articles included for this review after duplicates were removed. The findings indicate existence of some radiographer-led vetting activities in practice; however, the scope of this practice is associated with a large variance across settings. Key challenges relating to radiographer-led vetting include referral selectivity, medical professional dominance, and lack of clinical indication on referrals.

CONCLUSION

Radiographers vet various categories of referrals depending on jurisdictional policies and more clarity in regulation, advanced practice training and change in workplace culture is needed to support radiographer-led vetting.

IMPLICATION FOR PRACTICE

Radiographer-led vetting should be championed across settings through formalised training to widen the scope of advance practice and career progression pathways for radiographers as a means of ensuring optimal use of resources.

Guidance and mainstream epistemology

According to one prominent critique of mainstream epistemology, discoveries about what it takes to know or justifiedly believe that p can't provide the right kind of intellectual guidance. As Mark Webb puts it, "the kinds of principles that are developed in this tradition are of no use in helping people in their ordinary epistemic practices." In this paper I defend a certain form of traditional epistemology against this "regulative" critique. Traditional epistemology can provide-and, indeed, can be essential for-intellectual guidance. The reason is that, in many cases, how you should proceed intellectually depends on what you already know or justifiedly believe: how you should treat counterevidence to your beliefs, for example, can depend on whether those beliefs count as knowledge. Therefore, to get guidance on how to proceed intellectually, it will often be essential to be able to figure out what you know or justifiedly believe. And to do that it will often be helpful to try to figure out what it takes to count as knowledge or justified belief in the first place. To do this is precisely to engage in mainstream epistemology.

Justification of radiological procedures: Radiographers' experiences at two public hospitals

BACKGROUND

Justification is a process conducted by the radiographer in consultation with the radiologist to evaluate radiological procedures ordered by doctors. The main purpose for justifying all radiologic procedures is to assess the benefits and risks of a requested radiographic procedure and determine whether exposure will continue. Furthermore, justification helps to prevent unnecessary radiation exposure and reduce the chances of harmful effects of ionizing radiation.

OBJECTIVES

The study aimed to explore the experiences of radiographers regarding the justification of radiological procedures at two public hospitals in Namibia METHODS: This study made use of a qualitative, exploratory design. A total number of 13 purposefully selected radiographers from radiology departments in two tertiary public - hospitals in Namibia were interviewed using a semi-structured interview guide and audio recorder. All interviews were conducted face-to-face until data saturation was achieved. Data were analysed using Atlas.ti Windows (version 9.0 using Tesch's 8-step method of qualitative data analysis to generate themes and subthemes.

FINDINGS

The participants experienced an enhancement of patient care through enhanced radiation protection and optimised patient care. They also experienced defunct communication systems through deficient communication between radiographers and referrers, professional role conflict and incomplete referrals.

CONCLUSION

The study revealed that the justification of radiological procedures was linked to both negative and positive experiences. Enhanced patient-centred care was a positive experience related to the radiographers' job responsibilities. The defunct communication support system was a negative experience as it related to the limited availability and utilisation of communication systems that are meant to enhance and support justification by radiographers. The study recommends an in-depth study to quantify unjustified procedures in these two hospital departments. Continuous professional development focusing on justification and referral protocols must be conducted jointly between radiographers and referrers to create awareness and a platform for shared decision-making models.

Radiation risk-benefit communication during paediatric CT imaging: Experiences of radiographers at two public hospitals

INTRODUCTION

Radiation dose knowledge and effective communication skills are essential for both radiographers and radiologists to be able to appropriately fulfil their legal responsibilities to justify each medical exposure. Furthermore, they enable the optimisation of imaging protocols and techniques according to the child's characteristics and underlying clinical conditions. Previous studies have shown that radiographers do not provide paediatric patients and their parents/guardians with adequate information about doses and risks before a procedure. However, they have a legal responsibility to explain the radiation risk associated with performing the procedure as well as the associated risk of not performing the same procedure. There are several obstacles to describing ionizing radiation risk, including the ionizing radiation language that is not readily understood by non-imaging personnel. This study aimed to explore and describe the radiographers' experiences of radiation risk-benefit communication during paediatric CT imaging at two public hospitals. This is important to understand the effectiveness of the communication process and institute corrective action where shortcomings are evident.

METHODS

A qualitative, exploratory, descriptive research design was applied. The sample consisted of 12 purposively selected radiographers who were trained and working in the CT imaging department. Data were collected using face-to-face individual interviews. Tesch's 8 steps were used to analyse the data collected and generate themes and subthemes.

RESULTS

Two themes emerged from the data collected: (1)Positive experiences with two sub-themes (job satisfaction and mutual benefit) and (2) negative experiences with three sub-themes (.professional deprecation, ineffectual outcomes and communication impediments).

CONCLUSION

Positive experiences boosted radiographers' confidence and enhanced their participation in radiation risk-benefit communication with paediatric patients' parents and guardians while negative experiences hindered patient-centred care in the process of risk-benefit communication.

IMPLICATIONS FOR PRACTICE

Continuous education of radiographers and doctors on radiation risk-benefit communication before paediatric CT procedures is recommended, in line with their scope of practice, to improve patient-centred care.

How to be a capacitist

Capacitism is the view that capacities come first in epistemological theorising: they are explanatorily basic and key epistemic phenomena are to be analysed in terms of capacities. This paper develops a problem for capacitism and outlines a motivated way of solving it.

DENIAL: A conceptual framework to improve honesty nudges

Strategies to mitigate dishonesty have met with limited success, leading behavioral ethics scholars to call for a deeper understanding of the psychological mechanisms underlying dishonesty. In this article, I introduce a conceptual framework, DENIAL, that identifies four fundamental mechanisms, or justifications, which provide people a rationale to consider themselves as ethical while acting unethically. I derive these justifications from a review of scholarship within cognate fields, drawing on Moral Disengagement Theory and Neutralization Theory. I identify the victim (they Deserve it), the situation (I blame my Environment), the harm (I cause No Injury), and the social relationship (I have other ALlegiances) as fundamental justifications for dishonesty. I discuss how future mitigation strategies might harness these justifications to improve their efficacy.

Disagreement, justification, and equitable moral judgments: A brief training study

Although theorists agree that social interactions play a major role in moral development, previous research has not experimentally assessed how specific features of social interactions affect children's moral judgments and reasoning. The current study assessed two features: disagreement and justification. In a brief training phase, children aged 4-5.5 years (N = 129) discussed simple moral scenarios about issues of fairness (how to allocate things between individuals) with a puppet who, in a between-participants factorial design, either agreed or disagreed with the children's ideas and either asked or did not ask the children to justify their ideas. Children then responded to another set of moral scenarios in a test phase that was the same for all children. Children in the "agree and do not justify" baseline condition showed an inflexible equality bias (preferring only equal allocations regardless of context), but children who had experiences of disagreement or experiences of being asked to justify themselves shifted toward making equitable decisions based on common ground norms and values. Furthermore, false belief competence was related to children's decisions and justifications. These findings support the classic Piagetian hypothesis that social interactions are a catalyst of cognitive disequilibrium and moral development.

Unifying 'the' Precautionary Principle? Justification and Reflective Equilibrium

The precautionary principle (PP) is an influential principle for making decisions when facing uncertain, but potentially severe, harm. However, there is a persistent disagreement about what the principle entails, exactly. It exists in a multitude of formulations and has potentially conflicting ideas associated with it. Is there even such a thing as 'the precautionary principle'? This paper analyses the debate between unificationists and pluralists about 'the PP', arguing that the debate is hindered by neglecting the question of justification. It introduces reflective equilibrium as a method of justification, and sketches how it could be applied to justify a PP.

Against 'instantaneous' expertise

BACKGROUND

Healthcare is predicated on the use of biotechnology and medical technology, both of which are indispensable in diagnosis, treatment, and most aspects of patient care. It is therefore imperative that justifications for use of new technologies are appropriate, with the technologies working as advertised. In this paper, I consider philosophical accounts of how such justifications are made.

METHODS

Critical philosophical reflection and analysis.

RESULTS

I propose that justification in many prominent accounts is based on the designer's professional experience and on expert testimony. I argue, however, that professional designers are not in a position to justify a new biotechnology or medical device if the justification is based on testimony or past experience of presumably similar technologies. I argue (1) that similarity judgments offered by instantaneous experts cannot be viewed as contributing (epistemically) to evidential justification of new and unproven technologies; and (2) that designers and manufacturers cannot endorse a technology's effective function in a patient-care context until it has been successfully used in that context.

CONCLUSION

I show that an expert's past professional experiences can never predict or justify the impact of a novel technology on human health. This is because any new technology leads to the introduction of new mechanisms with unprecedented functions. The new technology therefore needs to be studied in situ and justified as a newly created mechanism within the relevant healthcare setting. Ultimately, justifications of this type rely on the scientific community and society engaging in repeated experimentation and observation of the technology, and confirming its successful use.

Evolution of logic as an information processing mechanism in advanced biological systems

Logic plays an important role in biological evolution. Some researchers even assume that evolution can be seen as a process of discovering the logic that works well in a particular environment. At the same time, logic can be treated as a biological system, or a superorganism, evolution of which goes in the social environment with its societal space and time. In this paper, syntactic aspects of the evolution of logic are studied demonstrating how logic evolves from the simplest logical species to the higher and higher logical species.

The rational dimension of understanding

It is natural to regard understanding as having a rational dimension, in the sense that understanding seems to require having justification for holding certain beliefs about the world. Some philosophers however argue that justification is not required to gain understanding of phenomena. In the present paper, my intention is to provide a critical examination of the arguments that have been offered against the view that understanding requires justification in order to show that, contrary to what they purport to establish, justification remains a plausible requirement on understanding.

Affectivism about intuitions

This article provides an account of intuitions: Affectivism. Affectivism states that intuitions are emotional experiences. The article proceeds as follows: first, the features that intuitions are typically taken to have are introduced. Then some issues with extant theories are outlined. After that, emotional experiences and their central features are brought into view. This is followed by a comparison of intuitions and emotional experiences, yielding the result that emotional experiences fit and elucidate the feature profile of intuitions. Finally, it is specified what kind of emotional experiences intuitions are: intuitions are typically mild emotional experiences that belong to the subclass of epistemic feelings.

Patients' perceptions, associations, and justifications for the causes of diabetes in North-East Ethiopia: A qualitative study

BACKGROUND AND AIMS

Diabetes management is strongly influenced by patients' beliefs about its causes. The study examined type 2 diabetes patients' perceptions of the causes of their illness in North-East Ethiopia.

METHODS

The study used a phenomenological approach triangulated with modified grounded theory based on the Causative Dimension of Self-Regulated Model, and was conducted from July 2019 to January 2020. Purposive sampling was used to select the participants. Semi-structured in-depth face-to-face interviews with twenty-four (11 males and 13 females) participants were used to collect data until saturation. QDA Miner Lite v2.0.8 was used to perform analysis, which was then discussed based on the themes that emerged.

RESULTS

The patients expressed and justified the causes of their illness by evidencing the temporal proximity of the onset of symptoms or indicators and specific misfortune. As such, diabetes has been attributed to emotional reactions, psycho-economic situations, supernatural evil spirits, substance use, nutritional problems, and other illness; emotional reactions, with psycho-economic and supernatural spirits being the most common. These causes were justified by referring to a specific earlier misfortune that related to the onset of the indicators.

CONCLUSION

Patients' perceptions for attributing their illness were linked with emotional, psycho-economic, and supernatural evil spirits and justified by a specific life calamity by establishing the temporal association of symptoms with that adversity; which entails culture-specific psycho-social and educational interventions in diabetes care. Moreover, the finding necessitates that the causality justifications and linkages to misfortunes be included in the Causality Dimension of the Self-Regulated Model.

Because you had a bad day: the role of negative affect and justification in self-control failure

Justification thinking (using excuses to "allow" giving into temptation) has been identified as a potential link between negative affect and self-control failure. We hypothesised that negative affect would prompt greater justification thinking, specifically deservingness thinking (i.e. "I deserve a treat"), and tested this for both inhibitory (temptation is to approach reward; self-control is to inhibit) and initiatory (temptation is to refrain from action, self-control is to initiate action) hypothetical self-control dilemmas. We found that only for inhibitory self-control (Study 1; N = 105) but not initiatory (Study 2; N = 116), negative affect resulted in greater deservingness thinking compared to neutral affect. We also hypothesised that negative mood coupled with justification would prompt greater likelihood of imagined self-control failure. We found that for inhibitory self-control (Study 3; N = 569), participants in negative affect (vs. neutral) and justification (vs. no justification) conditions were independently more likely to report they would fail at self-control. For initiatory self-control (Study 4; N = 321), we found an effect of negative affect on hypothetical self-control failure but no effect of justification. Overall, these studies confirm the role of negative affect in self-control processes and highlight differences between inhibitory and initiatory self-control situations.

Understanding and scientific progress: lessons from epistemology

Contemporary debate surrounding the nature of scientific progress has focused upon the precise role played by justification, with two realist accounts having dominated proceedings. Recently, however, a third realist account has been put forward, one which offers no role for justification at all. According to Finnur Dellsén's (Stud Hist Philos Sci Part A 56:72-83, 2016) noetic account, science progresses when understanding increases, that is, when scientists grasp how to correctly explain or predict more aspects of the world that they could before. In this paper, we argue that the noetic account is severely undermotivated. Dellsén provides three examples intended to show that understanding can increase absent the justification required for true belief to constitute knowledge. However, we demonstrate that a lack of clarity in each case allows for two contrasting interpretations, neither of which serves its intended purpose. On the first, the agent involved lacks both knowledge and understanding; and, on the second, the agent involved successfully gains both knowledge and understanding. While neither interpretation supports Dellsén's claim that understanding can be prised apart from knowledge, we argue that, in general, agents in such cases ought to be attributed neither knowledge nor understanding. Given that the separability of knowledge and understanding is a necessary component of the noetic account, we conclude that there is little support for the idea that science progresses through increasing understanding rather than the accumulation of knowledge.

Justification and Optimization Principles of ALARA in Pediatric CT at a Teaching Hospital in Ethiopia

Background

Radiation from CT (computerized tomography), poses risk of radiation associated cancer. Studies indicate a cumulative dose of 50mGy triples the risk of leukemia and a dose of 60mGy triples the risk of brain tumors in children. This study aimed to assess the application of “Justification and Optimization Principles of ALARA (As Low As Reasonably Achievable)” in pediatric CT.

Method

A prospective cross-sectional study was conducted from December 2017 to July 2018 G.C at Tikur Anbessa Specialized Hospital. CT request forms were reviewed. All pediatric patients listed for CT were included. The collected data were analyzed using SPSS version 25.

Results

Four hundred and twenty nine CT requests were reviewed, 246 (57.3%) were males and 183(42.7%) were females; 52(12.1%) were less than 1 year old, 153(35.7%) between 1 to 5 years, 113(26.3%) between 5 to 10 years and 111(25.8%) 10 to 14 years old. On the other hand, 28(6.5%) scan requests were rejected based on the ALARA justification principle, and from these, in 11(39.2%) MRI was recommended instead of CT, in 6(21.42%) US was recommended. Review of previous CT helped to reject 4(14.28%). Review of prior chest radiographs helped in rejecting 2(7.14%) requests. For 5(17.8%) and 19(4.4%), requests were optimized by applying principles of optimization to reduce received dose from CT.

Conclusion

Overall, 47(11%) patients were protected from unnecessary radiation exposure by applying the principles of ALARA. The use of other alternating imaging modalities is vital in pediatric patients who are more radiosensitive and have longer time to manifest radiation induced injury.

Workplace factors facilitating the radiographers' assessment of referrals for diagnostic imaging - A qualitative study

INTRODUCTION

Radiology referrals are assessed for appropriate imaging based on the available clinical information. The task is legally the responsibility of the radiologists but could be delegated to radiographers under guidance. Knowledge of how this task is organised in radiology departments is limited. The study aim was to identify workplace factors facilitating the radiographers' assessment of referrals for medical imaging.

METHODS

Five radiographers were recruited by convenience- and snowball-sampling techniques through the online social media platform LinkedIn. The participants represented different private and public hospitals and had from three to above ten years of experience with assessment of referrals for plain and cross sectional imaging. Following a qualitative approach, 60-min in-depth semi-structured interviews were conducted through online video meetings. Interviews followed a topic guide with 15 questions and 20 keywords, previously tested through a pilot interview. Systematic text condensation was performed using NVivo 12, where central themes and underlying subthemes were developed.

RESULTS

Five central facilitating factors were identified, each with subthemes identified as: (1) Formal responsibilities; Documented delegation, Specific role description, (2) Training; Achieving skills, Maintaining skills, (3) Guidelines; Clinical indications, Priority, (4) Resource allocation; Time, Staff, (5) a Supporting environment; Teamwork, Mutual benefits, Feedback and knowledge sharing.

CONCLUSION

The study adds new and valuable insights into workplace factors facilitating the radiographers' delegated task of assessing referrals. Workflows adapting such factors benefit radiographers by increasing knowledge and professional development, while positively re-allocating radiologist resources.

IMPLICATIONS FOR PRACTICE

The study findings may support radiology workplaces in establishing or improving referral assessment by radiographers. Subsequently, improved quality of patient services may be achieved.

ICRP recommendations for recovery

In 2020, the International Commission on Radiological Protection (ICRP) issued Publication 146 which provides a framework of the radiological protection of people and the environment in the case of a large nuclear accident. Mitigation of radiological consequences is achieved using the fundamental principles of justification of decisions and optimisation of protection. These recommendations emphasise the importance of the optimisation of protection for the rehabilitation of living and working conditions in the affected areas during the intermediate and long-term phases. They underline the role of co-operation between the authorities, experts, and the affected population in the co-expertise process to facilitate informed decisions about their own protection. ICRP defines reference levels to be selected within generic bands of exposure considering the induced risk of radiation, as well as the feasibility of controlling the situation.

Improving justification of medical exposures using ionising radiation: considerations and approaches from the European Society of Radiology

This discussion paper has been produced within the context of the European Society of Radiology EuroSafe Imaging initiative and considers primarily the issues and challenges associated with justification of medical exposures using ionising radiation for individual patient diagnostic imaging procedures. It addresses both regulatory requirements and practical considerations and discusses approaches that are intended to improve justification.

Infection control measures in times of antimicrobial resistance: a matter of solidarity

Control measures directed at carriers of multidrug-resistant organisms are traditionally approached as a trade-off between public interests on the one hand and individual autonomy on the other. We propose to reframe the ethical issue and consider control measures directed at carriers an issue of solidarity. Rather than asking “whether it is justified to impose strict measures”, we propose asking “how to best care for a person’s carriership and well-being in ways that do not imply an unacceptable risk for others?”. A solidarity approach could include elevating baseline levels of precaution measures and accepting certain risks in cases where there is exceptionally much at stake. A generous national compensation policy that also covers for costs related to dedicated care is essential in a solidarity approach. An additional benefit of reframing the questions is that it helps to better acknowledge that being subjected to control measures is a highly personal matter.

On the justification of justification in radiation protection - legal and sociological considerations

OBJECTIVES

The objectives of the review were to investigate the legal and sociological basis of justification in society in order to fully assess its relevance to radiation protection. The difference between the justification of practices as distinct from the justification of reasons for the justification of individual activities within a practice and the relevance of cost-benefit analysis to this process are key elements.

KEY FINDINGS

Justification of practices as a principle of radiation protection is automatically enshrined within the appropriate legislation once it has been enacted. However, the justification of reasons for justification of activities within a practice are subject to many sociological factors, which are often conflicting and indeterminate and can be subject to political, economic and environmental factors that may change over time. This applies especially to new developments where the primary reason for justification is based upon potential but possibly ill-defined future benefits.

CONCLUSION

The primary mechanism whereby society develops a collective consensus on the justification of practices lies within a legal framework. This represents the mechanism by which society defines the accepted standards that must be applied for acceptance of a practice. The justification of reasons for justifying activities that form part of a practice has largely been ignored within the framework of radiation protection.

IMPLICATIONS FOR PRACTICE

The employment of justification of practices as a fundamental principle of radiation protection should be eliminated since it is already enshrined within the legal framework applicable to applications of ionising radiation. Justification of reasons for pursuing new or modified practices is based upon their perceived benefits to society, which underpins most developments in society.

Graded epistemic justification

The adjective 'is justified' has all the hallmarks of a gradable adjective. But the relationship between gradable uses and straightforward predications of the form 'x is justified' has been underexplored by epistemologists. In this paper we undertake to do some ground clearing as a prelude to better understanding this relationship.

Making a case for a change to using CEFR-oriented placement test scores: A reflexive ethnographic decision making

The term ‘language testing and assessment’ (LTA) seems to often invoke ideas related to numbers, such as mathematical equation and statistical calculation. This may range from scoring performance or responses to examination questions as numbers, to informing stakeholders of test results. This article investigates a series of actions pertaining to LTA by bringing in reflexive ethnography (Davies, C.A. [2008]. Reflexive Ethnography: A Guide to Researching Selves and Others. Routledge: London.). The aims are to add a humanistic element to the discipline in general and to feed another piece of applicability information to ethnographers in particular. Attempting at introducing such an approach largely qualitative as ethnography to the field of LTA can be useful because it may open up possibilities for balanced views in assessing language competence in future studies, in which social factors can also be taken explicitly into account for a decision making in LTA. For ethnographers, applicability of reflexive ethnography in LTA could mean the methodology achieves greater generalizability through a larger sample in the universe of admissible observations. A primary research question is whether a change in using CEFR-oriented placement test scores can be justified using empirical reasoning. Participatory observations, situational weigh-in, and statistical analyses are found capable of synergizing using a reflexive-ethnographic perspective for a justifiable decision-making process.

De vuelta a la clínica: sin justificación no existe pregunta de investigación que valga

A clinical research question requires the concurrence of clinical experience and knowledge on methodology and statistics in that who formulates it. Initially, a research question should have a structure that clearly establishes what is that which is being sought (consequence or outcome), in whom (baseline status), and by action of what (maneuver). Subsequently, its reasoning must explore four aspects: feasibility and reasonableness of the questioning, lack of a prior answer, relevance of the answer to be obtained, and applicability. Once these aspects are satisfactorily covered, the question can be regarded as being "clinically relevant", which is different from being statistically significant, which refers to the probability of the result being driven by chance, which does not reflect the relevance of the question or the outcome. One should never forget that every maneuver entails adverse events that, when serious, discredit good results. It is imperative to have the possible answer estimated from within the structure of the question. The function of clinical research is to corroborate or reject a hypothesis, rather than to empirically test to find out what the outcome is.

Ethical Frameworks in Public Health Decision-Making: Defending a Value-Based and Pluralist Approach

A number of ethical frameworks have been proposed to support decision-making in public health and the evaluation of public health policy and practice. This is encouraging, since ethical considerations are of paramount importance in health policy. However, these frameworks have various deficiencies, in part because they incorporate substantial ethical positions. In this article, we discuss and criticise a framework developed by James Childress and Ruth Bernheim, which we consider to be the state of the art in the field. Their framework distinguishes aims, such as the promotion of public health, from constraints on the pursuit of those aims, such as the requirement to avoid limitations to liberty, or the requirement to be impartial. We show how this structure creates both theoretical and practical problems. We then go on to present and defend a more practical framework, one that is neutral in avoiding precommitment to particular values and how they ought to be weighted. We believe ethics is at the very heart of such weightings and our framework is developed to reflect this belief. It is therefore both pluralist and value-based. We compare our new framework to Childress and Bernheim's and outline its advantages. It is justified by its impetus to consider a wide range of alternatives and its tendency to direct decisions towards the best alternatives, as well as by the information provided by the ranking of alternatives and transparent explication of the judgements that motivate this ranking. The new framework presented should be useful to decision-makers in public health, as well as being a means to stimulate further reflection on the role of ethics in public health.

Can General Practitioners' personal knowledge base be justified?

This article was migrated. The article was marked as recommended. This paper explores whether, in our post-truth world the knowledge base of General Practice can be justified. It examines the different types of knowledge that make up a profession's knowledge base and how such knowledge may be justified. The justification of personal knowledge, which is often the most important for practice, requires a different approach to that of codified knowledge. A potential approach is outlined which can be evaluated against the norms of the profession. A number of methods are suggested that may foster its' development.

The norm of assertion: Empirical data

Assertions are speech acts by means of which we express beliefs. As such they are at the heart of our linguistic and social practices. Recent research has focused extensively on the question whether the speech act of assertion is governed by norms, and if so, under what conditions it is acceptable to make an assertion. Standard theories propose, for instance, that one should only assert that p if one knows that p (the knowledge account), or that one should only assert that p if p is true (the truth account). In a series of four experiments, this question is addressed empirically. Contrary to previous findings, knowledge turns out to be a poor predictor of assertability, and the norm of assertion is not factive either. The studies here presented provide empirical evidence in favour of the view that a speaker is warranted to assert that p only if her belief that p is justified.

Collaboration, campaigns and champions for appropriate imaging: feedback from the Zagreb workshop

Abstract

Leading radiologists and representatives from national radiation protection regulatory authorities and health ministries from 19 countries of the European region worked together with five experts at the workshop on justification and appropriate use of imaging in Zagreb, Croatia, from 26 to 28 October 2017 jointly organised by the IAEA and the European Society of Radiology. The workshop served as a forum to exchange information on challenges and solutions for improving justification and the appropriate use of diagnostic imaging. Common barriers to improving the use of imaging referral guidelines were discussed and the need for increased collaboration identified. Examples of good practices were presented, including use of Clinical Decision Support (CDS) systems to facilitate rapid and good justification decisions. The workshop identified some of the needs of European countries for achieving more appropriate imaging proposing wider use of collaboration, campaigns and champions.

Main messages

• Drivers for appropriate imaging in Europe are similar to those elsewhere globally.

• Implementing imaging referral guidelines is the main barrier to more appropriate imaging.

• Clinical Decision Support systems (CDS) facilitates good referral practice and justification decisions.

• Collaboration, campaigns and champions may improve awareness, appropriateness and audit.

Non-Scientific Criteria for Belief Sustain Counter-Scientific Beliefs

Why is evolutionary theory controversial among members of the American public? We propose a novel explanation: allegiance to different criteria for belief. In one interview study, two online surveys, and one nationally representative phone poll, we found that evolutionists and creationists take different justifications for belief as legitimate. Those who accept evolution emphasize empirical evidence and scientific consensus. Creationists emphasize not only the Bible and religious authority, but also knowledge of the heart. These criteria for belief remain predictive of views about evolution even when taking into account other related factors like religion, political affiliation, and education. Each view is supported by its own internally specified criteria for what constitutes a justified belief. Changing minds may thus require changing epistemic norms.

Many randomized clinical trials may not be justified: a cross-sectional analysis of the ethics and science of randomized clinical trials

OBJECTIVE

We have proposed that three scientific criteria are important for the ethical justification of randomized clinical trials (RCTs): (1) they should be designed around a clear hypothesis; (2) uncertainty should exist around that hypothesis; (3) that uncertainty should be as established through a systematic review. We hypothesized that the majority of a sample of recently published RCTs would not explicitly incorporate these criteria, therefore rendering them potentially unjustified on scientific grounds.

STUDY DESIGN AND SETTING

Cross-sectional analysis of all RCTs published in the New England Journal of Medicine and the Journal of the American Medical Association in 2015. Each article and protocol was reviewed for: (1) a clearly stated central hypothesis; (2) references to "equipoise," or "consensus;" (3) some indication of evidentiary uncertainty; (4) a meta-analysis or systematic review surrounding the hypothesis or study question.

RESULTS

We included 208 RCT articles and 199 protocols. Among combined articles and protocols, 76% had a clearly stated hypothesis, 99% referenced some form of uncertainty, and 54% cited a relevant systematic review or meta-analysis. Only 44% of combined texts contained all three scientific criteria. There were few references to "equipoise" (10%) or "consensus" (11%), and those references to equipoise were most often inconsistent with accepted definitions.

CONCLUSION

The majority of RCTs (56%) did not meet the three scientific criteria described previously and therefore may be scientifically and therefore ethically unjustified. We recommend that "equipoise," "clinical equipoise," and "lack of consensus" be abandoned as scientific criteria for RCTs and be replaced by an expectation that RCTs have a clearly stated, meaningful hypothesis around which uncertainty has been established through a systematic review of the literature.

[Guidelines in medical imaging : objectives, limits and radiation protection]

CONTEXT

Guidelines in medical imaging are aimed at increasing the appropriateness of prescriptions, eliminating unnecessary examina- tions, reducing the exposure of the population and minimizing the costs to public health.

METHOD

Our analysis is based on a bibliographic search and the discussions of the " quality " working group of the BELMIP platform.

RESULTS

The introduction in 2004 and its 2014 revision of the guideliness in medical imaging in Belgium had no measurable effect on the imaging prescription. These recommendations are in fact unrecognized, incomplete, poorly constructed and often unusable.

CONCLUSION

Recommendations in medical imaging need to be reviewed and will be reviewed in the near future in order to be better structured and usable. The legal and medico-legal constraints should be integrated in order for Belgium to comply with the relevant European directive.

The meaning of justified subjectivism and its role in the reconciliation of recent disagreements over forensic probabilism

In this paper we reply to recent comments in this Special Issue according to which subjective probability is not considered to be a concept fit for use in forensic evaluation and expert reporting. We identify the source of these criticisms to lie in a misunderstanding of subjective probability as unconstrained subjective probability; a lack of constraint that neither corresponds to the way in which we referred to subjective probability in our previous contributions, nor to the way in which probability assignment is understood by current evaluative guidelines (e.g., of ENFSI). Specifically, we explain that we understand subjective probability as a justified assertion, i.e. a conditional assessment based on task-relevant data and information, that may be thought of as a constrained subjective probability. This leads us to emphasise again the general conclusion that there is no gap between justified (or, reasonable) subjective probability and other concepts of probability in terms of its ability to provide assessments that are soundly based on whatever relevant information available. We also note that the challenges an expert faces in reporting probabilities apply equally to all interpretations of probability, not only to subjective probability.

The logic of epistemic justification

Theories of epistemic justification are commonly assessed by exploring their predictions about particular hypothetical cases-predictions as to whether justification is present or absent in this or that case. With a few exceptions, it is much less common for theories of epistemic justification to be assessed by exploring their predictions about logical principles. The exceptions are a handful of 'closure' principles, which have received a lot of attention, and which certain theories of justification are well known to invalidate. But these closure principles are only a small sample of the logical principles that we might consider. In this paper, I will outline four further logical principles that plausibly hold for justification and two which plausibly do not. While my primary aim is just to put these principles forward, I will use them to evaluate some different approaches to justification and (tentatively) conclude that a 'normic' theory of justification best captures its logic.

Common strategic research agenda for radiation protection in medicine

Reflecting the change in funding strategies for European research projects, and the goal to jointly improve medical radiation protection through sustainable research efforts, five medical societies involved in the application of ionising radiation (European Association of Nuclear Medicine, EANM; European Federation of Organizations for Medical Physics. EFOMP; European Federation of Radiographer Societies, EFRS; European Society of Radiology, ESR; European Society for Radiotherapy and Oncology, ESTRO) have identified research areas of common interest and developed this first edition of the Common Strategic Research Agenda (SRA) for medical radiation protection. The research topics considered necessary and most urgent for effective medical care and efficient in terms of radiation protection are summarised in five main themes: 1. Measurement and quantification in the field of medical applications of ionising radiation 2. Normal tissue reactions, radiation-induced morbidity and long-term health problems 3. Optimisation of radiation exposure and harmonisation of practices 4. Justification of the use of ionising radiation in medical practice 5. Infrastructures for quality assurance The SRA is a living document; thus comments and suggestions by all stakeholders in medical radiation protection are welcome and will be dealt with by the European Alliance for Medical Radiation Protection Research (EURAMED) established by the above-mentioned societies.

MAIN MESSAGES

• Overcome the fragmentation of medical radiation protection research in Europe • Identify research areas of joint interest in the field of medical radiation protection • Improve the use of ionising radiation in medicine • Collect stakeholder feedback and seek consensus • Emphasise importance of clinical translation and evaluation of research results.

Radiation Safety in Nuclear Medicine Procedures

Since the nuclear disaster at the Fukushima Daiichi Nuclear Power Plant in 2011, radiation safety has become an important issue in nuclear medicine. Many structured guidelines or recommendations of various academic societies or international campaigns demonstrate important issues of radiation safety in nuclear medicine procedures. There are ongoing efforts to fulfill the basic principles of radiation protection in daily nuclear medicine practice. This article reviews important principles of radiation protection in nuclear medicine procedures. Useful references, important issues, future perspectives of the optimization of nuclear medicine procedures, and diagnostic reference level are also discussed.

The pathway to RCTs: how many roads are there? Examining the homogeneity of RCT justification

Background

Randomized controlled trials (RCTs) form the foundational background of modern medical practice. They are considered the highest quality of evidence, and their results help inform decisions concerning drug development and use, preventive therapies, and screening programs. However, the inputs that justify an RCT to be conducted have not been studied.

Methods

We reviewed the MEDLINE and EMBASE databases across six specialties (Ophthalmology, Otorhinolaryngology (ENT), General Surgery, Psychiatry, Obstetrics-Gynecology (OB-GYN), and Internal Medicine) and randomly chose 25 RCTs from each specialty except for Otorhinolaryngology (20 studies) and Internal Medicine (28 studies). For each RCT, we recorded information relating to the justification for conducting RCTs such as average study size cited, number of studies cited, and types of studies cited. The justification varied widely both within and between specialties.

Results

For Ophthalmology and OB-GYN, the average study sizes cited were around 1100 patients, whereas they were around 500 patients for Psychiatry and General Surgery. Between specialties, the average number of studies cited ranged from around 4.5 for ENT to around 10 for Ophthalmology, but the standard deviations were large, indicating that there was even more discrepancy within each specialty. When standardizing by the sample size of the RCT, some of the discrepancies between and within specialties can be explained, but not all. On average, Ophthalmology papers cited review articles the most (2.96 studies per RCT) compared to less than 1.5 studies per RCT for all other specialties.

Conclusions

The justifications for RCTs vary widely both within and between specialties, and the justification for conducting RCTs is not standardized.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-1804-z) contains supplementary material, which is available to authorized users.

Ethics of radiological risk governance: justice of justification as a central concern

Due to the specific character of the radiological risk, judgements on whether the use of nuclear technology would be justified in society have to consider knowledge-related uncertainties and value pluralism. The justice of justification not only informs the right of the potentially affected to participate in decision making, but also implies the responsibility of concerned actors to give account of the way they rationalise their own position, interests, hopes, hypotheses, beliefs, and concerns in knowledge generation and decision making. This paper characterises the evaluation of whether the use of nuclear technology would be justified in society as a 'complex social problem', and reflects on what it would imply to deal with its complexity fairly. Based on this assessment, the paper proposes 'reflexivity' and 'intellectual solidarity' as ethical attitudes or virtues for all concerned actors, to be understood from a specific 'ethics of care' perspective 'bound in complexity'. Consequently, it argues that there is a need for an 'interactive' understanding of ethics in order to give ethical attitudes or virtues a practical meaning in a sociopolitical context, and draws conclusions for the case of radiological risk governance.

Current global and Korean issues in radiation safety of nuclear medicine procedures

In recent years, the management of patient doses in medical imaging has evolved as concern about radiation exposure has increased. Efforts and techniques to reduce radiation doses are focussed not only on the basis of patient safety, but also on the fundamentals of justification and optimisation in cooperation with international organisations such as the International Commission on Radiological Protection, the International Atomic Energy Agency, and the World Health Organization. The Image Gently campaign in children and Image Wisely campaign in adults to lower radiation doses have been initiated in the USA. The European Association of Nuclear Medicine paediatric dosage card, North American consensus guidelines, and Nuclear Medicine Global Initiative have recommended the activities of radiopharmaceuticals that should be administered in children. Diagnostic reference levels (DRLs), developed predominantly in Europe, may be an important tool to manage patient doses. In Korea, overexposure to radiation, even from the use of medical imaging, has become a public issue, particularly since the accident at the Fukushima nuclear power plant. As a result, the Korean Nuclear Safety and Security Commission revised the technical standards for radiation safety management in medical fields. In parallel, DRLs for nuclear medicine procedures have been collected on a nationwide scale. Notice of total effective dose from positron emission tomography-computed tomography for cancer screening has been mandatory since mid-November 2014.

Radiological Justification for and Optimization of Nuclear Medicine Practices in Korea

Nuclear medicine is a rapidly growing discipline that employs advanced novel hybrid techniques that provide unique anatomical and functional information, as well as targets for molecular therapy. Concomitantly, there has been an increase in the attention paid to medical radiation exposure. A radiological justification for the practice of nuclear medicine has been implemented mainly through referral guidelines based on research results such as prospective randomized clinical trials. The International Commission on Radiological Protection recommends diagnostic reference levels as a practical mechanism to optimize medical radiation exposure in order to be commensurate with the medical purpose. The Korean Society of Nuclear Medicine has been implementing radiological optimization through a survey of the protocols on how each hospital determines the dose of administration of each radiopharmaceutical. In the case of nuclear medicine, radiation exposure of caregivers and comforters of patients discharged after administration of therapeutic radiopharmaceuticals can occur; therefore, optimization has been implemented through written instructions for patients, based on international recommendations. The development of patient-radiation-dose monitoring software, and a national registry and management system of patient-radiation-dose is needed to implement radiological optimization through diagnostic reference levels. This management system must work in agreement with the "Institute for Quality Management of Nuclear Medicine", and must take into account the medical reality of Korea, such as low medicine fee, in order to implement reasonable radiological justification and optimization.

Imaging Guidelines for Enhancing Justifications for Radiologic Studies

Justification in the field of radiology refers to the appropriate use of radiologic imaging modalities, and may be achieved by establishing clinical imaging guidelines (CIGs). Recently, CIGs have been shown to be useful in selecting the proper medical imaging modality, resulting in the reduction of inappropriate radiologic examinations, thereby enhancing justifications. However, the development of CIGs is both time-consuming and difficult as the methodology of evidence-based medicine should be adhered to. Thus, although the radiologic societies in developed countries such as the United Kingdom and USA are already developing and implementing CIGs in their clinical practices, CIGs are not yet readily available in many other countries owing to differences in medical circumstances and resources. In this review, we assess the role and limitations of CIGs by examining the current status of CIGs in developed countries, and also describe the specific efforts made to establish CIGs in Korea.

Justifying molecular images in cell biology textbooks: From constructions to primary data

For scientific claims to be reliable and productive they have to be justified. However, on the one hand little is known on what justification precisely means to scientists, and on the other the position held by philosophers of science on what it entails is rather limited; for justifications customarily refer to the written form (textual expressions) of scientific claims, leaving aside images, which, as many cases from the history of science show are relevant to this process. The fact that images can visually express scientific claims independently from text, plus their vast variety and origins, requires an assessment of the way they are currently justified and in turn used as sources to justify scientific claims in the case of particular scientific fields. Similarly, in view of the different nature of images, analysis is required to determine on what side of the philosophical distinction between data and phenomena these different kinds of images fall. This paper historicizes and documents a particular aspect of contemporary life sciences research: the use of the molecular image as vehicle of knowledge production in cell studies, a field that has undergone a significant shift in visual expressions from the early 1980s onwards. Focussing on textbooks as sources that have been overlooked in the historiography of contemporary biomedicine, the aim is to explore (1) whether the shift of cell studies, entailing a superseding of the optical image traditionally conceptualised as primary data, by the molecular image, corresponds with a shift of justificatory practices, and (2) to assess the role of the molecular image as primary data. This paper also explores the dual role of images as teaching resources and as resources for the construction of knowledge in cell studies especially in its relation to discovery and justification. Finally, this paper seeks to stimulate reflection on what kind of archival resources could benefit the work of present and future epistemic historians in particular those interested on the role of images as sources of training and knowledge production in scientific disciplines.

General Principles of Radiation Protection in Fields of Diagnostic Medical Exposure

After the rapid development of medical equipment including CT or PET-CT, radiation doses from medical exposure are now the largest source of man-made radiation exposure. General principles of radiation protection from the hazard of ionizing radiation are summarized as three key words; justification, optimization, and dose limit. Because medical exposure of radiation has unique considerations, diagnostic reference level is generally used as a reference value, instead of dose limits. In Korea, medical radiation exposure has increased rapidly. For medical radiation exposure control, Korea has two separate control systems. Regulation is essential to control medical radiation exposure. Physicians and radiologists must be aware of the radiation risks and benefits associated with medical exposure, and understand and implement the principles of radiation protection for patients. The education of the referring physicians and radiologists is also important.

Patient Dose Management: Focus on Practical Actions

Medical radiation is a very important part of modern medicine, and should be only used when needed and optimized. Justification and optimization of radiation examinations must be performed. The first step of reduction of medical exposure is to know the radiation dose in currently performed examinations. This review covers radiation units, how various imaging modalities report dose, and the current status of radiation dose reports and legislation. Also, practical tips that can be applied to clinical practice are introduced. Afterwards, the importance of radiology exposure related education is emphasized and the current status of education for medical personal and the public is explained, and appropriate education strategies are suggested. Commonly asked radiation dose related example questions and answers are provided in detail to allow medical personnel to answer patients. Lastly, we talk about computerized programs that can be used in medical facilities for managing patient dose. While patient dose monitoring and management should be used to decrease and optimize overall radiation dose, it should not be used to assess individual cancer risk. One must always remember that medically justified examinations should always be performed, and unneeded examinations should be avoided in the first place.

Referral criteria and clinical decision support: radiological protection aspects for justification

Advanced imaging technology has opened new horizons for medical diagnostics and improved patient care. However, many procedures are unjustified and do not provide a net benefit. An area of particular concern is the unnecessary use of radiation when clinical evaluation or other imaging modalities could provide an accurate diagnosis. Referral criteria for medical imaging are consensus statements based on the best-available evidence to assist the decision-making process when choosing the best imaging procedure for a given patient. Although they are advisory rather than compulsory, physicians should have good reasons for deviation from these criteria. Voluntary use of referral criteria has shown limited success compared with integration into clinical decision support systems. These systems support good medical practice, can improve health service delivery, and foster safer, more efficient, fair, cost-effective care, thus contributing to the strengthening of health systems. Justification of procedures and optimisation of protection, the two pillars of radiological protection in health care, are implicit in the notion of good medical practice. However, some health professionals are not familiar with these principles, and have low awareness of radiological protection aspects of justification. A stronger collaboration between radiation protection and healthcare communities could contribute to improve the radiation protection culture in medical practice.