Clinical examples of different scenarios | Conventional radiology referral for CT scan | “Mixed” involvement in PCI (physician refers a patient to a cardiologist; a non-interventional cardiologist refers a patient to an interventional radiologist) | “Pure” cardiological involvement in PCI (patient referred directly to an interventional cardiologist who also performs the procedure) |
Duty holder | |||
Referrer | Normally a referring clinician. This person need not have any knowledge of radiation protection but must impart sufficient clinical information to the practitioner to permit proper assessment of the risks and benefits of the proposed examination. | A cardiologist or physician who refers a patient to a specialist in PCI, providing sufficient clinical information for the specialist to judge that PCI is indicated. | The clinical cardiologist who clinically assesses a patient themselves and decides they require PCI. |
Practitioner | Normally a radiologist. This individual must understand fully the radiation risks of the procedure and the potential benefits and will justify the examination. | The specialist, usually a cardiologist, who justifies the PCI and usually performs the clinical and catheter related aspects of the procedure, having evaluated the risks and benefits of the procedure, including those related to radiation exposure. | The same cardiologist who lists his patient for a PCI procedure, having evaluated the risks and benefits of the procedure, including those related to radiation exposure (justifying the exposure). |
Operator | This would typically be a radiographer who was fully trained in operating the equipment and as such would understand the means of optimising diagnostic quality while minimising patient radiation dose. The individual would authorise the exposure. | This would often be the cardiological specialist (authorising the exposure, operating the angiographic equipment, including the adjustment of the equipment and the initiation of exposures), but might be a radiographer assisting the PCI specialist by operating the equipment. | The same cardiologist who operates the angiographic unit during the procedure, including the adjustment of the equipment and has authorised the exposure. |
CT, computed tomographic; PCI percutaneous coronary intervention.