Awareness of the Bonn Call for Action

Radiation Protection and Safety in Canada: Awareness of the Bonn Call for Action

Andra Morrison, Program Development Officer, CADTH; Dr. Sandor Demeter, Nuclear Medicine, Health Sciences Centre, Winnipeg; Dr. David Koff, Chair Department Radiology, McMaster University, Ontario.


The increased use of radiation for diagnostic purposes has raised potential health concerns for patients and medical staff.  Most of the emphasis on radiation protection is focused on CT exams.1This is partly because CT accounts for the majority of total radiation received by patients from any imaging modality2but also because the use of CT in Canada continues to rise, with new data suggesting that the number of exams conducted in Canada over the last 10 years has increased by 75%.3

In 2017, Canada Safe Imaging in collaboration with CADTH conducted a pan-Canadian survey to determine awareness and implementation of the Bonn Call for Action recommendations amongst the radiation safety community. The Bonn Call for Action is defined by ten priorities for promoting radiation protection, including optimizing equipment, quality assurance and protocols, and justification to ensure the best test is chosen for the patient’s specific clinical scenario.


A 12 question survey asked Canadian health professionals working in radiation safety to report on the extent to which the 10 Bonn Call for Action priorities have been implemented in their jurisdictions. As well, for each priority, survey responders were invited to provide feedback on: initiatives that promote compliance; policy and practice issues that impact the application of the priorities; actions to help harmonize radiation protection activities across Canada; and ideas to support the priorities in the future.


Overall, 33 participants across Canada agreed to share information on their knowledge of the Bonn Call for Action and related initiatives in Canada. Of these, 9 declared an awareness of the Bonn Call for Action, 14 were not aware and 10 provided no answer to the question (see figure 1). Many survey respondents reported initiatives in Canada intended to address radiation protection that align with Bonn Call for Action priorities. For example, for Action 3 (strengthening manufacturer’s role in contributing to the overall safety regime) 8 survey respondents reported fully implementing activities around the sub-action pertaining to reinforcing conformance to applicable standards of equipment regarding performance, safety and dose parameters. Similarly, for Action 7 (improving prevention of medical radiation incidents and accidents) 8 respondents reported that they had fully implemented activities related to the sub-action of implementing and supporting voluntary educational safety reporting systems for the purpose of learning from the return of experience of safety related events in medical uses of radiation.

Some common themes that emerged included the role of industry and government in supporting radiation protection practices, the importance of education and training, and the need for stakeholder engagement and collaboration amongst the medical imaging community. As well, numerous survey respondents were supportive of federal oversight of radiation protection, especially with regard to provincial adherence to Health Canada’s Safety Code 35.


While there are numerous initiatives aimed at radiation protection and safety at the federal, provincial, and local level, it is still a challenge in Canada. Not all initiatives are implemented, and adherence may vary from province to province, facility to facility, and in some instances from department to department. There was general agreement that more could be done to support radiation protection and safety for patients and workers in Canada.

For the full report, please see: