[Radioprotection and medical practice: progress, distress and treats]

Radiological protection belongs for a long time to the concerns of radiotherapists and, more recently, of specialists in nuclear medicine. Those practitioners are generally aware of the risks arising from their activities--although this could not prevent recent series of incidents and accidents. This risk awareness is much lower among practitioners using X-rays for diagnostic purposes (including fluoroscopically guided procedures). Paradoxically, safety culture, based on justification and optimization, is clearly less common in the health care world, whatever the sector you consider, than in many industrial areas. As a consequence, the possibility of significant reductions in individual as well as collective doses is still considerable, and this is true for patients as well as for practitioners. This has been the starting point for the 2007 EU directive regarding medical exposures that was far-reaching in enforcing changes in the medical departments and, hopefully, in the safety culture. This article will discuss some of the key issues that are at stake in the development of this safety culture.