FEA­TURES Ef­forts amp up to re­duce ra­di­a­tion ex­po­sure

Modern Healthcare - - MODERN HEALTHCARE -

Sev­eral years ago, a physi­cian at Scripps Health launched a pi­lot pro­gram that used a pa­tient’s body mass in­dex to mea­sure dose for a com­puted to­mog­ra­phy scan.

Us­ing BMI to com­pute dose re­duces the pa­tient’s ra­di­a­tion dose by up to 50% and is one method the San Diego-based health sys­tem is us­ing to cut the ra­di­a­tion dose from CT scans, ac­cord­ing to Dr. John John­son, chief of CT imag­ing at Scripps Mercy Hos­pi­tal, a 439-bed fa­cil­ity that is part of the Scripps Health sys­tem.

“One strat­egy is to re-en­gi­neer all of the CT pro­to­cols from stan­dard pro­to­cols to low­dose pro­to­cols,” he says.

A grow­ing aware­ness about the risks of di­ag­nos­tic imag­ing, in par­tic­u­lar with CT, in re­cent years has gen­er­ated dis­cus­sion among hos­pi­tal ex­ec­u­tives, ra­di­ol­o­gists, man­u­fac­tur­ers, govern­ment agen­cies and pa­tients about over­all use of CT scans in the U.S.

John­son says two years ago, it would have been dif­fi­cult to lo­cate a med­i­cal jour­nal ar­ti­cle that ad­dressed ra­di­a­tion risk re­duc­tion. Last year, the Food and Drug Ad­min­is­tra­tion held a hear­ing and an­nounced the re­sults of an in­ves­ti­ga­tion in re­ported ra­di­a­tion over­doses that oc­curred from 2008 to Oc­to­ber 2010 at hos­pi­tals in Cal­i­for­nia and Alabama. The agency and the Cen­ters for Dis­ease Con­trol and Pre­ven­tion

Ef­forts to re­duce ra­di­a­tion ex­po­sure in­crease as aware­ness grows

later re­leased re­ports about di­ag­nos­tic imag­ing.

More re­cently, the Joint Com­mis­sion is­sued a Sen­tinel Event alert that noted the U.S. pop­u­la­tion’s to­tal ex­po­sure to ion­iz­ing ra­di­a­tion has al­most dou­bled in the past 20 years and rec­om­mended new ac­tions for hos­pi­tals.

In Cal­i­for­nia, where 260 pa­tients at CedarsSi­nai Med­i­cal Cen­ter in Los An­ge­les were ex­posed to ra­di­a­tion doses that were about eight times the ex­pected level dur­ing a nearly twoyear pe­riod, the first phase of a law that re­quires providers to record CT ra­di­a­tion doses and re­ceive state ac­cred­i­ta­tion goes into ef­fect Jan. 1. The pa­tients had been un­der­go­ing CT brain per­fu­sion scans.

“It’s not just mak­ing sure that it’s the right amount, but whether that test is nec­es­sary, that num­ber of tests is nec­es­sary, and whether there are al­ter­na­tive meth­ods,” says Dr. Robert Wise, med­i­cal ad­viser to the divi­sion of health­care qual­ity eval­u­a­tion at the Joint Com­mis­sion.

The Joint Com­mis­sion alert, is­sued in Au­gust, made a num­ber of rec­om­men­da­tions for providers. They in­clude: us­ing ul­tra­sound or MRI when sim­i­lar imag­ing qual­ity can be pro- duced; ad­here to guide­lines set by the Nu­clear Reg­u­la­tory Com­mis­sion, the So­ci­ety for Pe­di­atric Ra­di­ol­ogy, the Amer­i­can Col­lege of Ra­di­ol­ogy and the Ra­di­o­log­i­cal So­ci­ety of North Amer­ica; en­sur­ing the proper dos­ing pro­to­col is in place; es­tab­lish­ing ef­fec­tive pro­cesses and pro­to­cols; eval­u­at­ing the safety of equip­ment; and es­tab­lish­ing a cul­ture of safety and ex­pand­ing the ra­di­a­tion safety of­fi­cer’s role to in­clude pa­tient safety and ed­u­ca­tion of dos­ing and equip­ment us­age for physi­cians and tech­nol­o­gists.

The com­mis­sion also said in the alert that it en­dorses the cre­ation of a national registry that tracks ra­di­a­tion doses, such as the one es­tab­lished by the ACR ear­lier this year; en­cour­ages man­u­fac­tur­ers to im­ple­ment dose safe­guards into equip­ment; and sup­ports reg­u­la­tions that elim­i­nate avoid­able imag­ing and mon­i­tor ap­pro­pri­ate use of self-re­fer­rals.

The ACR, which has of­fered a CT ac­cred­i­ta­tion pro­gram since 2002, launched its national dose registry in May.

As of Oct. 31, 164 out­pa­tient and in­pa­tient fa­cil­i­ties have en­rolled in the registry and more than 300,000 ex­ams have been reg­is­tered, says Pamela Wil­cox, the ACR’S as­sis­tant ex­ec­u­tive di­rec­tor of qual­ity and safety. The Dose In­dex Registry gath­ers anonymized dose in­for­ma­tion from CT scans, al­low­ing fa­cil­i­ties to com­pare their CT dosage with other sites and national bench­marks.

The registry “helps imag­ing providers gauge

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