FEATURES Efforts amp up to reduce radiation exposure
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