business: 908-788-9440 cell/text: 845-849-8336 presented by: thomas j. larocca, m.s., d.a.b.r....

Business: 908-788-9440

Cell/Text: 845-849-8336

Presented by:

Thomas J. LaRocca, M.S., D.A.B.R.

Medical Physicisttlarocca@biomedphysics.com

ISSUE 47, AUGUST 24, 2011  RADIATION RISKS OF DIAGNOSTIC

IMAGING

From the 72 million CT scans performed in the U.S. during 2007, one study estimated that 29,000 future cancers and 14,500 future deaths could develop due to radiation (cancer) = 0.04%

PUBLIC PRESS

Feb 10, 2010

FDA addresses radiation safetyThe agency aims to protect patients from unnecessary exposure…

June 17, 2011

Medicare Claims Show Overuse for CT Scanning

JCAHO RECOMMENDED 21 ACTIONS:

Right Test (1-2)Right Dose (3-9)Effective Process (10-13)Safe Technology (14-17)Safety Culture (18)National Dose Registry (19-20)Monitoring of self-referral imaging

studies (21)

DEVELOP AN ACTION PLAN … ASSEMBLE A TEAM …

Administrators, radiologists, physicists, nursing, technologists, ect.

Diagnostic Imaging, Emergency Dept, Cardiology, Operating Room, Nursing, ect.

Review JCAHO 21 recommended actions.

Assign responsibilities;Short term & long term goals.

RIGHT TEST

Other imaging modalitiesultrasound, MRIPediatric appendicitis

Radiologist guidanceACR Web SiteAppropriateness criteriaCT with/without contrast ??

ACR Search Engine: http://acsearch.acr.org/Example: Low Back Pain

ACR: RADIATION DOSE RATING SYSTEM

RIGHT DOSEKEEPING DOSES A.L.A.R.A.

Keeping doses A.L.A.R.A.

RIGHT DOSEEXISTING DOSE MONITORING

NYSDOH:X-Ray Skin Entrance Dose

Fluoroscopy Dose Rate (R/min)

Record Fluoro timeRepeat Analysis, CT?

ACR:Mammography AGDCT Dosimetry Analysis

RIGHT DOSEREFERENCE DOSES

Provide physicians & technologists with references doses;

Establish appropriate dose ranges.

Bariatrics, CCL, IR ??

AAPM maximum ALERT values 50 mGy for CT Abdomen/Pelvis (Torso).

ACR / NYSDOH upper dose range for CT Head, Abdomen exams.

Radiologist dictation of cumulative DLP on patient reports (CA).

RIGHT DOSE

RIGHT DOSE

HEAD SCANBODY SCAN

CT Exam  NYS & ACR Dose Limits

Adult Head 80.0 mGy Pediatric Abdomen

25.0 mGy

Adult Abdomen 30.0 mGy

Establish Policies & Procedures:• Password protected

protocols;• Risk reduction – gonad and

bismuth CT shields;• RSO involvement;• Patient Safety Committee;• Radiation reduction

education for hospital staff

EFFECTIVE PROCESS

Medical Physics QC testing;

RT routine quality control

Departmental audits; Engineering PM’s; Dose Reduction

technology:• CT “Auto or Smart MA”• Fluoro “Low/Pulse” mode

SAFE TECHNOLOGY

JCAHO standards support safe & effective diagnostic Imaging;

National registry to track radiation dose;

Monitoring appropriateness of self referred imaging studies.

SAFETY CULTURE

GE CT Scanner

SAFETY CULTUREVENDOR CAPTURED PATIENT DOSIMETRY

OEC Mobile C-Arm

SAFETY CULTUREVENDOR CAPTURED PATIENT DOSIMETRY

SAFETY CULTUREVENDOR CAPTURED PATIENT DOSIMETRY

Interventional Radiology

SAFETY CULTUREVENDOR CAPTURED PATIENT DOSIMETRY

Cardiac Catherization Lab

SAFETY CULTUREVENDOR CAPTURED PATIENT DOSIMETRY

Digital Radiography

Bone Scan & CT Scan Abdomen/Pelvis• 20 mCi (740 MBq) for Bone Scan:

• Effective dose: 0.008 mSv/MBq • 740 MBq = 5.92 mSv (592 mrem)

• Total CT Dose: DLP = 1038 mGy-cm• Normalized Effective Dose Factor = 0.018• 1038 x 0.018 = 18.68 mSv (1868 mrem)

Total Effective Dose = 5.92 + 18.68 = 24.6 mSv

SAFETY CULTURETOTAL “EFFECTIVE” DOSE

How much is too much?• EPA threshold dose (750 mSv) for skin

erythema and hair epilation.• Earlier noted risks of

cancer incidence. Alert Physicians of

total dose prior to ordering x-ray exam.

SAFETY CULTURE

THE END