business: 908-788-9440 cell/text: 845-849-8336 presented by: thomas j. larocca, m.s., d.a.b.r....
TRANSCRIPT
Business: 908-788-9440
Cell/Text: 845-849-8336
Presented by:
Thomas J. LaRocca, M.S., D.A.B.R.
Medical [email protected]
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