Business: Cell/Text: Presented by: Thomas J. LaRocca, M.S., D.A.B.R. Medical Physicist

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 safety  The 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 modalities  ultrasound, MRI  Pediatric appendicitis  Radiologist guidance  ACR Web Site  Appropriateness criteria  CT with/without contrast ??

ACR Search Engine: Example: Low Back Pain

ACR: RADIATION DOSE RATING SYSTEM

RIGHT DOSE KEEPING DOSES A.L.A.R.A. Keeping doses A.L.A.R.A.

RIGHT DOSE EXISTING DOSE MONITORING  NYSDOH:  X-Ray Skin Entrance Dose  Fluoroscopy Dose Rate (R/min)  Record Fluoro time  Repeat Analysis, CT?  ACR:  Mammography AGD  CT Dosimetry Analysis

RIGHT DOSE REFERENCE DOSES l Provide physicians & technologists with references doses; l Establish appropriate dose ranges. l Bariatrics, CCL, IR ??

l AAPM maximum ALERT values 50 mGy for CT Abdomen/Pelvis (Torso). l ACR / NYSDOH upper dose range for CT Head, Abdomen exams. l Radiologist dictation of cumulative DLP on patient reports (CA). RIGHT DOSE

HEAD SCANBODY SCAN CT Exam NYS & ACR Dose Limits Adult Head80.0mGy Pediatric Abdomen25.0mGy Adult Abdomen30.0mGy

l 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

l Medical Physics QC testing; l RT routine quality control l Departmental audits; l Engineering PM’s; l Dose Reduction technology: CT “Auto or Smart MA” Fluoro “Low/Pulse” mode SAFE TECHNOLOGY

l JCAHO standards support safe & effective diagnostic Imaging; l National registry to track radiation dose; l Monitoring appropriateness of self referred imaging studies. SAFETY CULTURE

GE CT Scanner SAFETY CULTURE VENDOR CAPTURED PATIENT DOSIMETRY

OEC Mobile C-Arm SAFETY CULTURE VENDOR CAPTURED PATIENT DOSIMETRY

Interventional Radiology

SAFETY CULTURE VENDOR CAPTURED PATIENT DOSIMETRY Cardiac Catherization Lab

SAFETY CULTURE VENDOR CAPTURED PATIENT DOSIMETRY Digital Radiography

l Bone Scan & CT Scan Abdomen/Pelvis 20 mCi (740 MBq) for Bone Scan: Effective dose: mSv/MBq 740 MBq = 5.92 mSv (592 mrem) Total CT Dose: DLP = 1038 mGy-cm Normalized Effective Dose Factor = x = mSv (1868 mrem) Total Effective Dose = = 24.6 mSv SAFETY CULTURE TOTAL “EFFECTIVE” DOSE

l How much is too much? EPA threshold dose (750 mSv) for skin erythema and hair epilation. Earlier noted risks of cancer incidence. l Alert Physicians of total dose prior to ordering x-ray exam. SAFETY CULTURE

THE END