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Business: 908-788-9440 Cell/Text: 845-849-8336. Presented by: Thomas J. LaRocca , M.S., D.A.B.R. Medical Physicist [email protected] Issue 47, August 24, 2011  Radiation risks of diagnostic imaging.

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business 908 788 9440 cell text 845 849 8336
Business: 908-788-9440

Cell/Text: 845-849-8336

Presented by:

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

Medical Physicist

[email protected]

issue 47 august 24 2011 radiation risks of diagnostic imaging
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
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
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
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
RIGHT TEST
  • Other imaging modalities
    • ultrasound, MRI
    • Pediatric appendicitis
  • Radiologist guidance
    • ACR Web Site
    • Appropriateness criteria
    • CT with/without contrast ??
right dose keeping doses a l a r a
RIGHT DOSEKeeping doses A.L.A.R.A.

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

right dose existing dose monitoring
RIGHT DOSEExisting 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
RIGHT DOSEReference Doses
  • Provide physicians & technologists with references doses;
  • Establish appropriate dose ranges.
  • Bariatrics, CCL, IR ??
right dose
RIGHT DOSE
  • 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 dose1
RIGHT DOSE

BODY SCAN

HEAD SCAN

effective process
EFFECTIVE PROCESS
  • Establish Policies & Procedures:
    • Password protected protocols;
    • Risk reduction – gonad and bismuth CT shields;
    • RSO involvement;
    • Patient Safety Committee;
    • Radiation reduction education for hospital staff
safe technology
SAFE TECHNOLOGY
  • 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
safety culture
SAFETY CULTURE
  • JCAHO standards support safe & effective diagnostic Imaging;
  • National registry to track radiation dose;
  • Monitoring appropriateness of self referred imaging studies.
safety culture total effective dose
SAFETY CULTURETotal “Effective” dose
  • 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 culture1
SAFETY CULTURE
  • 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.
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