Business: 908-788-9440 Cell/Text: 845-849-8336

1. Business: 908-788-9440 Cell/Text: 845-849-8336 Presented by: Thomas J. LaRocca, M.S., D.A.B.R. Medical Physicist tlarocca@biomedphysics.com

2. 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%

3. 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

4. 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)

5. 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.

6. RIGHT TEST • Other imaging modalities • ultrasound, MRI • Pediatric appendicitis • Radiologist guidance • ACR Web Site • Appropriateness criteria • CT with/without contrast ??

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

8. ACR: Radiation Dose Rating System

9. RIGHT DOSEKeeping doses A.L.A.R.A. Keeping doses A.L.A.R.A.

10. 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

11. RIGHT DOSEReference Doses • Provide physicians & technologists with references doses; • Establish appropriate dose ranges. • Bariatrics, CCL, IR ??

12. 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).

13. RIGHT DOSE BODY SCAN HEAD SCAN

14. 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

15. 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

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

17. SAFETY CULTUREVendor captured patient dosimetry GE CT Scanner

18. SAFETY CULTUREVendor captured patient dosimetry OEC Mobile C-Arm

19. SAFETY CULTUREVendor captured patient dosimetry InterventionalRadiology

20. SAFETY CULTUREVendor captured patient dosimetry Cardiac Catherization Lab

21. SAFETY CULTUREVendor captured patient dosimetry Digital Radiography

22. 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

23. 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.

24. The End