Transcript (JCAHO) Sentinel Event Alert - Bio-Med Associates Medical Physics

Presented by:
Business:
Thomas J. LaRocca, M.S., D.A.B.R.
908-788-9440
Medical Physicist
845-849-8336
[email protected]
Cell/Text:
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: http://acsearch.acr.org/
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



Provide physicians
& technologists
with references
doses;
Establish
appropriate dose
ranges.
Bariatrics, CCL, IR ??
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 DOSE
BODY SCAN
HEAD SCAN
CT Exam
NYS & ACR
Dose Limits
Adult Head
Pediatric Abdomen
Adult Abdomen
80.0
25.0
30.0
mGy
mGy
mGy
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





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
JCAHO standards support
safe & effective diagnostic
Imaging;
 National registry to track
radiation dose;
 Monitoring appropriateness of
self referred imaging studies.

SAFETY CULTURE
VENDOR CAPTURED PATIENT DOSIMETRY
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
SAFETY CULTURE
TOTAL “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 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.
THE END