Radiation Dose Monitoring: Watching Ourselves as We Watch Our Kids. Donald Frush, MD No Disclosures

Transcription

1 Radiation Dose Monitoring: Watching Ourselves as We Watch Our Kids Donald Frush, MD No Disclosures 1

2 Radiation Dose Monitoring: Watching Ourselves as We Watch Our Kids 8:00-8:15 a.m. Into Oz: Follow the Yellow Brick Rad Donald P. Frush, MD, FACR 8:15-8:55 a.m. ABCs of Dose Metrics for Dose Monitoring Samuel L. Brady, MD, PhD Keith J. Strauss, MSc, FACR 8:55-9:25 a.m. A Walk Through the Market Sarah McKenney, PhD, DABR 9:25-9:40 a.m. Dose Metrics in the Patient Report: Myopic or Foresighted? Beverley Newman, MD, FACR

3 Radiation Dose Monitoring: Watching Ourselves as We Watch Our Kids 10:10-10:50 a.m. Navigating Dose Monitoring: Panel Discussion Panelists: Donald P. Frush, MD, FACR R. Paul Guillermann, MD Ehsan Samei, PhD, DABR, FAAPM, FSPIE Keith J. Strauss, MSc, FACR Beverley Newman, MD, FACR Samuel L. Brady, MS, PhD Sarah McKenney, PhD, DABR

4 Radiation Dose Monitoring: Watching Ourselves as We Watch Our Kids 10:50-11:20 a.m. Into the Mist? Future Opportunities and Challenges R. Paul Guillerman, MD Ehsan Samei, PhD, DABR, FAAPM, FSPIE 11:20-11:50 a.m. Concluding Statements and Audience Q&A

5 Background Why we are here Stewardship for what we do International drivers National drivers Considerations for our walk

6 Imaging Examination Radiation 0.2% of enrollees >20 msv Fazel 2009 NEJM 361 SAH: mean dose 12.8 Gy (max 36.1 Gy) Moskowitz 2010 Am J Neuroradiol 31 Other investigations: Chronic illness (Stein 2010 JACR 7 ) Emergency setting (Griffey and Sodickson 2009 AJR 192) Pediatric cardiology (Ait-Ali 2010 Heart 96) Oncology: max 642 msv (Ahmed 2010 Pediatrics 126)

7 Imaging Radiation Safety Continues to be a public concern Continues to be misunderstood/debated We have not been successful stewards Dose monitoring Growing international efforts EuroSafe, AfroSafe, Canada Safe Imaging, Japan Safe Imaging Safe LatinSafe, ArabSafe

8 September 11 th, 2011 I am contacting you to ask about the radiation exposure my son has had when having a CT angiogram Can I make the radiation exposure request or does his physician need to? Here is my son s information and the date of his CT angiogram. I am wanting to get his radiation exposure in a file for his health history. Thank you for your time.

9 January 20 th, 2012

10 al%20imaging%20history.pdf

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12 If we don t control this, someone will for us We have a responsibility to know individual and cumulative (CT) dose, and what this does or doesn t signify patients colleagues regulatory organizations

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15 Some US Efforts (CT) The Joint Commission NEMA FDA EPA CMS State law(s) Registries (for benchmarking performance)

16 In July 2015, TJC mandated that: 1. The [hospital/practice] documents the radiation dose (CTDI vol or DLP) on every study produced during a computed tomography (CT) examination. The radiation dose must be exam specific, summarized by series or anatomic area, and documented in a retrievable format., and 2. The [hospital/practice] reviews and analyzes incidents where the radiation dose (CTDI vol or DLP) emitted by the computed tomography (CT) imaging system during diagnostic CT exams exceeded expected dose ranges identified in imaging protocols.

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18 NEMA Standard Attributes on CT Equipment Related to Dose Optimization and Management (XR-29) DICOM structured dose reporting, A CT Dose Check feature for dose alerts and notifications, Automatic Exposure Control (AEC) to help manage radiation dose and image quality, and Reference Adult and Pediatric Protocols pre-loaded Not Meeting Guidelines: January 2016: 5% reimbursement reduction January 2017: 15% reimbursement reduction

19 CT: pages updated the interpretive guidelines for the hospital Conditions of Participation (CoPs) for the below to reflect current accepted standards of practice

20 Diagnostic Reference Levels and Achievable Doses DRL: ICRP 1990, 1996 An optimization tool Are not for regulatory or commercial purposes, not a dose restraint and not linked to limits or constraints 75% of dose survey from broad base e.g., country or region Achievable Dose (AD): 1999 United Kingdom National Radiation Protection Board NCRP 2012: ADs set at the median (50th percentile) of dose distribution half higher, half lower

21 Representation by a variety of facilities nationwide Courtesy: Mythreyi Chatfield, PhD Debapriya Sengupta, MBBS, MPH Lu Meyer, MS Victoria O Brien, BS 21 21

22 22 For each exam, facility data are compared to that of similar facilities.

23 As We Walk, for Consideration All ionizing radiation modalities All users of this equipment (Changing) Dose metrics Meaning of cumulative dose Big data Benchmarks reference ranges vs levels Dose alone as measure of performance

24 References EPA: httpwww.epa.govradiationfederalfgr-14.html CMS: Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and- Regions-Items/Survey-and-Cert-Letter html?DLPage=4&DLEntries=10&DLSort=3&DLSortDir=descending NEMA XR-29 and HR 4302: 113hr4302enr/pdf/BILLS-113hr4302enr.pdfDf NEMA XR-29 and HR 4302 (from ACR): 20Safety/XR29%20FAQs_91015.pdf Harvey HB, Pandharipande PV. The federal government s oversight of CT safety: regulatory possibilities. Radiology 2012; 262(2): The Joint Commission: ging_services_requirements/