The Joint Commission issued a sentinel event alert Wednesday on diagnostic radiation in medical imaging, urging doctors to pay greater attention to the long-term hazards of repeated X-ray exposures.

"Diagnostic imaging is a necessary medical tool, but it must be used with great care," Dr. Mark R. Chassin, president of TJC, said in a statement.

In its alert, the Oak Park, Ill.-based health care accreditation group suggested a handful of strategies, such as swapping X-ray based scans for ultrasound or MRI, when appropriate, and adhering to dose-lowering guidelines put out by the American College of Radiology and other medical societies.
The alert comes as medical imaging use has grown rapidly over the past few decades, while a growing chorus of voices express worries about the potential harms of cumulative exams, especially from CT scans.

Specific recommendations from the commission include:

• Meeting ALARA -- "as low as reasonably achievable" -- recommendations for keeping dose low without sacrificing image quality.
• Following the ACR's Image Gently (for children) and Image Wisely (for adults) dose-awareness campaigns.
• Investing in new, dose-reducing equipment.

In addition, the group also took a stand on three positions. It said it supports a national dose registry to track patient radiation exposure, urges manufacturers to include dosage safeguards in new devices and it backs "stricter regulations" to monitor self-referred imaging studies.

A national dose registry for CT scans, the Dose Index Registry, was launched by the ACR in May at the society's annual meeting. Around 200 facilities are participating, the ACR said.

The alert was developed in part from discussions with the ECRI Institute, Institute for Healthcare Improvement and West Physics Consulting LLC, the commission said.

“Sentinel event” is the term TJC gives to unexpected occurrences at a hospital or clinic that risk, or lead to, death or serious injury. These include wrong-site errors, discharging an infant to the wrong family and even criminal attacks. As of June 30, nearly 5,400 such incidents had been voluntarily reported to TJC since 2004, according to a statistics sheet on the commission's website.

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