by
Loren Bonner, DOTmed News Online Editor | August 29, 2013
Rosemary Gibson is national leader in health care quality and safety. She recently spoke at the American Board of Radiology Foundation's National Summit about patient safety and imaging. DOTmed News asked her to share her thoughts on why it's important to bring more attention to this subject.
DMN: Why are we only now, in more recent years, beginning to finally open up the discussion on patient safety and imaging?
RG: Evidence is emerging in the medical literature and Medicare data about the need for more appropriate diagnostic imaging. It is part of an important dialogue taking place about overuse in medicine.
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For example, studies report unwarranted variation in radiation dose for the same imaging study or clinical indication. Patients may be exposed to risk from unnecessary radiation.
Also, Hospital Compare data show that many hospitals continue to perform double chest CT scans. These occur when a person has a CT scan and then another CT scan with a contrast agent. Patients should have one scan, not two, because the two tests expose them to more radiation and won't necessarily give additional diagnostic information. This is an example of overuse of diagnostic imaging.
DMN: Why is this an important discussion to be having?
RG: Overuse of diagnostic imaging yields no benefit to patients. It can cause more harm than good if incidental findings beget more testing that finds nothing, while exposing patients to risks and the potential for complications. This is the primary reason to be having this discussion.
Also, as a society, we can't afford to keep doing what we are doing, whether it is unnecessary surgery, tests, procedures, or drugs. Many health insurance plans now have high deductibles, which require people to pay even more out-of-pocket.
DMN: What's your background and experience with patient safety as it relates to imaging?
RG: I did a deep dive on patient safety when I wrote Wall of Silence, the first book to tell the human story of medical errors, while at the Robert Wood Johnson Foundation. It became clear that errors in medicine too often occur when medically inappropriate tests and treatment are provided. So next, I wrote about overuse in
The Treatment Trap and one of the chapters is on diagnostic imaging. The American mind has been marinated to believe that more testing, more doing, is better. It isn't so. Overuse is a patient safety issue.
DMN: What are some of the main patient safety issues with imaging? Which events stand out to you in particular?
Archil Kapanadze
Human oriented concept of Radiation Safety
August 30, 2013 11:31
Human oriented concept of Radiation Safety
Archil Kapanadze,
Alla Zedginidze
The corner stone of contemporary radiation safety is ALARA (As Low As Rationally Available) principle.
Dosimetry is a base of radiation safety. The main methods of it are Physical dosimetry methods. But this methods gives as only extrapolation knowledge about absorbed by Human organism dose and the biological effects of it. In contrast, biodosimetry methods give us opportunity to register the real biological damage to organism caused by ionizing radiation.
Until now, biodosimetry is assumed as Nuclear incident or technogenic disaster method. But development of these methods allows us to broaden area of their implementation.
Biodosimetry (cyto-genetic methods) became very important in case of irradiation of Human organism by small doses of radiation when we have not clinical manifestation but mutagenic effect of radiation is significant and increase the risk of different diseases including cancer.
Scientific knowledge about effect of small doses of ionizing radiation on Human organism became more and more important because of dramatic increase of implementation of it in medicine (CT, interventional radiology, nuclear medicine etc.). This causes the increase of population dose and needs the maintenance. There are proposed several methods of control of absorbed by Human organism doses during medical procedures: harden the indications for procedures, increase of sensitivity of equipment etc.
One of the good organizational method is to create the patients dose registry. We propose to include biodosimetry methods in this technological process. After reaching some cumulative, calculated, dose patient goes to biodosimetry (cyto-genetic methods). This will help doctor to correctly assess the real biological impact of ionizing radiation and administer medical management of this condition. After two or three months repeat of biodosimetry (cyto-genetic methods) will show doctor the results of medical management. This procedure can be founded by insurance.
Above presented reasoning allow us to conclude that contemporary concept of radiation safety is environment oriented concept of disasters.
To date the main source of irradiation for population is not a disasters, but everyday irradiation: increase of radioactive background, increase of occupational irradiation, dramatic increase of medical irradiation etc.
For this reason we want to propose
Human oriented concept of radiation safety where the cyto-genetic methods of biodosimetry will be implemented not for calculation of absorbed dose, but if we will detect any mutagenic effect it must be considered as a clinical situation and need to be medically managed.
The technology scheme of this concept can be the same:
1. assessment of risks;
2. definition of risk-groups in the elevated risk regions;
3. assessment of real biological (mutagenic effect) damage by cyto-genetic methods among individuals in risk-groups;
4. medical management of assessed mutagenic damage;
5. monitoring in time of results of medical management.
To perform this technological scheme needs:
1. prepare the stuff (basic and continuing education);
2. appropriated equipment;
3. specialized institution;
4. working founding mechanisms.
Also, very important to educate medical stuff and population in radiation safety.
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