by
Loren Bonner, DOTmed News Online Editor | August 29, 2013
RG: I gave grand rounds at a hospital on the East Coast and an internist candidly talked about a woman who kept coming to the ED complaining of abdominal pain. Each time, she got a CT scan and the results were always inconclusive. Her pain never went away so she kept coming back. After more than 2 years, she had had more than a dozen abdominal CT scans in the same ER. No one noticed. Finally, when the internist saw her for the first time, he checked and counted all the scans that had been done. He diagnosed her correctly as having lead poisoning with a simple blood test.
Diagnostic imaging is no substitute for clinical assessment skills, a competently-performed physical exam, and good clinical judgment. Often, CT scans are ordered before a physician examines a patient.
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I remember a seasoned hospice physician tell how the first inclination of palliative care fellows who came to train at his hospice was to order a CT scan on dying patients. The seasoned physician had to turn off the default button and ask, "So how will the test results change how you care for this patient?" With all the technology at our disposal, it is too easy to lose sight of how to use it so it truly benefits patients.
How do you think these patient safety risks for imaging can best be prevented?
RG: A first step is for hospitals to routinely identify "outlier" cases where repeat patients in the ED have an inordinate number of diagnostic imaging tests.
To prevent double chest CT scans, facilities can institute a "hard stop" when a physician orders a double scan. It would have to be approved before it can be performed.
Hospitals need to ensure that children are given "child size" radiation exposure rather than "adult size."
DMN: How have campaigns like Image Gently, Image Wisely and Choosing Wisely been helping this effort?
RG: These campaigns have raised awareness about the need to reduce unnecessary imaging and ensure that children receive the right level of radiation exposure. Pediatric specialty hospitals have had success in reducing CT volume. Image Wisely is focused on radiation exposure in adults. For Choosing Wisely, the American College of Radiology identified common clinical scenarios where imaging is overused, such as CT scans for uncomplicated headaches.
DMN: The American Board of Radiology Foundation has been working on a national strategy for safe and appropriate medical imaging. How is this coming along and what do you think any plan should look like?
RG: The Foundation has held a series of conferences to develop the strategy and it has attracted thoughtful people who want to improve patient care. One of the challenges is embedding continuous quality improvement — and the knowledge to undertake it — in the day-to-day work. Professionalism requires not only doing the work but improving it.
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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