AHRA: Dose safety improves care, boosts value

WASHINGTON, D.C.—Radiation dose safety presents an outstanding opportunity for radiologists to add value and assert their role in the care continuum, according to a pair of presentations at the annual meeting of AHRA.

During the first presentation, Chris Tomlinson, MBA, administrative director of radiology at the Children's Hospital of Philadelphia (CHOP), described his organization’s experiences in creating a pediatric radiation safety initiative. One issue was the general public doesn’t quite understand the risk, but that doesn’t stop them from being concerned, as was evidenced by focus groups conducted by CHOP.

“What came back from the focus groups was ‘dose, dose, dose,’” said Tomlinson. “That’s what moms, dads, everyone was looking at.”

Shawn McKenzie, MPA, president and CEO of Ascendian Healthcare Consulting, who also spoke, added that the media doesn’t help and often sensationalizes the radiation risk of even a single CT scan.

A strong radiation dose safety program can provide better care for patients and, if marketed properly, can calm the fears of the public while serving as a differentiator for providers.

Tomlinson and McKenzie broke down the components of a radiation safety program, including:

  • Radiation safety committee – Team should include stakeholders from radiology, IT, risk management/legal, the C-suite level, and a medical physicist.
  • Optimized workflows – Providers must understand upstream workflows to a micro level, including all the providers involved.
  • Protocols – Multiple phantoms should be used to better reflect variation in patient size. There is a need to make sure protocols haven’t been modified erroneously, and automated software can help to manage protocols and provide surveillance.
  • Automated dose management solutions – Various software tools exist to help optimized workflow, provide dose data across the enterprise, and perform advanced phantom modeling.
  • Policies and procedures – Policies should be reviewed and updated by the committee annually, and have detailed risk management steps along with tactics for communicating with patients.
  • Risk management and legal – A provider’s risk management and legal team needs to be involved to share their concerns, and it won’t always be about dose itself. With radiation getting such a high profile in the media, some worry that scans won’t be ordered out of dose fears. “It can’t get in the way of medicine, bottom line,” said McKenzie.
  • Outreach – In addition to educating patients, radiologists can reach out to referring physicians to make sure they are up to date on the latest technology and guidelines. This outreach can even extend to other providers in the community, said Tomlinson. “When we do see [pediatric studies] being done at greater than the ACR [dose] limits for adults, that becomes a concern. We’re not in the business of telling other hospitals what to do, but we do spend time calling those hospitals and offering our services.”

McKenzie was joined by Neomi Mullens, project manager for Ascendian Healthcare Consulting, for a second presentation, which included a look at radiation dose legislation at the state level. California’s law, which took effect in July 2012, focused on CT dose management, incident reporting and dictating dose values in the final report. However, the law had gaps and lacked clear definitions. Texas then refined the ideas in the California law and added fluoroscopy and radiation safety committees to the mix.

A similar law is awaiting hearing in the Connecticut house, and policymakers in all states are looking at the initial regulations from California and Texas, according to McKenzie and Mullens.