Radiation protection and dose monitoring in medical imaging: A journey from awareness, through accountability, ability and action...but where will we arrive?

Journal of Patient Safety

Volumn 9, Issue 4, 2013, Pages 232-238

  Frush, Donald ^a   Denham, Charles R ^b   Goske, Marilyn J ^c   Brink, James A ^d   Morin, Richard L ^e   Mills, Thalia T ^f   Butler, Priscilla F ^g   McCollough, Cynthia ^h   Miller, Donald L ^f  

^a DUKE UNIVERSITY MEDICAL CENTER   (United States)

^b TMIT   (United States)

^c CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER   (United States)

^d MASSACHUSETTS GENERAL HOSPITAL   (United States)

^e MAYO CLINIC   (United States)

^f CENTER FOR DEVICES AND RADIOLOGICAL HEALTH   (United States)

^g AMERICAN COLLEGE OF RADIOLOGY   (United States)

^h MAYO CLINIC   (United States)

Author keywords

children; computedtomography; CT scan; image gently; radiation dose; radiation protection; radiation risk

Indexed keywords

ATTITUDE TO HEALTH; HUMAN; PATIENT SAFETY; PROCEDURES; RADIATION DOSE; RADIATION MONITORING; RADIATION PROTECTION; SOCIAL RESPONSIBILITY; STANDARDS; TRENDS; X-RAY COMPUTED TOMOGRAPHY;

HEALTH KNOWLEDGE, ATTITUDES, PRACTICE; HUMANS; PATIENT SAFETY; RADIATION DOSAGE; RADIATION MONITORING; RADIATION PROTECTION; SOCIAL RESPONSIBILITY; TOMOGRAPHY, X-RAY COMPUTED;

MLCS; MLOWN;

EID: 84889015174     PISSN: 15498417     EISSN: 15498425     Source Type: Journal    
DOI: 10.1097/PTS.0b013e3182a8c2c4     Document Type: Review

References (61)

1. Hrabak M, Marko RS, Kralik M, et al. Nikola Tesla and the discovery of X-rays. Radiographics. 2008;28:1189-1192. Available at: http://radiographics. rsnajnls.org/cgi/pmidlookup?view=long&pmid=18635636. Last accessed July 19, 2012.
2. Hricak H, Brenner DJ, Adelstein SJ, et al. Managing radiation use in medical imaging: a multifaceted challenge. Radiology. 2011;258:889-905. Epub 2010 Dec 16.258:889-905, 2011 Available at: http://radiology.rsnajnls.org/cgi/ pmidlookup?view=long&pmid=21163918. Last accessed July 19, 2012.
3. Fuchs VR, Sox HC. Physicians' views of the relative importance of thirty medical innovations. Health Aff (Millwood). 2001;20:30-42. Available at: http://content.healthaffairs.org/cgi/pmidlookup?view= long&pmid=11558715. Last accessed July 19, 2012.
4. Lincoln L, Berland LL, Stuart G, et al. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol. 2010;7:754-773.
5. Denham CR. Patient safety practices: leaders can turn barriers into accelerators. J Patient Saf. 2005;1:41-55.
6. George WW, Denham CR, Burgess LH, et al. Leading in crisis: lessons for safety leaders. J Patient Saf. 2010;6:24-30.
7. National Quality Forum (NQF). Safe Practices for Better Healthcare Y 2010 Update: A Consensus Report. Washington, DC: National Quality Forum; 2010.
8. Goske MJ, Applegate KE, Frush DP, et al. The Image Gently campaign: working together to change practice. AJR Am J Roentgenol. 2008;190:273-274. Available at: http://www.ajronline.org/cgi/pmidlookup?view=long&pmid= 18212208. Last accessed July 19, 2012.
9. Goske MJ, Applegate KE, Frush DP, et al. Image Gently: a national education and communication campaign in radiology using the science of social marketing. J Am Coll Radiol. 2008;5:1200.
10. National Quality Forum (NQF). Safe practice 34: pediatric imaging. In: Safe Practices for Better Healthcare Y 2010 Update: A Consensus Report. Washington, DC: National Quality Forum; 2010:389-394.
11. Miller DL, Balter S, Dixon RG, et al. Quality improvement guidelines for recording patient radiation dose in the medical record for fluoroscopically guided procedures. J Vasc Interv Radiol. 2012;23:11-18.
12. Brink JA, Amis ES. Image wisely: a campaign to increase awareness about adult radiation protection. Radiology. 2010;257:601-602. Available at: http://radiology.rsnajnls.org/cgi/pmidlookup?view=long& pmid=21084410. Last accessed July 19, 2012.2010.
13. International Atomic Energy Agency. Radiation Safety. International Standards for Radiation Protection. Vienna, Austria. : International Atomic Energy Agency. [Online] ND. Available at: http://www.iaea.org/Publications/ Booklets/Radiation/radsafe.html#seven. Last accessed July 19, 2012.
14. International Commission on Radiological Protection. Radiological Protection in Medicine. ICRP Publication 105. Ann. ICRP 2007 Dec; 37(6).
15. Committee on Tracking Radiation Doses from Medical Diagnostic Procedures; Nuclear and Radiation Studies Board; Division on Earth and Life Studies; National Research Council. Tracking Radiation Exposure from Medical Diagnostic Procedures: Workshop Reports. Report. Committee on Tracking Radiation Doses from Medical Diagnostic Procedures; Nuclear and Radiation Studies Board; Division on Earth and Life Studies; National Research Council. Washington, DC: National Academy of Sciences. The National Academies Press; 2012.
16. National Quality Forum (NQF). NQF Patient Safety Measure #0739-: Radiation Dose of Computed Tomography (CT). [Online] Jan. 25, 2012, Update. Available at: http://www.qualityforum.org/MeasureDetails. aspx?actid= 0&SubmissionId=221#k=739. Last accessed July 13, 2012.
17. Rehani M, Einstein A, Frush DP. Patient radiation exposure tracking: worldwide programs and needsVresults from the first IAEA survey. Eur J Radiol. In press.
18. Frush DP. Our responsibility for medical radiation dose determinations. J Vasc Interv Radiol. 2012;23:451-452.
19. Rehani M, Frush DP. Patient exposure tracking: the IAEA SmartCard Project. Radiat Prot Dosimetry. 2011;147:314-316.
20. National Council on Radiation Protection and Measurements (NCRP). Radiation dose management for fluoroscopically-guided interventional medical procedures. NCRP Report No. 168. Bethesda, MD: National Council on Radiation Protection and Measurements; 2010.
21. International Atomic Energy Agency. Establishing guidance levels in x ray guided medical interventional procedures: a pilot study. Safety Reports Series No.
22. Vienna, Austria: International Atomic Energy Agency; 2009.
23. Conference of Radiation Control Program Directors. Technical White Paper: Monitoring and tracking of fluoroscopic dose. CRCPD Publication #E-10-7. Frankfort, KY: Conference of Radiation Control Program Directors; 2010. Available at: http://www.crcpd.org/Pubs/WhitePaper- MonitoringAndTrackingFluoroDose-PubE-10-7.pdf. Accessed July 19, 2012.
24. U.S. Food and Drug Administration. Radiation-Emitting Products. [Online] Webpage last updated 12/14/2010 Dec 14. Available at: http://www.fda.gov/ Radiation-EmittingProducts/RadiationSafety/RadiationDoseReduction/ucm199994.htm. Accessed July 19, 2012.
25. Centers for Medicare & Medicaid Services. Quality Measures. [Online] Page Webpage last updated April 6, 2012. Available at: http://www.cms.gov/ Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/ index.html?redirect=/QualityMeasures/01-Overview.asp. Accessed July 1619, 2012.
26. National Quality Forum. Measure Applications Partnership. 2012. [online] Available at: http://www.qualityforum.org/map/. Accessed August 23, 2012.
27. California State Senate. Bill Number: SB 1237, Chapter D. [Online] Feb. 19, 2010. Available at: http://www.leginfo.ca.gov/pub/09-10/bill/sen/sb-1201- 1250/sb-1237-bill-20100929-chaptered.html. Accessed July 1619, 2012.
28. The Joint Commission. Radiation risks of diagnostic imaging. Sentinel Event Alert, Issue 47, Aug. 24, 2011 [Online] Available at: http://www. jointcommission.org/assets/1/18/sea-471.pdf. Accessed June 26, 2012.
29. Miller DL, Kwon D, Bonavia GH. Reference levels for patient radiation doses in interventional radiology: proposed initial values for U.S. practice. Radiology. 2009;253:753-764. Available at http://radiology.rsnajnls.org/cgi/ pmidlookup?view=long&pmid=19789226. Accessed July 19, 2012.
30. National Council on Radiation Protection & Measurements. SC 4-3: Diagnostic Reference Levels in Medical Imaging: Recommendations for Application in the United States. NCRP Report in review July 2012. Available at: http://www.ncrponline.org/Current-Prog/SC-4-3.html. Accessed August 22, 2012.
31. Outpatient and Emergency CT Procedure Volume. [online] June 5, 2012. Available at: http://www.imvinfo.com/user/documents/content-documents/def-dis/ 2012-06-05-04-54-16-458-IMV-2012-CT-Press-Release.pdf. Accessed July 3, 2012.
32. Frush DP, Applegate K. Computed tomography and radiation: understanding the issues. J Am Coll Radiol. 2004;1:113-119.
33. National Council on Radiation Protection (NCRP). Ionizing radiation exposure of the population of the United States. NCRP Report No. 160, Bethesda, MD: National Council on Radiation Protection; 2009.
34. Sternberg S. CT scans in children linked to cancer later. USA Today. January 22, 2001, p 1;01.A.
35. BogdanichW.West Virginia Hospital Overradiated Brain Scan Patients, Records Show. The New York Times. March 5, 2011;A20. [Online] Available at: http://www.nytimes.com/2011/03/06/health/06radiation.html?-r=1. Accessed July 19, 2012.
36. Bogdanich W, McGinty JC. Radiation Worries for Children in Dentists' Chairs. The New York Times. November 22, 2010;A1. [Online] Available at: http://www.nytimes.com/2010/11/23/us/23scan.html? pagewanted=allhttp://www. nytimes.com/2010/11/23/us/23scan.html?-r=1&pagewanted=allNY. Accessed July 19, 2012.
37. BogdanichW. Radiation Overdoses Point Up Dangers of CT Scans. The New York Times. October 15, 2009;A13. [Online] Available at: http://www.nytimes.com/ 2009/10/16/us/16radiation.html?-r=1. Accessed July 19, 2012.
38. Brenner DJ, Hall EJ. Computed tomographyVan increasing source of radiation exposure. N Engl J Med. 2007;357:2277-2284.
39. Smith-Bindman R, Lipson J, Marcus R, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med. 2009;169:2078-2086. Available at: http://archinte.jamanetwork.com/article.aspx?articleid=415384. Accessed July 19, 2012.
40. Berrington de González A, Mahesh M, Kim KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med. 2009;169:2071-2077. Available at: http://archinte. jamanetwork.com/article.aspx?articleid=415368. Accessed July 19, 2012.
41. Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380:499-505.
42. Linet MS, Slovis TL, Miller DL, et al. Cancer risks associated with external radiation from diagnostic imaging procedures. CA Cancer J Clin. 2012;62:220-241.
43. Amis ES Jr, Butler PF, Applegate KE, et al. American College of Radiology white paper on radiation dose in medicine. J Am Coll Radiol. 2007;4:272-284.
44. American Association of Physicists in Medicine website. AAPM Position Statement on Radiation Risks from Medical Imaging Procedures. December 13, 2011. [online] Available at: http://www.aapm.org/org/policies/details.asp?id= 318&type=PP. Accessed July 19, 2012.
45. Durand DJ. A rational approach to the clinical use of cumulative effective dose estimates. AJR Am J Roentgenol. 2011;197:160-162. Available at: http://www.ajronline.org/cgi/pmidlookup?view=long& pmid=21701025. Accessed July 19, 2012.
46. McNitt-Gray MF. AAPM/RSNA physics tutorial for residents: topics in CT. Radiation dose in CT. Radiographics. 2002;22:1541-1553. Available at: http://radiographics.rsnajnls.org/cgi/pmidlookup? view=long&pmid=12432127. Accessed July 19, 2012.
47. McCollough CH, Leng S, Yu L, et al. CT dose index and patient dose: they are not the same thing. Radiology. 2011;259:311-316. Available at: http://radiology.rsnajnls.org/cgi/pmidlookup?view=long&pmid= 21502387. Accessed July 19, 2012.
48. Strauss KJ, Goske MJ. Estimated pediatric radiation dose during CT. Pediatr Radiol. 2011;41(Suppl 2):472-482.
49. Harrison JD, Streffer C. The ICRP protection quantities, equivalent and effective dose: their basis and application. Radiat Prot Dosimetry. 2007;127:12-28.
50. Martin CJ. Effective dose: how should it be applied to medical exposures? Br J Radiol. 2007;80:639-647. Epub 2007 Jul 23. Available at: http://bjr.birjournals.org/cgi/pmidlookup?view=long&pmid=17646189. Accessed July 19, 2012.
51. McCollough CH, Christner JA, Kofler JM. How effective is effective dose as a predictor of radiation risk? AJR Am J Roentgenol. 2010; 194:890-896. Available at: http://www.ajronline.org/cgi/pmidlookup? view=long&pmid= 20308487. Accessed July 19, 2012.
52. Mettler FA, Huda W, Yoshizumi TT, et al. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology. 2008;248:254-263. Available at: http://radiology.rsnajnls.org/cgi/pmidlookup?view=long&pmid=18566177. Accessed July 19, 2012.
53. American Association of Physicists in Medicine. Size-Specific Dose Estimates (SSDE) in Pediatric and Adult Body CT Examinations. Report of AAPM Task Group 204, developed in collaboration with the International Commission on Radiation Units and Measurements (ICRU) and the Image Gently campaign of the Alliance for Radiation Safety in Pediatric Imaging. College Park, MD: American Association of Physicists in Medicine; 2011. Available at: http://www.aapm.org/ pubs/reports/RPT-204.pdf. Accessed July 19, 2012.
54. Li X, Samei E, Segars WP, et al. Patient-specific radiation dose and cancer risk for pediatric chest CT. Radiology. 2011;259:862-874. Epub 2011 Apr 5. Available at: http://radiology.rsnajnls.org/cgi/pmidlookup?view= long&pmid=21467251. Accessed July 19, 2012.
55. Li X, Samei E, Segars WP, Frush DP, et al. Patient-specific radiation dose and cancer risk estimation in CT: Part I. Development and validation of a Monte Carlo program. Med Phys. 2011;38:397-407. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21361208/?tool=pubmed. Accessed July 19, 2012.
56. Li X, Samei E, Segars WP, Frush DP, et al. Patient-specific radiation dose and cancer risk estimation in CT: Part II. Applications to patients. Med Phys. 2011;38:408-419. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/ pmid/21361209/?tool=pubmed. Accessed July 19, 2012.
57. Shuren JE. Dept. of Health and Human Services. Letter to National Quality Forum Re: NQF Measure #0739: Radiation Dost Dose of Computed Tomography (CT). Dept. of Health and Human Services. [Online] October 19, 2011. Available at: http://www.qualityforum.org/Projects/n-r/Patient-Safety-Measures/HHS-Appeal. aspx. Accessed July 19, 2012.
58. American College of Radiology. Dose Index Registry. [Online]. ND. Available at: https://nrdr.acr.org/Portal/DIR/Main/page.aspx. Accessed July 19, 2012.
59. Radiological Society of North America. RadLex. [online] Available at: https://www.rsna.org/RadLex.aspx. Accessed July 19, 2012.
60. The American Association of Physicists in Medicine. AAPM CT Lexicon version 1.2. 3/20/2012. [online] Available at: http://www.aapm.org/pubs/ CTProtocols/documents/CTTerminologyLexicon.pdf. Accessed: July 19, 2012.
61. Hendee WR, O'Conner MK. Radiation risks of medical imaging: separating fact from fancy. Radiology. 2012;264:312-321.