CT dose optimization and its global impact on stakeholders

CT dose optimization and its global impact on stakeholders

September 21, 2016
From the September 2016 issue of HealthCare Business News magazine

This campaign followed and augmented the Image Gently campaign, directed specifically at pediatric radiation protection, which had launched previously in 2007. Also, in 2010, the Food and Drug Administration (FDA) released an “Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging,” which targeted high-dose imaging modalities, including CT. And California passed SB1237, which required reporting of CT overexposures, recording of patient dose data in the radiology report and accreditation for all CT facilities.

In 2011, the Joint Commission (JC) issued Sentinel Event Alert, Issue 47, “Radiation Risks of Diagnostic Imaging.” In 2012, the AAPM Working Group on Standardization of CT Nomenclature and Protocols (now the Alliance for Quality Computed Tomography, AQCT) began publishing reference CT protocols. In December 2013, the JC released substantially enhanced medical imaging standards in pre-publication form. These standards, after public comment and revision, were implemented on July 1, 2015. In 2013, the National Electrical Manufacturers Association (NEMA) published its XR-29-2013 standard, which by subsequent law (in 2014) became required for full CT reimbursement starting on Jan. 1, 2016, and with more cuts on Jan. 1, 2017.

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These milestones and their resulting requirement or guidance documents, in the aggregate, have created an industry (i.e., technical, regulatory and accreditation) “framework” for CT dose optimization activities in U.S. health care facilities. While I expect that framework to be augmented and refined further in the coming years, this current structure has already substantially advanced radiation safety in CT departments nationwide and is continuing to push advancement even today, as described in the following sections of this article.

Impact on health care facilities
Health care facilities performing CT imaging in the U.S. have responded to the public concern, industry recommendations and regulatory and accreditation requirements in a variety of ways. While the approaches are numerous and varied, some common elements of successful programs have emerged. For example, most facilities with successful CT dose optimization programs started these programs by assembling one or more radiology administrators, CT technologists, radiologists and medical physicists into some type of dose optimization planning committee. This committee discusses, deliberates, and through various actions, guides the creation and implementation of a dose optimization program that meets the specific needs of the facility or facilities it serves.

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