TJC Calls for Restraint in Diagnostic Radiation

In recent years, several mishaps involving CT imaging, such as one in September, 2009 in which more than 300 patients undergoing CT brain perfusion imaging to rule out stroke at Cedars Sinai Medical Center in Los Angeles, have received doses of radiation eight times what was expected, which caused or carried risks of skin damage, hair loss, cataracts, cancer and other secondary health problems.

According to a chart from the American College of Radiology and the Radiological Society of North America, diagnostic radiation doses vary significantly, from an intraoral X-ray, which imposes .005 millisievert (mSv), about the amount one would be exposed to from the environment during one day, to a CT of the abdomen and pelvis without, and repeated with contrast material, which imposes 30 mSv, roughly the amount of environmental exposure for 10 years.

The Joint Commission recommends that healthcare settings consider these alternatives:

• Use of imaging techniques other than CT, such as ultrasound or magnetic resonance imaging (MRI), and collaboration between radiologists and referring physicians about the appropriate use of diagnostic imaging.
• Adherence to the Nuclear Regulatory Commission's ALARA ("as low as reasonably achievable") guidelines, as well as guidelines from the Society for Pediatric Radiology, American College of Radiology and the Radiological Society of North America for imaging for children and adults, respectively.
• Assurance by radiologists that the proper dosing protocol is in place for the patient being treated and review of all dosing protocols against the latest evidence either annually or every two years.
• Expansion of the radiation safety officer's role to explicitly include patient safety as it relates to radiation and dosing, as well as education on proper dosing and equipment usage for all physicians and technologists who prescribe diagnostic radiation or use diagnostic radiation equipment.
• Implementation of centralized quality and safety performance monitoring of all diagnostic imaging equipment that may emit high amounts of radiation cumulatively.