Radiation Dose Management: A Multidisciplinary Approach

By Rupinder Colby

January 2014—The ACR and the American Association of Physicists in Medicine (AAPM) have established radiation exposure guidelines for healthcare providers to follow, and the Joint Commission has conducted a field review on healthcare providers’ initiatives for managing patient radiation dose related risks. In 2014, hospitals must include radiation dose safety as a strategic growth initiative. Healthcare providers must reinforce their existing patient radiation dose safety programs with robust patient imaging decision points.

Establishing a robust patient radiation dose safety program provides a multitude of benefits for a healthcare provider. Dose conscious providers across the country are using radiation dose management as a marketing tool; affirming the organization’s awareness of patient radiation exposure to their patients in the community. These providers offer their patients  responsible healthcare delivery by using aggregate dose data to assist in clinical decision making practices, and making the patient’s dose data part of their medical record. The Wall Street Journal reported earlier this year that the Mayo Clinic and North Shore-LIJ Health System are among the leaders who are aiming to reduce patient radiation doses beginning in 2013. Nash General Hospital, a 280-bed acute care facility in Rocky Mount, NC, has also launched a comprehensive radiation dose safety program in 2013.  Children’s Hospital of Philadelphia also reported launching a large pediatric radiation dose awareness initiative.

While proactively addressing radiation dose exposure is advised, organizations should beware of drawing up a narrowly driven program which does not engage the proper imaging staff and stakeholders. Many hospital based radiation dose management initiatives are being led solely by the organization’s physicist(s), who are brilliant at understanding radiation dose and safety, but are not effective in bringing all imaging professionals to the table for a collaborative radiation safety program design and deployment. The result may be procurement and deployment of an automated patient dose management solution, which does not adequately address the needs of the organization’s imaging operation, provides an ineffective integration to the organization’s enterprise imaging operations, or is unable to meet the organization’s growth initiative and integration into the clinical imaging decision support model. When dose initiatives are assigned to one person or a single department, the imaging workflow, appropriate decision support integration, and patient care suffer. Whether the organization’s dose management solution is a manual process or automated, it’s imperative for organizations to understand how the solution will be integrated into the imaging workflow and IT infrastructure. A multidisciplinary approach is crucial to a successful patient radiation dose management program. The inability to use this implementation approach will not leverage the solution to its fullest capacity and capability. A dose program should be robust in design, meet the organization’s patient safety vision and strategy, and reduce the risk of radiation overexposure.

Industry leaders see radiation dose management as an opportunity to offer patients high quality care while mitigating risk. Hospitals are encouraged to include radiation dose management initiatives in their overarching imaging strategy.

California and Texas have legal provisions in place. Connecticut has a bill currently in the House Committee, and if you depend on Medicare dollars, then the Joint Commission’s interest in radiation safety must motivate you in deploying a dose initiative in 2014. Healthcare providers must be proactive in risk management and drive the radiation dose safety sense of urgency in their organizations. The architecture of a good patient radiation dose safety program can be found in the article, “7 Requirements for an Enterprise Dose Program,” in the October 2013 issue of Link.

Rupinder Colby is an Analyst at Ascendian Healthcare Consulting and a frequent writer and thought leader on the Health Information Exchange (HIE), Health Information Technology (HIT) and industry transformation topics. If you have questions you can contact Rupinder via email rcolby@ascendian.com.