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By Tom Wall, RDMS, RVT
I attended the Pennsylvania Area meeting on October 29, 2019 at Lehigh Valley Medical Center in Allentown Pennsylvania. As I was trying to find my way in I met one of the sponsors of the event from Nuance. We just started chatting like we knew each other. This is always the way I feel when attending an AHRA event so I knew I was in the right place.
The meeting kicked off with AHRA President, Chris Tomlinson welcoming everyone and laying out the benefits of AHRA membership like the local area meeting we were all attending. The first presentation addressed Pennsylvania’s Patient Test Result Information Act (PA Act 112 dun dun dun). This law requires any entity that performs an outpatient diagnostic imaging service in which a significant abnormality may exist to directly notify the patient or their designee within 20 days. The speaker went into the rules and the regulation but what I heard was the reasoning behind it as well. Unfortunately sometimes incidental findings on exams lack effective communication to the ordering providers, primary care physicians, and ultimately the patients themselves. We have a precedent in our field emanating from mammography. Through regulation, quality control and advocacy a structure for communication of results and recommendations for follow up are clearly defined. BIRADS (MQSA) and the advocacy efforts for breast density reporting have established a clear and consistent communication channel directly to the patient we care for and engage them in the decision making process. I see this regulation potentially making its way out of Pennsylvania and being adopted by other states because it makes sense and improves patient care.
We moved on to the topic of Gonadal Shielding related to a new position statement issued by the American Association of Physicists in Medicine (AAPM). I honestly wasn’t sure what I would glean from this presentation. The speaker made it interactive asking the audience questions toward the end, after challenging people to think and let go of their sacred cows. He presented evidence that the combination of equipment improvements, technique and reclassification of radiation resistance and that internal scatter is not reduced by shielding. In fact, shielding can potentially cause unwanted effects (ie. increased radiation, compromised image quality, etc.). Add repeat exposure due to misplacement of or obscuration by the shielding and the pendulum potentially goes toward not shielding. It reminded me of the movie Sleeper by Woody Allen where in the future, everything we thought was bad for us was actually good for us. Okay, I digress but if you know me, you get it.
Last but far from least was Imaging Utilization and Evidence-based medicine. These are two things that are foremost in the minds of us all or at least our finance folk. We all deal with imaging utilization daily and try to prioritize exams and tailor them to best suit the reason for the exam to answer the question asked in the most cost efficient and medically appropriate way possible. They are not two distinct and unique entities but both sides of the same coin. The presentation was geared toward efficient use of imaging to best tell the patient’s story and collecting the evidence to show why it is in the best interest of the patient. The comparison of ordering patterns and diagnostic yield can be assessed and utilized to educate, maximize and standardize care. Data drives the world and having the evidence to show that improving patient outcome is achieved by adapting to this imaging management guideline actually makes everyone’s job easier. Obviously, like anything worthwhile it takes time and effort but we are moving in the right direction.
Tom Wall, RDMS, RVT is the sonography Imaging Manager at Holy Name Medical Center in Teaneck, NJ. He can be reached at t-wall@mail.holyname.org.
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