Sign In
CPSI Share                                                                      
​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​ ​​
Back to Search
Single or Multiple Incident: Multiple
Date: 8/24/2011 12:00:00 AM
This safety alert discusses the many patient safety incidents possible using diagnostic radiation. Diagnostic radiation is an effective tool that can save lives. The higher the dose of radiation delivered at any one time, however, the greater the risk for long-term damage. If a patient receives repeated doses, harm can also occur as the cumulative effect of those multiple doses over time. Conversely, using insufficient radiation may increase the risk of misdiagnosis, delayed treatment, or, if the initial test is inadequate, repeat testing with the attendant exposure to even more radiation. The risks associated with the use of ionizing radiation in diagnostic imaging include cancer, burns and other injuries. While experts disagree on the extent of the risks of cancer from diagnostic imaging, there is agreement that care should be taken to weigh the medical necessity of a given level of radiation exposure against the risks, and that steps should be taken to eliminate avoidable exposure to radiation. This alert provides extensive information on methods to eliminate avoidable radiation dosing, ensuring the right imaging test is selected, ensuring the correct dose of radiation is used, creating and implementing effective processes that ensure safety, employing safe technology and practicing a safety culture.


Environment / Equipment
  1. Guidance in the appropriate use of potentially dangerous procedures and equipment.
  2. Safety, operational and functional checks of the equipment before initial use and periodically thereafter.
  3. Perform an organization-wide audit/survey of diagnostic imaging equipment that have the potential of emitting high amounts of cumulative radiation. Implement a system for centralized quality and safety performance monitoring of this inventoried equipment under the supervision of a qualified medical physicist or your organization’s multidisciplinary group with radiation expertise or both. (This equipment may no longer solely be within the province of the radiology department and may be located within a variety of hospital or clinical departments, including the cardiac catheterization suite and the OR. In the ambulatory setting, this equipment may be found in physician or dental offices.)
  4. Have a qualified medical physicist test all diagnostic imaging equipment initially and at least annually or every two years thereafter to assure proper installation and calibration, and review scanning protocols and doses.4 Such tests should be conducted in accordance with applicable state and federal laws and regulations. Where no such regulations exist, tests should be conducted in accordance with the applicable standards as promulgated by the American Association of Physicists in Medicine.
  5. Ensure that recommended quality control, testing (including daily functional tests) and preventive maintenance activities are performed in accordance with manufacturer’s guidelines. The health care organization, in consultation with the medical physicist, should identify in writing these activities, their frequencies, and who will perform them.
  6. Invest in technologies that optimize or reduce dose.
  7. Guidance in the appropriate use of potentially dangerous procedures and equipment.
  8. Safety, operational and functional checks of the equipment before initial use and periodically thereafter.
  9. Perform an organization-wide audit/survey of diagnostic imaging equipment that have the potential of emitting high amounts of cumulative radiation. Implement a system for centralized quality and safety performance monitoring of this inventoried equipment under the supervision of a qualified medical physicist or your organization’s multidisciplinary group with radiation expertise or both. (This equipment may no longer solely be within the province of the radiology department and may be located within a variety of hospital or clinical departments, including the cardiac catheterization suite and the OR. In the ambulatory setting, this equipment may be found in physician or dental offices.)
  10. Have a qualified medical physicist test all diagnostic imaging equipment initially and at least annually or every two years thereafter to assure proper installation and calibration, and review scanning protocols and doses.4 Such tests should be conducted in accordance with applicable state and federal laws and regulations. Where no such regulations exist, tests should be conducted in accordance with the applicable standards as promulgated by the American Association of Physicists in Medicine.
  11. Ensure that recommended quality control, testing (including daily functional tests) and preventive maintenance activities are performed in accordance with manufacturer’s guidelines. The health care organization, in consultation with the medical physicist, should identify in writing these activities, their frequencies, and who will perform them.
  12. Invest in technologies that optimize or reduce dose.
Communication
  1. Awareness of the potential dangers from diagnostic radiation among organizational leadership, hospital staff and patients.
  2. Adequate awareness among physicians and other clinicians about the levels of radiation typically used and related risks.
  3. Communication among clinicians, medical physicists, technologists and staff.
  4. Awareness of the potential dangers from diagnostic radiation among organizational leadership, hospital staff and patients.
  5. Adequate awareness among physicians and other clinicians about the levels of radiation typically used and related risks.
  6. Communication among clinicians, medical physicists, technologists and staff.
Rules / Policies / Procedures
  1. Clear protocols that identify the maximum dose for each type of study.
  2. Consulting with a qualified medical physicist when designing or altering scan protocols.
  3. In order to reduce the exposure of the patient to ionizing radiation, use other imaging techniques, such as ultrasound or MRI, whenever these tests will produce the required diagnostic information at a similar quality level.
  4. Create and implement processes that enable radiologists to provide guidance to and dialogue with referring physicians regarding the appropriate use of diagnostic imaging using the American College of Radiology’s Appropriateness Criteria.
  5. Adhere to ALARA guidelines as required by the Nuclear Regulatory Commission. The ALARA acronym stands for “as low as reasonably achievable” – making sure doses are as low as possible while achieving the purposes of the study.
  6. Adhere to the Society for Pediatric Radiology’s Image Gently guidelines when providing imaging radiation (or fluoroscopy) to children and, for adults, adhere to the Image Wisely guidelines (developed by the American College of Radiology and the Radiological Society of North America in collaboration with the American Association of Physicists in Medicine and the American Society of Radiologic Technologists).
  7. Provide physicians and technologists with reference doses based on anatomy, purpose of the study, and patient size. Establish appropriate dose ranges for high-volume and high-dose diagnostic imaging studies.
  8. Radiologists should assure that the proper dosing protocol is in place for the patient being treated.
  9. Institute a process for the review of all dosing protocols either annually or every two years to ensure that protocols adhere to the latest evidence.
  10. Investigate patterns outside the range of appropriate doses. Track radiation doses from exams repeated due to insufficient image quality or lack of availability of previous studies to identify the causes. Address and resolve these problems through education and other measures.
  11. Record the dosage or exposure as part of the study’s summary report of findings.
  12. Create and implement policies and procedures delineating those responsible for approving changes to password-protected diagnostic imaging protocols and for monitoring new developments in diagnostic imaging. Provide for oversight of these policies and procedures and related activities, including control of the password, by a multidisciplinary group with expertise in radiation (such as a radiation safety committee), including a medical physicist.
  13. Develop and implement policies and procedures that delineate physical protective risk reduction measures to be taken by staff delivering radiation to patients, including appropriate lead shielding for both patients and employees and radiation-protection training for all technologists.
  14. Expand the radiation safety officer’s role to explicitly include patient safety and involve the officer in the organization’s patient safety committee.
  15. Use the following Joint Commission standards to support the use of safe and effective diagnostic radiation: LD.03.01.01, LD.03.04.01, LD.03.05.01, LD.03.06.01 (all programs). The concepts in these standards promote a safety culture, which is necessary for the safe use of diagnostic radiation.
  16. Endorse the creation of a national registry to track radiation doses as the start of a process to identify optimal and reference doses.
  17. Clear protocols that identify the maximum dose for each type of study.
  18. Consulting with a qualified medical physicist when designing or altering scan protocols.
  19. In order to reduce the exposure of the patient to ionizing radiation, use other imaging techniques, such as ultrasound or MRI, whenever these tests will produce the required diagnostic information at a similar quality level.
  20. Create and implement processes that enable radiologists to provide guidance to and dialogue with referring physicians regarding the appropriate use of diagnostic imaging using the American College of Radiology’s Appropriateness Criteria.
  21. Adhere to ALARA guidelines as required by the Nuclear Regulatory Commission. The ALARA acronym stands for “as low as reasonably achievable” – making sure doses are as low as possible while achieving the purposes of the study.
  22. Adhere to the Society for Pediatric Radiology’s Image Gently guidelines when providing imaging radiation (or fluoroscopy) to children and, for adults, adhere to the Image Wisely guidelines (developed by the American College of Radiology and the Radiological Society of North America in collaboration with the American Association of Physicists in Medicine and the American Society of Radiologic Technologists).
  23. Provide physicians and technologists with reference doses based on anatomy, purpose of the study, and patient size. Establish appropriate dose ranges for high-volume and high-dose diagnostic imaging studies.
  24. Radiologists should assure that the proper dosing protocol is in place for the patient being treated.
  25. Institute a process for the review of all dosing protocols either annually or every two years to ensure that protocols adhere to the latest evidence.
  26. Investigate patterns outside the range of appropriate doses. Track radiation doses from exams repeated due to insufficient image quality or lack of availability of previous studies to identify the causes. Address and resolve these problems through education and other measures.
  27. Record the dosage or exposure as part of the study’s summary report of findings.
  28. Create and implement policies and procedures delineating those responsible for approving changes to password-protected diagnostic imaging protocols and for monitoring new developments in diagnostic imaging. Provide for oversight of these policies and procedures and related activities, including control of the password, by a multidisciplinary group with expertise in radiation (such as a radiation safety committee), including a medical physicist.
  29. Develop and implement policies and procedures that delineate physical protective risk reduction measures to be taken by staff delivering radiation to patients, including appropriate lead shielding for both patients and employees and radiation-protection training for all technologists.
  30. Expand the radiation safety officer’s role to explicitly include patient safety and involve the officer in the organization’s patient safety committee.
  31. Use the following Joint Commission standards to support the use of safe and effective diagnostic radiation: LD.03.01.01, LD.03.04.01, LD.03.05.01, LD.03.06.01 (all programs). The concepts in these standards promote a safety culture, which is necessary for the safe use of diagnostic radiation.
  32. Endorse the creation of a national registry to track radiation doses as the start of a process to identify optimal and reference doses.
Training
  1. A comprehensive patient safety program, including education about dosing in imaging departments.
  2. Training on how to use complex new technology.
  3. Adequately trained and competent staff.
  4. Knowledge regarding typical doses.
  5. Ensure all physicians and technologists who prescribe diagnostic radiation or use diagnostic radiation equipment receive dosing education and are trained on the specific model of equipment being used. Institute a process for annual education, review and competency testing.
  6. A comprehensive patient safety program, including education about dosing in imaging departments.
  7. Training on how to use complex new technology.
  8. Adequately trained and competent staff.
  9. Knowledge regarding typical doses.
  10. Ensure all physicians and technologists who prescribe diagnostic radiation or use diagnostic radiation equipment receive dosing education and are trained on the specific model of equipment being used. Institute a process for annual education, review and competency testing.

Radiation risks of diagnostic imaging