The U.S. population’s total exposure to ionizing radiation has nearly doubled over the past two decades, according to a 2009 report by the National Council on Radiation Protection and Measurements. The rise is largely attributable to increased exposure from CT, nuclear medicine and interventional fluoroscopy. NCRP estimates that 67 million CT scans, 18 million nuclear medicine procedures and 17 million interventional fluoroscopy procedures were performed in this country in 2006, and the organization expects the number to grow.
As you’ve seen in the news – as well as in this month’s article about radiation safety – healthcare providers and lawmakers are concerned about all this. Recent articles in the New York Times and other media outlets have graphically described what can happen to patients who are exposed to too much radiation. The Food and Drug Administration has launched an initiative to reduce unnecessary radiation exposure from medical imaging, and the House Energy and Commerce Committee’s Subcommittee on Health held a public hearing on the matter in late February.
What’s going on? First, policymakers and clinicians are coming to grips with the fact that providers might simply be performing too many imaging procedures. As Congressman Frank Pallone pointed out in the Health Subcommittee hearing, “Many in Congress have questioned the overuse of medical imaging, but for the most part, those conversations have centered on cost implications. I have to wonder, though, if there are not also health implications as well?” That’s a clinical issue that will have to be worked through.
Second, despite the fact that imaging and radiation-based therapeutic equipment is more complicated than ever, only four states require that operators be licensed. The overdose of 260 patients at Cedars-Sinai Medical Center in Los Angeles was attributed to operator error, according to a January article in the New York Times. Technicians administering CT scans on possible stroke victims at the facility simply failed to accurately read the numbers displayed on computer screens. If they had, they would have seen that they were delivering as much as eight times the amount of radiation needed.
Third, as Pallone pointed out during the hearing on Capitol Hill, even in those states that demand that operators be licensed, requirements to report errors – and penalties for making errors – are “basically non-existent or not enforced.”
What’s the role of the contracting executive? In our article in this month’s issue, Anthony Zietman, M.B.B.S., M.D., professor of radiation oncology, Harvard Medical School, and president of the American Society for Radiation Oncology, points out that vendors typically provide only a couple of days’ training, and then leave medical physicists and radiation therapists on their own. “Hospitals need to negotiate for longer, and ongoing, training,” he says. It seems to be a point well taken, and one on which the contracting executive can have an impact.
JHC readers might not be at the table discussing clinical protocols or even the specs of the imaging equipment that their clinicians and financial officers want to acquire, but they can use their negotiating skills to ensure that manufacturers of sophisticated equipment provide thorough and ongoing training.