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New Joint Commissions Radiation Dose Standards: What They Mean and How to Tackle Them  

Radiation exposure is becoming a key priority for health systems, especially since July 1, when the Joint Commission introduced new standards that will require hospitals to establish stricter radiation dose management processes. One in every five patients receives a Computed Tomography (CT) scan, since they are critical to many diagnoses, yet they expose patients to a higher radiation dose than some other diagnostic exams.

Finding the balance between radiation dose risk and benefits will be the challenge for hospitals looking to ensure they are prepared to meet these new standards, and keep patients and clinicians safe.

 

The proposed standards require a number of changes, the most important of which requires hospitals to optimize dose for a patient’s specific exam type. Optimizing exam protocols is the key first step in ensuring that for a particular patient, the correct dose index range is being used to gauge if the level of exposure is justified. The standards also focus on data collection, including exam specific criteria in an easily retrievable format. Hospitals will also be accountable for radiation exposure across all departments, to better understand differences in radiation delivery and standardize exam ordering.

While the standards are designed to establish more stringent guidelines and consistent benchmarks across the board, hospitals will have to make key changes. Here are some tips on how they can get started:

 

Analyze dose exposure for patients – Hospitals should start tracking radiation usage and mitigate radiation risk for patients, even if it is manually. Over the long term, tracking efforts should be automated as the new standards require that information to be “readily retrievable” and also cuts the cost of data gathering. A software-based technology solution that can automate the tracking process will become a critical investment for hospitals.

 

Improve access clinical data – As the industry shifts toward value-based care, more access to meaningful data is critical for clinicians to make informed decisions and customize treatment for patient needs. Access to a patient’s “radiation exposure history” can allow clinicians to identify the patient’s exposure to radiation dose, and recommend alternatives if needed, leading to improved overall patient outcomes. Since more patients are now aware of radiation risks, this will also allow providers to keep patients more informed about their radiation dose exposure.

 

Manage dose exposure for clinicians – Ongoing radiation exposure has been associated with an increased risk of cataracts and cancer among clinicians performing diagnostic testing. As clinicians become more aware of their risks, hospitals willing to proactively take steps to protect their staff and address these concerns today will attract clinicians.

 

Avoid penalties with lower dose medical equipment – Investing in “low dose” imaging equipment today can be beneficial for hospitals in the long-run, especially as more and more patients are attracted to “lower dose” hospitals. It can also help hospitals remain compliant with the Medical Imaging & Technology Alliance (MITA) Smart Dose XR-29 standard, and the Protecting Access to Medicare Act, which will implement a five percent penalty in 2016 for CT scans performed on equipment that does not meet low dose standards. This penalty is expected to rise to 15 percent in 2017.

 

Rely on best practices to select scans – Radiology departments should work within the American College of Radiology’s Appropriateness Criteria, which assist health care providers in determining the most suitable imaging or treatment decision, to evaluate if a diagnostic exam is the best option clinically. Technology also exists to account for a patient’s body size and age in order to suggest the radiation dose that is clinically optimal for a diagnostic scan.

 

Patients are becoming more and more involved in their care, and utilizing resources to learn more about the benefit-risk factors associated with their testing and treatment. Implementing an effective dose management program will not only ensure health system comply with today’s standards, but also give them a competitive edge, as patients and clinicians will be more attracted to hospitals that monitor their radiation risk. The Joint Commissions standards are a great starting point, but providers have to continue to prioritize, upgrade and improve their radiation dose management programs.

Dominic Siewko

Clinical Marketing Manager - DoseWise Solutions at Philips Healthcare

Radiation Safety/Quality System professional with expertise in radio-biology, risk, instrumentation and regulatory affairs.

 

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