AHRA: Reduce radiation doses through focus and commitment

 - Systematic radiation reduction possible for fluoroscopic procedures

With detailed data analysis and updated protocols, hospitals can expose patients to significantly less radiation, according to a presentation at the AHRA Annual Meeting 2015 in Las Vegas.

The Heritage Valley Health System (HVHS) in Beaver, Penn., developed the Imaging Efficiency and Dose Reduction Program in collaboration with Highmark from July 2014 to March 2015. Their goal was to bring awareness of radiation dose reduction to the general population, physicians, and other staff.

Roland McGraner, HVHS system director of diagnostic imaging services, and Sue Antonini, HVHS RIS and digital imaging administrator, presented the program’s results. They said one of their first steps was to look at, and gain a better understanding of, their radiation dose data.

“What we had to do was parse the data and look at the variables,” Antonini told RadiologyBusiness.com in a phone interview. “Did we have higher radiation exposure during the 3 p.m.-11 p.m. shift? Did we have higher exposure because of the emergency department? Or because we were using GE instead of Siemens?”

Antonini said examining the data so closely helped the team determine several dose reduction strategies, including:

  • Radiation reductions to elbow, ankle and tibia/fibula digital radiography;
  • Replacing CT Enterography with MR Enterography;
  • Replacing fluoroscopy-guided diagnostic ERCP procedures with MR endoscopic cholangiopancreatography;
  • Transitioning first-pass evaluation for pediatric appendicitis from CT to ultrasound;
  • Replacing fluoroscopy guidance with ultrasound guidance when applicable;
  • Increasing CT scan slice thickness for CT abdomen/pelvis without contrast; and
  • Performing more CT thorax scans and CT abdomen/pelvis scans with contrast as opposed to without contrast.

Antonini is most proud of the improvements that were made to treating potential pediatric appendicitis cases. By modifying the pathways and working with emergency department physicians, she said they were able to go from one out of 10 patients having an ultrasound first in Q1 to nine out of 10 patients having an ultrasound first in Q3.

“I think that was our biggest sense of accomplishment,” Antonini said. “Even though we do a very low volume of pediatric patients, you want to make sure you’re not irradiating kids if you don’t have to, so that was a big one.”

Another dose reduction that stands out to Antonini is the change to CT thorax scans with contrast instead of performing so many without contrast. This results in a 45% reduction in dose length product (DLP), and Antonini said it was mostly just a matter of giving physicians and staff additional training.

Training also resulted in more pulsed fluoroscopy—which is much better for the patient than continuous fluoroscopy—being used throughout HVHS facilities. Antonini said the radiology staff knew this difference already, but physicians with other specialties weren’t as knowledgeable.

“Our radiologists use pulsed fluoroscopy,” Antonini said. “So what we tried to do is advocate pulsed fluoroscopy when, say, a pulmonologist might be doing fluoroscopy or someone from the gastrointestinal lab (GI) might be doing fluoroscopy.”

Besides providing physicians with additional training, the HVHS program also put a new emphasis on patient education. Before participating in this program, Antonini said the entire health system was failing to properly educate patients, but the decision was made to change that once and for all.

“It sort of brought the whole issue into focus again,” she said. “It brings total awareness back to what’s important: focus on the patient, focus on the exam, and start looking for even small ways to reduce dose, because it’s morally and ethically the right thing to do.”

As a part of that new focus, fliers about radiation and dose reduction were distributed, and technologists were asked to share specific information when speaking with patients.