Reducing radiation dose is one of the biggest topics in modern medical imaging, and it’s something Dominic Siewko, MBA, CHP, CSP, Philips’ radiation health and safety officer, has specialized in for a number of years now.
On Wednesday, August 3, Siewko will give a presentation at the AHRA 2016 Annual Meeting and Exposition in Nashville, Tennessee, on the topic of radiation dose. His presentation, “The Role of Dose Tracking Systems in Radiation Safety Programs,” was developed to help providers study and track dose while meeting all of the latest Joint Commission requirements for diagnostic imaging.
Siewko spoke with Radiology Business to discuss his presentation and look ahead at how radiation dose will be tracked and regulated in the future.
Radiology Business: How did reducing radiation dose become one of the primary focuses of your career? Why is this issue so important?
Dominic Siewko: I started my career in 1997 working at a local Boston hospital in the radiation safety department as a health physicist. I was assigned to the nuclear medicine department to monitor staff and patient radiation dose, among other tasks. There has always been a requirement by the United States Nuclear Regulatory Commission (NRC) in every Agreement State to report radiation dose exceedances in nuclear medicine procedures of a certain threshold to the NRC/State Agency. I found it very interesting and deeply personal to be able to perform calculations for individual patients related to their risk and for reportability.
I later moved on to work for a large nuclear pharmacy chain and expanded my knowledge of patient dose. I was surprised that, when I moved to working on x-ray dose for patients, monitoring was neither required nor reportable at any level. Whether the dose to the patient comes from x-rays or from nuclear materials, it all has the same effect, so creating products that help hospitals manage radiation exposure to patients is gratifying.
What can attendees at AHRA 2016 expect to learn from your session?
We have been raising awareness of the requirements for tracking and optimizing radiation exposure to patients, and explaining the new Joint Commission requirements to hospitals we work with, which requires them to abide by more stringent dose management procedures. Now, the message must move from raising awareness to helping healthcare providers use this information in the correct and most efficient way.
Historically, there has never been a requirement to track patient x-ray dose, and certainly not to measure, evaluate and optimize it. Now that providers are using automated dose tracking software tools in their institutions, they need help using and understanding this abundance of data. What types of data should be they evaluating? At what frequency? Who owns this data? What does success look like? These are all questions I hear from customers, so I want to give my advice on how to help them implement patient dose tracking into their radiation safety programs.
Why do you think it is so difficult for imaging experts to estimate radiation dosage?
Patient radiation dose is very difficult to estimate, mainly due to the technology available today. Although we have made leaps and bounds—CT dose is a fraction of what it was 10 years ago—the technology does not allow us to look at the dose given to an individual patient.
For example, the current FDA and international requirement for CT is to use standard plastic phantoms to approximate tissue equivalency with detectors inside. Of course, we know patients come in all shapes and sizes, but the machines only know one reference dose. It gets even harder when you consider different ages, genders, biological excretion rates and individual sensitivities to radiation.
This isn’t to say that we believe we have it wrong now. We estimate radiation dose to patients with pretty good accuracy, but these are just some of the obstacles we face when trying to determine dose to individual patients. We are getting better and more accurate every day as our equipment and software become more sophisticated through innovation.
What are your initial thoughts on the new Joint Commission requirements for diagnostic imaging services that go into effect September 1? What’s the biggest change to come from that update?
There are two main updates in the upcoming standards: technologist education standardization and CT exam protocol optimization. There are still varying educational and certification requirements for CT technologists within the U.S., and the Joint Commission is helping to standardize this, which is good for patient care.
The other change will have a significant operational impact on radiology departments. The new requirement for optimizing CT exam protocols will require new work for the technologist, medical physicist and radiologist. Essentially, radiology departments will need to review CT machine parameters by exam and evaluate against image quality with the goal of lowering technique factors, and thereby lowering dose (on average) to patients. Of course, some may lower dose more than others, but the goal is for everyone to evaluate their exams and benchmark themselves against peers and diagnostic level standard levels.
Looking ahead, what do you think will play the biggest role in reducing dose in the next 5 to 10 years?
Honestly, I think it will be the combination of new quality/regulatory requirements and technology upgrades in image processing. Nothing moves the needle in the industry quite like new requirements that everyone must follow. While the Joint Commission is not a government organization, they have considerable influence over care planning, including radiology.
We now see that CMS has chosen to tie reimbursement to low dose CT via XR-29, and MACRA has draft quality metrics that will also influence reimbursement. These new requirements will help set the stage for providers to create their programs while manufacturers will always look for new ways to lower dose for patient exams. When you combine these, the biggest task will be regulators, manufacturers and healthcare providers working together to establish realistic goals and meet them.
Is there anything else you would like to share before AHRA?
The one thing that I have realized from speaking to many customers and healthcare providers is that this is still very new and lots of people are confused by the necessity, the requirements and, generally, how to approach this. More and more attention paid to radiation dose tracking, and, when you consider that it has never been part of patient medical records, it’s time we track and use this data as part of their care plan.
This text was edited for clarity and space.