RSNA 2016: What’s up with the new Joint Commission regulations?

Lion and zebra, fox and the hare, Joint Commission and hospital—all classic rivalries. However, a Tuesday, Nov. 29, presentation at RSNA 2016 featured a Joint Commission member and a practicing medical physicist reaching across the aisle in the name of compliance in an imaging department.

Tyler S. Fisher, MD, of Therapy Physics in Los Angeles, outlined the Joint Commission’s two new focuses: justification and dose optimization.

“Justification is being able to say the procedure does more good than harm, a pretty basic idea for imaging services,” Fisher said. “The trick is we’d like to document that, and know where the level of harm is.”

While practices are directed to follow standards made public by a federal or accreditation agency, the alphabet soup of oversight can make it hard to know whose standards to follow.

“It’s up to you to write your own policies, what you find is helpful,” said Fisher. “The key is documenting whose standards you are using to create your policies.”

For example, many policies at a mammography center likely come from the American College of Radiology standards, and properly recording that influence can help during a Joint Commission inspection.

Dose optimization starts with encouraging physicians to order studies that consider the benefits of the scan versus the risk of the radiation. Dose tracking and notification alerts are another plus, but the traditional method of tracking fluoroscopy time has significant holes, according to Fisher.

“It’s a poor indicator of dose,” Fisher said. “I test a lot of cath labs, and the cine exposure might be 50 times higher than a flouro exposure, but it still counts as one second of flouro time in the rolling clock.”

A dose-area-product display is a much better practice, explained Fisher, and required for any fluoroscopy devices made after 2006.

Fisher was followed by Andrea Browne, PhD, a longtime medical physicist who works in the Joint Commission’s engineering department. Browne walked the audience through the Commission’s tracing process and highlighted common mistakes made by imaging practices.

Inspectors will often pick a patient and shadow them through their visit to an imaging department, starting with the waiting room where they assess security and the public environment of the practice.

If the patient is receiving imaging they’ll follow them into the procedure room where important determinations about imaging safety are made, according to Browne.

“How access to procedure rooms is controlled, infection control on scanners, life safety standards—they are looking at all of these,” said Browne.

The most common violation for radiology departments is the improper handling of hazardous materials and waste, which accounts for both ionizing radiation equipment and any nuclear medicine technology. According to Fisher, proper labeling of materials along with a documented, standardized workflow can reduce these citations.

“From the guy delivering at the loading doc, to when its injected, to when the patient leaves, you need to have a policy about what you’re doing with the material.” said Fisher. “A patient gets a scan, they go up to their room, they throw something away…especially with kids. It’s dirty diapers—I do not want to get a phone call that I have to go search for a hot diaper.”

Read more about the Joint Commission’s changes for providers of diagnostic imaging services.