Developing an Action Plan for Patient Radiation Safety in Adult Cardiovascular Medicine: Proceedings From the Duke University Clinical Research Institute/American College of Cardiology Foundation/American Heart Association Think Tank Held on February 28, 2011
The following are 10 points to remember about this conference report.
1. Technological advances and increased utilization of medical testing and procedures have prompted greater attention to ensuring the patient safety of radiation use in the practice of adult cardiovascular medicine.
2. The biological effects of ionizing radiation fall into two broad categories. Deterministic effects predictably occur above certain thresholds of absorbed dose to a specific tissue and include skin erythema, epilation, and possibly even direct cardiac toxicity. Stochastic effects are those in which radiation causes damage that may result in a malignancy, usually at a much later time.
3. Approaches to patient radiation safety must be lifelong and not confined to simply reducing the exposure during a single test or procedure. Tests and procedures utilizing radiation should be performed in the right patient, for the right reason, at the right time, and alternatives to radiation should be considered.
4. There are many opportunities to reduce variability in the performance of procedures that use ionizing radiation for guidance, such as patient shielding during fluoroscopic procedures, reduction of fluoroscopy and cineangiography procedural times, and image processing techniques to eliminate unnecessary duplicated images and radiation exposure.
5. Sustained education and quality improvement programs can lead to meaningful radiation dose reduction. Such programs should recognize the opportunity to engage not only imagers, but also ordering physicians in efforts to achieve population dose minimization through education on test and procedure selection.
6. Mandatory annual online training on basic radiation safety techniques for health care professionals involved in the ordering or performing of medical procedures using ionizing radiation is recommended.
7. Health care providers need to help patients understand the benefits of cardiovascular imaging and minimize situations where patients avoid potentially life-saving procedures because they involve ionizing radiation.
8. Every effort must be made to keep the dose As Low As Reasonable Achievable (ALARA) while at the same time keeping the benefit from diagnosis and optimal management As High As Reasonably Achievable (AHARA).
9. Continuing the progress on improving radiation safety as it relates to cardiovascular medicine will require the efforts of numerous stakeholders in health care, government, and patient advocacy.
10. It is only through focused attention on an improved understanding of the scientific and technical considerations related to radiation exposure and practical application of these principles in the day-to-day care of patients that radiation safety will be improved.
Keywords: Quality Improvement, Fluoroscopy, Safety, Radiation, Ionizing, Patient Advocacy, Erythema, Patient Safety, Radiation Dosage, United States, Cineangiography
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