An open letter to the x-ray imaging community from the American Association of Physicists in Medicine (AAPM)

August 19, 2019
An open letter to the x-ray imaging community from the American Association of Physicists in Medicine (AAPM)

Since April of 2019, there has been considerable discussion about the use of patient gonadal and fetal shielding in diagnostic x-ray imaging, prompted primarily by the publication of a position statement on this topic by the AAPM. The AAPM position statement reflects the growing consensus among medical physicists that the routine use of patient gonadal and fetal shielding, once a mainstay of patient radiation protection, may no longer be best practice for protecting our patients. Since its release, the AAPM statement has been endorsed by the American College of Radiology, the Canadian Organization of Medical Physics, and the Health Physics Society.

The AAPM statement was intended to be the beginning of a much larger conversation, one that includes many other stakeholder organizations and individuals. Its purpose is to educate the imaging community that these shields provide no tangible benefit to patients, slow down workflow, and in a small number of cases, compromise an exam by blocking important patient anatomy or increase patient dose when detected by an automatic exposure control system.

While science can lay the groundwork, facilitating a data-driven discussion, any meaningful dialogue about potential changes to clinical practice must include all members of the medical imaging community. Radiologic technologists, medical physicists, health physicists, radiologists, and regulatory agencies are all committed to the same goal – the safe and effective use of medical imaging. Each member of the imaging community brings a unique and valuable perspective to this discussion, all of which must be considered as potential changes to clinical practice are contemplated.

To help facilitate these discussions, [Continue to full letter]

Utilization of a Radiation Safety Time-Out Reduces Radiation Exposure During Electrophysiology Procedures

AnthonyAizer MD, MSc; Jessica K. Qiu BS; Austin V.Cheng BS; Patrick B. Wu MD; Douglas S. Holmes MD; Steven R. Wagner MS; Scott A. Bernstein MD; David S. Park MD, PhD; Barbara Cartolano RN; Chirag R. Barbhaiya MD; Larry A. Chinitz MD

This study sought to determine whether a radiation safety time-out reduces radiation exposure in electrophysiology procedures.
Time-outs are integral to improving quality and safety. The authors hypothesized that a radiation safety time-out would reduce radiation exposure levels for patients and the health care team members.
The study was performed at the New York University Langone Health Electrophysiology Lab. Baseline data were collected for 6 months prior to the time-out. On implementation of the time-out, data were collected prospectively with analyses to be performed every 3 months. The primary endpoint was dose area product. The secondary endpoints included reference point dose, fluoroscopy time, use of additional shielding, and use of alternative imaging such as intracardiac and intravascular ultrasound.
A total of 1,040 patient cases were included. The median dose area product prior to time-out was 18.7 Gy∙cm2, and the median during the time-out was [Read more…]

Radiation dose to the paediatric undergoing diagnostic coronary angiography and percutaneous intervention procedures

M. Abuzaid; A. Abdelrazig; A. Sulieman; M. Alkhorayef; E. Babikir; B. Alonazi; D. A. Bradley

•Pediatric radiation dose is a critical issue and should be optimized.

•Radiation dose benchmark guideline should be available to achieve ALARA.

•Monitoring of radiation dose and awareness improvement among healthcare workers.

Successful diagnostic and clinical outcomes in use of interventional cardiac imaging procedures make them strong choices in dealing with cardiovascular disease. Interventional procedures in developing countries are now growing markedly, increasing with the availability of equipment and trained staff. Present study in Sudan has examined pediatric radiation doses during Diagnostic Coronary Angiography (DCA) and Percutaneous Intervention Procedures (PCI), identifying relationships leading to high values, in particular with patient characteristics and exposure parameters. Retrospective data analysis from DCA cases (n = 9) and PCI (n = 48) examined patient-based characteristics, exposure parameters and the Kerma Area Product (KAP). For DCA and PCI, the mean KAP and fluoroscopic time were 4372.4 ± 3190.1 and 3877.6 ± 1249.1 cGy cm2 and 5 ± 4.7 and 5.3 ± 3.6 min respectively, with correlations between KAP and weight and KAP and fluoroscopic time of r = 0.91 and r = 0.71 respectively. The radiation dose for children during DCA and PCI is a critical issue, avoidable radiogenic risk, needing to be mitigated through optimization.

Cardiac catheterizationPediatric imagingRadiation doseEffective doseCoronary angiography PCI

1. Introduction
Cardiac catheterization [Read more…]

Simple preoperative radiation safety interventions significantly lower radiation doses during central venous line placement in children

Beatrix Hyemin Choi, Kamalou Yaya, Vinay Prabhu, Nancy Fefferman, Beverly Mitchell, Keith A Kuenzler, Howard B Ginsburg, Jason C Fisher, Sandra Tomita

The purpose of this study was to reduce radiation exposure during pediatric central venous line (CVL) placement by implementing a radiation safety process including a radiation safety briefing and a job-instruction model with a preradiation time-out.


Sample time-out checklist used in the study

We reviewed records of all patients under 21 who underwent CVL placement in the operating room covering 22 months before the intervention through 10 months after 2013–2016. The intervention consisted of [Read more]

Update: Image Gently and Nuclear Medicine at 10 Years

S. Ted Treves, MD; Michael Gelfand, MD; Marguerite Parisi, MD, MS Ed; Michael Lassmann, PhD; Marilyn Goske, MD; Briana Sexton-Stallone; and Frederic Fahey, DSc

Nuclear medicine offers well-established and valuable clinical diagnostic instrumentation and techniques in several disciplines, including urology, neurology, orthopedics, and oncology (1). Although radiation exposure from nuclear medicine studies is on par with (and often lower than) that of other medical imaging procedures, it is still prudent to limit the amount of radiation exposure to the lowest amount possible without reducing its diagnostic capability. This is particularly relevant in children because their longer life span and developing tissues may be more sensitive to the effects of ionizing radiation (2). It is also essential to be prepared to communicate the potential benefits as well as risks of each procedure with our patients and their families (3). The Image Gently Alliance was formed in 2007 to help change practice and raise awareness about radiation exposure from medical imaging in children. This effort included the dissemination of free educational materials to patients, parents, and health care providers. The group’s mission remains: ‘‘through advocacy, to improve safe and effective imaging care of children worldwide.’’ During the past decade, the Nuclear Medicine Working Group of the Image Gently Alliance has been coordinating efforts toward [Read more here: J Nucl Med-2019-Treves-7N-9N]