Unnecessary radiation exposure and radiation burns during diagnostic radiology procedures are ranked No. 3 on the ECRI Institute’s top 10 list of medical/technology hazards. A few of the other hazards listed, while not specific to radiology, are related to the field.
The quality of radiology procedures that use ionizing radiation often depends on the amount of radiation used — the higher the dose, the clearer the images. In addition, the ease at which many of these tests can be done may increase their use, even if other, non-radiation exposing tests may be as appropriate. These higher levels of radiation exposure by dose or by incidence can add up cumulatively, increasing cancer risk and, in some extreme situations, resulting in radiation burns, according to ECRI.
For this reason, the group suggested that certain questions be asked before ordering tests that use ionizing radiation:
• Is there another test that does not require ionizing radiation that would be as appropriate?
• If this is a repeat test, is it really necessary?
• Is the ALARA principle in use, using doses that are “as low as reasonably achievable” to acquire the desired diagnostic information?
• Are the screened areas limited to the area that must be screened?
• With fluoroscopic procedures, are skin dose levels being tracked?
In 2012, exposure to radiation therapy and CT ranked No. 2 on the top 10 list.
Adopting the Image Wisely campaign, an initiative of the American College of Radiology, the Radiological Society of North America, the American Association of Physicists in Medicine , and the American Society of Radiologic Technologists, would help facilities lower the amount of radiation used in medically necessary imaging studies and eliminate unnecessary procedures, the institute stated. Similarly, the Image Gently campaign, initiated by the Alliance for Radiation Safety in Pediatric Imaging, aims to increase awareness of the opportunities to promote radiation protection in the imaging of children.
Other hazards on the list are not limited to diagnostic radiology but do affect the industry:
• Patient/data mismatches in electronic health records (EHR) and other IT systems, which can lead to the wrong patient receiving the wrong diagnosis and treatment;
• Interoperability failures with medical devices and health IT systems, which could mean system or management incompatibilities; and
• Inattention to the needs of pediatric patients when using “adult” technologies, seen when adult doses may be used for pediatric diagnostic testing.
The hazards met one or all of the following criteria: it has resulted in injury or death; it has occurred frequently; it can affect a large number of individuals; it is difficult to recognize; it's had high-profile, widespread news coverage.
The ECRI complements its annual hazards list with a web-based Health Technology Hazard Self-Assessment Tool, which provides a facility or department risk factor ratings of low, medium, or high related to each of the Top 10 hazards, as well as facility- and department-specific recommendations. This tool allows for prioritizing of efforts to address the hazards.