2020 Health Physics Society Midyear Meeting & ExhibitionTAM-A
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| Chair(s): Kathy Held, Donald Miller |
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TAM-A.1 10:00 Gonadal Shielding During Abdominal and Pelvic Radiography. Strauss Keith J.*, University of Cincinnati School of Medicine; Gingold Eric L., Thomas Jefferson University; Frush Donald P., Stanford University School of Medicine kstrauss@xraycomp.com
Gonadal shielding during abdominal and pelvic radiography for adults and children has been considered good practice for more than 60 years. However, the efficacy of gonadal shielding has recently been questioned. Recent data on the limited effectiveness of gonadal shielding is presented for both males and females, but especially females. First, since automatic exposure control (AEC) capability of current equipment has replaced most manual techniques, the dose to the gonads and surrounding abdominal organs can increases when the shields cover the AEC sensors. In addition, the International Commission on Radiological Protection has revised tissue weighting factors with the colon, stomach, and bone marrow unchanged at 0.12 while reducing this factor for the gonads from 0.2 to 0.08. Thus, gonadal shielding and the impact of AEC is focused on protecting a less sensitive organ while actually increasing the radiation dose to more sensitive surrounding organs. Discontinuing a ‘good practice’ is difficult when patients and/or their parents, regulatory agencies, and medical professionals (radiologic technologists, physicians, medical and health physicists) expect consistency and tradition. This presentation includes recommendations and guidance on the actual merits of gonadal shielding for all relevant professionals. These individuals are custodians for patients and or their parents for understanding that their imaging experience is evolving to deliver the best possible care. |
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TAM-A.2 10:25 Patient Radiation Management in Interventional Fluoroscopy. Balter Stephen*, Columbia University sb2455@cumc.columbia.edu
Image guided interventional medical procedures often require fluoroscopy (FGI) for their completion. This can result in the delivery of substantial amounts of radiation to the patient. Radiation use poses a stochastic risk and may also induce tissue reactions. FGI patients are accepted for a procedure when the benefits of that procedure are expected to outweigh radiation and other risks. In almost all cases, radiation is a very minor contributor to overall procedural risk. Optimization involves complex interactions between patient characteristics, the capabilities of available fluoroscopes, and the operator. FGI differs from most imaging procedures (e.g. CT) in that the operator continually interacts with the fluoroscope during the procedure, and that changes in the patient’s condition will influence the operator’s options. Unfortunately, about ten major tissue reactions occur each year around the world. Most of these are not justified and are attributable to operator factors. NCRP Report 168 (Radiation Dose Management for Fluoroscopically-Guided Interventional Medical Procedures - 2010) and Statement 11 (Outline of Administrative Policies for Quality Assurance and Peer Review of Tissue Reactions Associated with FGI - 2014) provide necessary detailed guidance. Means for compliance with the 2019 Joint Commission standards for FGI dose tracking and action levels are also available from these documents. This presentation reviews key radiation guidance elements and present data demonstrating considerable radiation use reduction in the past decade. |
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TAM-A.3 10:50 NCRP Report No. 177: Radiation Protection In Dentistry And Oral & Maxillofacial Radiology. Lurie Alan G*, University of Connecticut School of Dental Medicine; Lurie Alan, University of Connecticut School of Dental Medicine lurie@uchc.edu
Diagnostic imaging is essential in dentistry. Doses range from low to very low, benefits to patients can be immense, and safe techniques are well known but widely ignored. Doses range from very low with properly executed intraoral, cephalometric and panoramic imaging to higher than Multidetector CT (MDCT) with Conebeam CT (CBCT). Benefits are substantial: imaged dental disease, often obscured from direct vision by size and anatomy, can pose a mortal threat to the patient. Additionally, imaging is often central in planning complex dental procedures. NCRP Report No. 177 addresses the methods by which safety and diagnostic efficacy in dentistry are maximized. Safe imaging in dental environments is straight-forward; the means for minimizing dose and maximizing diagnostic efficacy have been widely and inexpensively available for decades. Digital receptors and rectangular collimators, coupled with stable receptor holding and directional devices, reduce patient dose by some 80% over traditional techniques but are infrequently used. Digital panoramic equipment reduces doses markedly. For CBCT imaging, selection criteria are critical in defining appropriate fields of view and equipment presets. It is treacherous to discuss risk in oral and maxillofacial radiology. There are between one and two billion dental x-ray examinations annually, the majority being intraoral examinations, with steady increases in panoramic and CBCT. Radiation carcinogenesis from conventional imaging is unlikely, although large field-of-view, high-resolution preset CBCT can be comparable in carcinogenesis risk to craniofacial MDCT. Uncertainties in risk estimation from low doses, coupled with the huge numbers of dental images taken annually and the rapid growth of CBCT imaging dictate that safe oral and maxillofacial imaging is in the interests of patients, staff and the public. ALARA practices and LNT risk modeling continue to be prudent and appropriate. |
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TAM-A.4 11:15 Program Components for Error Prevention in Radiation Therapy. Sutlief Steven G*, Banner MD Anderson Cancer Center steven.sutlief@gmail.com
Considerable efforts have been made in recent years to refine principles of quality and safety in radiation therapy. The intent of this NCRP Statement project is to provide a short guidance document for external assessment of a radiation therapy department in terms of quality and safety. The Statement will be of value to external reviewers as a guide for quality and safety assessment, to radiotherapy departments as a source of practice improvement initiatives, and to facilities for the assessment of accreditation readiness. Three themes of the Statement are the assessment of documentation, metrics, and processes as indicators of quality and safety. Documentation is an essential tool for demonstrating quality and encompasses physician and physicist peer review, commissioning of new modalities and equipment, machine and patient quality assurance records, and policies and procedures. Metrics include staffing levels, participation in remote dosimetry programs such as by the IROC Houston Quality Assurance Center, incident reporting participation, and the presence of in-service continuing education. Process techniques that aid safety include time outs, sterile cockpit, and shared authority to halt a procedure. This document differs from quality and safety initiatives and reports from professional organizations in that its scope specifically targets external review. |
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TAM-A.5 11:40 The Role of the Conference of Radiation Control Program Directors and State Radiation Control Programs in Radiation Protection in Medicine. Bruedigan Lisa R.*, Texas Department of State Health Services (DSHS) Radiation Control Program; Winston John P., PA Bureau of Radiation Protection jwinston@pa.gov
The state radiation control programs regulate the use of radiation producing machines in medicine. The Conference of Radiation Control Program Directors (CRCPD) is a partnership of the state radiation control programs whose mission is to promote consistency in addressing and resolving radiation protection issues, encourage high standards of quality in radiation protection programs, and provide leadership in radiation safety and education. State programs are challenged with the exceedingly difficult task of maintaining regulations that adequately protect patients, workers, and caregivers as innovations in technology result in new ways to use ionizing radiation for improved diagnostic, interventional, and therapeutic purposes. The goals of CRCPD include providing up to date guidance and suggested state regulations on the safe use of ionizing radiation in medicine in an effort to assist the states with the development of standards and policy based on sound science and professional consensus. |
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TAM-A.6 12:05 Evaluating and Communicating Radiation Risks for Studies Involving Human Subjects: Guidance for Researchers and Institutional Review Boards. Timins Julie K*, NCRP; Timins Julie julietimins@gmail.com
Because of the need for a comprehensive approach guiding human studies research involving radiation, the NCRP (National Council on Radiation Protection and Measurements) developed a guidance document: “Evaluating and Communicating Radiation Risks for Studies Involving Human Subjects: Guidance for Researchers and Institutional Review Boards.” This report is targeted to those developing research protocols and to members of Institutional Review Boards (IRBs). There are widely varying levels of knowledge about ionizing radiation and radiological procedures among members of the public, medical professionals, and even among radiologists. The report addresses these knowledge gaps, starting with a history of international and national guidance on human studies research in general, and specifically research involving ionizing radiation. The fundamental principles of Radiation Biology are discussed, the basic quantities and units used in describing radiation dose are defined, and the basic principles of Radiation Protection are presented. Regulatory requirements for research are summarized, with links to the relevant regulations in the Reference section. Imaging modalities and image-guided interventional procedures are described, including which do and which do not employ ionizing radiation. There is discussion of radiation therapy and radionuclide therapy. The need to distinguish between the radiation related to the research protocol and radiation encountered in standard patient care is examined. Estimation of radiation dose and radiation risk, and optimization of radiation dose are addressed. There is a discourse on Ethics in Human Studies Research, followed by the elements necessary for informed consent. |