WPM-D - Special Session: Health Physicis Evolution in Medical Physics Enterprise Centennial Ballroom 300D 14:30 - 15:30
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| Chair(s): Ronald Leuenberger
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WPM-D.1
14:30 Health Physics Evolution in Medical Physics Enterprise RD Leuenberger*, Louis Stokes VA Medical Center
Abstract: Medical physics enterprise using a network of advanced technology platforms reflects the modern evolution of healthcare. Health physics is evolving with medical physics enterprise to enhance quality assurance, patient radiation protection and occupational safety. As healthcare systems continue evolving into larger networks using advanced software integrated with electronic health records; the lines of delineation between health physics and medical physics diminish.
This special session will describe evolutionary changes underway within the Veterans Health Administration (VHA) to establish a medical physics enterprise encompassing advanced software platforms with dose registry and the impact of these evolutionary changes on the responsibilities of the Radiation Safety Officer (RSO).
Advanced software platforms allow enterprise applications for American College of Radiology (ACR) physics testing, improved quality assurance for diagnostic imaging and machine learning for the improved diagnosis of disease.
Radiation Safety Officer (RSO) originates from Nuclear Regulatory Commission licensing for use of radioactive materials. In the medical setting, RSO responsibilities extend to occupational radiation safety from machine sources of ionizing radiation and patient radiation safety. Medical physics enterprise and advanced software platforms with dose tracking and dose registry are transforming RSO roles and responsibilities.
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WPM-D.2
14:45 Enterprise Applications for Medical Physics: Past, Present & Future RD Leuenberger, RSO, Supervisor for Radiation Safety
; RE Misseldine*, ARSO
Abstract: Abstract:
The VA North East Ohio Healthcare System (VANEOHS) has adopted and grown various medical physics initiatives that aim to increase Joint Commission compliance and improved metrics for QA/QC. This presentation aims to outline past, present and future enterprise applications employed by the VANEOHS and partner sites.
Past: Joint Commission passed requirements to provide dose tracking metrics for CT and Fluoroscopy procedures. The VANEOHS responded by implementing a local dose tracking program. Successful implementation resulted in regional and national dose tracking initiatives with partner sites throughout the VA healthcare system. VA Radiation Dose Network (VARDN) was the first enterprise medical physics model employed by Cleveland VA.
Present: The VANEOHS operates multiple enterprise medical physics modules. Current systems include VARDN national initiatives using Philips Dosewise, Regional (i.e. VISN) initiatives aggregating radiation dose using AGFA Dose Monitor, National Innovators initiative using AGFA Dose Monitor to create a VA Radiation Exposure Monitoring (REM) national registry.
VANEOHS utilizes various enterprise software and hardware including dosimetric infusion systems, electronic hot lab dose management, enterprise dosimetry, enterprise training software, etc. Aspects of selection, implementation and integration will be discussed.
Future: The VANEOHS plans to continue future initiatives in supporting enterprise medical physics. Several diagnostic imaging QC/QA platforms are currently under review. Requirements and recommendations vary throughout various diagnostic imaging modalities and their respective accrediting bodies.
The goal of enterprise QC tracking is to maximize automated QC evaluation, compliance, portability of care and enterprise access to relevant QC tools for technologists, physicians, physicists, and ensure quality of care for the veterans we serve.
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WPM-D.3
15:00 Medical Physics Enterprise - VHA Radiation Exposure Monitoring (REM) Registry RD Leuenberger, RSO, VA Northeast Ohio Healthcare System (VANEOHS)
; RE Misseldine, ARSO, VA Northeast Ohio Healthcare System (VANEOHS); AT Dietz*, VA Northeast Ohio Healthcare System (VANEOHS); D Jordan, Chief Medical Physicist, University Hospitals of Cleveland
Abstract: The VANEOHS Cleveland VA Medical Center has established the VHA Radiation Exposure Monitoring (REM) Registry. It compares device performance of diagnostic imaging equipment dose metrics locally and nationally. Performance can also be evaluated by device, manufacturer, and model. These quality measures will ensure safe, high-quality imaging with optimum patient care.
The REM Registry involves the aggregation of patient dose information within a network of virtual servers. Diagnostic imaging equipment (e.g., computed tomography, fluoroscopy) deliver radiation dose structured reports (RDSR) used for patient dose tracking and these RSDRs are also shared with the REM Registry. The Registry allows for the sharing of patient dose information across various dose tracking software platforms and advanced software platforms applied to quality assurance. Dose tracking is the backbone of the REM Registry. In order to have a registry, data must first live inside a dose tracking application.
The VA Radiation Dose Network (VARDN) is the mechanism for medical physics enterprise at the Cleveland VA. VARDN supports enterprise dose tracking for several Veterans Integrated Services Networks (VISN’s) in addition to the REM Registry. The VARDN medical physics enterprise is accomplished through the support of medical physicists and health physicists. The traditional role of RSO is evolving along with the advances in technology.
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WPM-D.4
15:15 Evolving Role of Radiation Safety Officer DW Jordan*, University Hospitals Cleveland Medical Center, Case Western Reserve University
Abstract: Large integrated care delivery systems are the future of healthcare in the United States. The VA Healthcare system can serve as a model for evolving practices that will become widespread due to consolidation in public and private healthcare systems. One of the benefits of large enterprises is economy of scale, and a powerful opportunity in the enterprise model is use of software to collect vast quantities of data and to use automation to simplify its interpretation. Automation can also be used to monitor events or even to trigger them.
In the midst of the uncertainty and change associated with consolidation and evolving practice and business models, medical physicists and health physicists must examine how their contributions fit into the larger healthcare ecosystem. For radiation safety professionals to be clinically relevant, we must evolve from creating and monitoring lag indicators of quality (audits, inspections, reactive policies, etc.) to being the drivers of high performance. Driving performance in an enterprise medical physics program means adapting current and future technologies to such tasks as: identifying major quality issues prior to the completion of an exam; predicting equipment failures (MRI magnet quench or CT tube failure) prior to the event happening based on trends in QC performance; and brokering relevant physics data to health care providers to make data-informed decisions to improve outcomes for patients. Compliance with regulations is often used as a proxy for quality and safety, but they are not the same thing.
Radiation Safety Officers are uniquely positioned to drive enterprise medical physics implementation. They interface with multiple clinical services and with executive administration. They have established systems and processes for collecting data - although these usually require further integration and automation to be useful for enterprise performance management. They understand the physical processes, measurements, and instrumentation that produce the data. Their knowledge, skills, tools, and frameworks are readily adaptable to other safety and performance needs in healthcare, such as laser and MRI safety.
Professionally, the RSO's traditional role has been primarily to play defense - to prevent or respond to breaches of compliance, with a focus on protection standards, radiation dose limits, and required and restricted actions. While many of these measures impact the safety of patients, the primary focus has historically been on occupational protection of physicians, technologists, and other healthcare personnel.
The evolution of the RSO will require a shift in focus to encompass the entire system of care delivery: patients, staff, and the public, as well as the facilities, equipment, and other resources involved. The RSO and physics team must develop a game plan to play offense - driving performance above the levels needed to achieve compliance, to improve and ultimately optimize patient care. The scale of enterprise healthcare delivery systems will provide the platforms to conduct mass data collection, analytics, and automation to improve patient care.
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