Patient Safety: Optimizing Doses to Reduce Radiation Exposure

As we head into the month of March it's time for Patient Safety Awareness Week.

Yes…it’s that time of year when healthcare organizations from around the world join forces to encourage and promote safe care. While, as with you, optimal patient safety is a year-round concern for Jubiulant Radiopharma Radiopharmacies Division, it is nice to have a dedicated time set aside to re-focus on this most critical priority of our profession.

One aspect of patient safety that we have emphasized with our healthcare partners in recent years has been on the importance of optimizing doses to reduce radiation exposure. Best practice standards in nuclear medicine today require practitioners to reduce the risk of avoidable exposure of radiation — both to their patients and to themselves — by adhering to the ALARA principle (As Low as Reasonably Achievable). These standards, which are required by the Nuclear Regulatory Commission, specify that, in nuclear medicine and molecular imaging procedures, the diagnostic or therapeutic dosage should be optimized so that the patient receives the smallest possible activity from a radiopharmaceutical while maintaining effective image quality or therapy to meet clinical expectations.

So what does this mean in our daily practice of nuclear imaging?

In recent years, broad industry support has coalesced around even tighter regulations with regards to patient radiation exposure. Specific recommendations endorsed by leaders throughout the nuclear medicine profession include the following:

  • Decrease patient radiation exposure to less than 9 mSv per entire study in 50 percent of patients.1,2

  • Implement “half time/half dose” software-aided imaging methods, incorporating iterative reconstruction, resolution recovery, and noise modulation, that cope with lower cardiac SPECT counting statistics and thereby provide excellent image quality despite reduced injected radiopharmaceutical activities.3,4

  • Implement new hardware methods, including cardio-focused collimation and solid state detectors that provide excellent image quality despite reduced injected radiopharmaceutical activities.3,4

  • Replace traditional “weight-based” dosing, in which injected radiopharmaceutical activity is increased in larger patients, with prolonged SPECT acquisition times (as tolerated by the patient) to achieve equivalent myocardial count density scans.3,4

Broad industry support has also coalesced around the Image Wisely® Nuclear Medicine Initiative, which urges providers to perform nuclear medicine procedures only when clinically indicated; to individualize the radiation dose based on the specific clinical task; to employ maneuvers to minimize radiation dose; and to familiarize themselves with recommended administered activities. Similarly, the Image Gently® campaign provides clear guidelines designed to increase radiation protection in the imaging of children.

In fact, as of July 1, 2015, The Joint Commission has put forth additional standards that address radiation exposure; not only to patients, but also to employees as well. Specifically:

  • Elements of Performance for EC.02.02.01 addresses radiation exposure in employees;

  • Elements of Performance for HR.01.05.03 addresses staff awareness and knowledge of radiation dose optimization techniques and tools for pediatric and adult patients, further bolstering guidelines put forth in the Image Gently® and Image Wisely® campaigns;

  • Elements of Performance for PC.01.02.15 mandates that the organization documents, in the patient’s record, the radiation dose index (CTDIvol, DLP, or size-specific dose estimate [SSDE]) on every study produced during a diagnostic computed tomography (CT) examination. The radiation dose index must be exam-specific, summarized by series or anatomic area, and documented in a retrievable format.

Luckily, for those of us striving to meet and exceed these standards on a daily basis, several easily accessible tools are available to help practitioners evaluate recommended dose activity. Specifically, in addition to the RADAR Medical Procedure Radiation Dose Calculator and Consent Language Generator, a Nuclear Medicine Radiation Dose Tool is available through the Dose Optimization section of the SNMMI website. (As always, you should consult a medical physicist to determine a patient’s specific exposure from a radiopharmaceutical administration.)

Patient Safety Awareness Week also provides a good opportunity to remind you that we are “United for Patient Safety”. Our nuclear pharmacists are specialists in the preparation and optimization of radiopharmaceutical doses. If you would like, we can arrange a time to visit your department; to observe how doses are stored, manipulated and administered; and to subsequently advise your team on additional ways to optimize dose utilization.

For more information on best safety practices, visit  our Education section. In addition to our Jubilant Radiopharma, Radiopharmacies Division Quality & Safety Pledge, our Educational Information Resources series includes information on Dose Optimization, Syringe Shield Protection, FDA-Approved Radiopharmaceuticals, Dose-Splitting, and much more.

Citations

1. DePuey, EG. Moving Awareness to Action in Nuclear Medicine Dose. Imaging Technology News. September 2013. 

2. Cerquiera MD et al, Recommendations for reducing radiation exposure in myocardial perfusion imaging. J Nucl Cardiol, May 2010. 

3. DePuey EG et al. Patient-Centered Imaging: ASNC Preferred Practice Statement. J Nucl Cardiol, March 2012, in press. 

4. DePuey EG. Advances in SPECT camera software and hardware: currently available and on the horizon. J Nucl Cardiol, 2012, in press.