Radiation Dose & Safety

As part of its ongoing commitment to ensuring safe, appropriate and effective medical imaging and radiation therapy, MITA supports the following principles to reduce exposure to unnecessary radiation.

• Expanding and integrating appropriateness criteria into physician decision-making.
• Creating a national dosage registry to ensure longitudinal tracking of dose levels for patients across America.
• Adopting a standardized method of storing of diagnostic imaging and radiation therapy information within electronic health records.
• Exploring the expansion of mandatory accreditation for advanced imaging facilities.
• Establishing minimum standards for training and education for hospital and imaging facility personnel who perform medical imaging exams and deliver radiation therapy treatments.
• Develop enhanced operational safety procedures and checklists to reduce medical errors.
• Expanding and standardizing the reporting of medical errors associated with medical radiation across stakeholders in a manner that is transparent for patients, families and physicians.

Manufacturers have long supported ways to reduce medically unnecessary radiation dose exposure.  MITA joins the imaging community in championing the ALARA principle, which stands for “as low as reasonably achievable. This is a universally adhered to principle of radiation dose management and optimization incorporated into all imaging procedures and technologies and is mandated by nearly all regulatory bodies and licensing agencies, including the Nuclear Regulatory Commission.  This foundational industry consensus principle to minimize and optimize radiation exposure demonstrates the commitment of all involved parties to patient dose concerns, both in the short and long term.  MITA members have also involved with Image Gently in development of targeted training on pediatric CT.

MITA has also taken action to expansively address patient safety in medical imaging.  MITA’s Computed Tomography (CT) and Radiation Therapy (RT) members have each taken the lead on separate industry-wide initiatives to develop and implement additional patient protection features for CT and RT equipment.

CT Dose Check Initiative

An unprecedented commitment to further ensure that scans are safe and effective, CT manufactures will be introducing features on new machines and on equipment in the installed base that will:

• Reduce cumulative dose by deploying additional notifications on CT machines so operators know when recommended radiation dose levels will be exceeded; and
• Reduce medical errors by adding additional dose alerts that can be configured to prevent CT machines from scanning if certain dose levels are exceeded.
• Record dose information consistently to facilitate longitudinal tracking of dose levels for each and every patient.

In applauding MITA’s initiative, The Alliance for Radiation Safety in Pediatric Imaging, which leads the Image Gently campaign to reduce radiation dose to children who undergo medical imaging exams said: “We need to ensure that all imaging exams that use medical radiation are performed in the safest way possible,” said Marilyn Goske, MD, Chair of the Alliance and Professor of Radiology at Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio. “The safeguards proposed by MITA represent a major step forward in managing radiation dose during CT scans performed on children, who are much more sensitive to radiation than adults.”

Radiation Therapy Readiness Check Initiative

Together with the Advanced Medical Technology Association (AdvaMed), MITA recently announced the Radiation Therapy Readiness Check Initiative, to develop and implement additional patient protection features for radiation therapy equipment.  These features will confirm that patient treatment plans are delivered as intended, and that radiation therapy equipment, accessories, and patients are properly positioned prior to delivery of therapy.

The Radiation Therapy Readiness Check Initiative will provide technologists, physicists and physicians additional checkpoints to enable radiation therapy procedures to be performed correctly.  The initiative includes the following:

• Radiation Therapy Pre-Treatment Quality Assurance Verification and Approval Treatment plans are initially approved and subject to quality assurance (QA) by authorized professional personnel (e.g., physician, assigned medical physicist) before the device can deliver the treatment.  With the new verification, if the system has not recorded a QA approval for an initial and/or modified treatment plan, the machine will not run until authorized professional personnel acknowledge that the QA check is complete.
• Verification of Beam Modifying Accessories Beam modification techniques are essential to focusing medical radiation to kill cancer cells while minimizing damage to surrounding tissues.  The enhanced beam modification check verifies the correct placement of appropriate beam modifying accessories (e.g., wedges, blocks, compensators, etc.) and prevents a machine from operating if the accessories are incorrect, missing, or out of place.
• Patient Positioning Confirmation Enhancements to the treatment system will generate a visual representation of the planned relative positions of the patient and the treatment device to allow the operator to quickly compare with the patient’s actual position.  The operator can confirm visually that the patient is positioned as intended in the treatment plan.  The operator will then have to enter a confirmation of a positive comparison.

In concert with these initiatives, MITA convened a stakeholders meeting including physicians, physicists, industry and FDA officials to discuss ways to prevent future medical errors that involve radiation. MITA members also co-sponsored the American Association of Physicists in Medicine’s CT Dose Summit to further the education of providers and physicists on the new technologies our member companies have developed and are manufacturing.