Controlling Dose in the Emergency Department

Over the previous decade, radiation dose exposure has fallen precipitously. However, when you are asked to make split-second choices in the emergency room, it could sometimes still be difficult to make the alternatives that will limit exposures.

In his presentation in the course of the American Society of Emergency Radiology 2020 annual assembly, Mahadevappa Mahesh, M.S., Ph.D., chief physicist at The Johns Hopkins Hospital and professor of radiology and radiological sciences at Johns Hopkins Medicine, outlined a number of steps emergency radiologists can take to make sure you are controlling dose in your patients.

Controlling Dose in the Emergency Department

“We need to be sure that the people who are ordering the imaging understand the risks and benefits of imaging,” he informed Diagnostic Imaging.

Since 2010, Mahesh mentioned, CT dose publicity has fallen by almost 20 %. The use of extra advanced medical imaging technologies and greater dose awareness campaigns can largely be credited for this success, as can provider education round optimizing imaging protocols. These are all vital achievements, he mentioned, because within the emergency room, imaging should never be declined or denied with the scientific appropriateness may be very high.

“One shouldn’t hesitate to do medical imaging, corresponding to CT, X-ray, or fluoroscopy as a result of they bring a lot of value,” he mentioned. “However, in the emergency room, there is always a priority when we are ordering large imaging studies.”

Consequently, Mahesh shared a number of suggestions you can use to ensure that you’re controlling the exposure and optimizing protocols.

Have a Good Team: For these “in-the-moment” choices about how much radiation dose you must actually use with a patient in an emergency situation, Mahesh mentioned, you must be sure you have the fitting folks in your staff. Along with you and your colleagues, however positive to incorporate two different individuals – a medical physicist and a technologist who evaluations the protocols on an annual foundation to make sure you’re utilizing the fitting protocols. This staff also needs to adapt all dose optimization methods to the protocol. That is especially essential with CT, he mentioned, as they need to take note of using modulation techniques.

Track Scan Utilization: As much as possible, maintain tabs on the scans you might be conducting. Monitor whether you might be performing too many scans or repeating scans. Doing so will make it easier to control utilization when – and if – it’s necessary, he mentioned.

Forego Lead Aprons: Though using a lead apron with patients has long been thought-about a protection strategy against radiation exposure, that paradigm is shifting, Mahesh mentioned, significantly with gonad shielding in CT and X-ray. Foregoing their use can help you avoid duplicate research.

“Now a day we are advocating to keep away from placing the shield on the during imaging,” he mentioned. “The American Affiliation of Physicists in Medicine got here up with a position statement that it’s now advocating that it’s not important to make use of the lead shield, it may even be contraindicated. It could actually obscure objects within the path of the beam.”

As well as, he mentioned, the lead apron can get shifted around, doubtlessly interfering with the picture of high quality, forcing you to repeat an image.

General, Mahesh mentioned, you because the radiologists should focus efforts on being sure you and your colleagues are the suppliers who convey information to patients about radiation dose.

“The radiation dangers should be defined or communicated by people who find themselves knowledgeable about each the advantages and the dangers of the imaging,” he explained.