Patient Safety in Medical Imaging, Research Paper Example

Abstract

This paper examines the patient safety aspects of radiology and that of medical imaging. The safety issues are identified together with the risks and precautions that are taken in order to avoid over exposure to radiation. Quality Assurance measurement tools are considered as one aspect of patient safety measures. The paper is structured into three distinct sections: Section 1 – Introduction and background: outlines the safety issues and concerns Section 2: – An examination of Preventative measures and quality assurance measurement techniques Section 3: – Summary and conclusions

Introduction and Background

In April 2006 research released from the ‘healthgrade’ report examined 40 million Medicare reports between the periods 2002 to 2004.  From this research it was discovered that some 1.24 million patient safety incidents had been reported. This impact extended to that of Radiology departments. (Bell, 2011). Patient safety issues in Radiology departments are similar to that of other health departments and include such items as failing to adequately supervise patients or leave them unattended, being negligent, human error and that specific to the department like radiation exposure and magnetic image resonance safety.

To a certain extent the radiology department staff must expect human error and accidents to occur. The emphasis should be placed upon prevention and minimising the risk of such events taking place.  This is best accomplished by examining the problem through the eyes of the patients. From that analysis putting appropriate health and safety measures in place to address the specific areas of concern.  For example: care in organising drug cabinets, wheelchair and stretcher maintenance, ease of getting onto procedure tables etc. The emphasis being on designing processes that make it difficult for humans to perform errors.

The University of Virginia Health Department has adopted a ‘Radiology Patient Safety Committee’ and this approach of committee based management has had considerable success in the adoption of method approach to patient safety.  One of the most important accomplishments was the improvement of communications and as such raising the awareness of patient safety.  This holistic approach has been very successful in obtaining better patient / hospital staff interaction. They have introduced many posters throughout the area that describe the instructional procedures for how to lock and lower stretchers, patient safety goals etc. Statistics have shown that this has resulted in a reduction of patient falls by up to 50%. (Bell, 2011).

Preventative Measures

One of the important factors when carrying out X Ray procedures is for the radiologist to have full access to the patients clinical records in order to understand any potential issues that might have an impact on the routine being carried out – “Dr. Khorasani[1] said that doing the right things right also requires understanding patient clinical profiles. “In many instances, radiologists need to have the patient’s medical history—medication allergies, IV contrast allergies, medical conditions, cardiac and renal status, and the reason for the current test. This not only improves medical safety, but it also can help produce higher quality radiology reports,” he said.” (Curtis P. Langlotz, 2011).

The World Health Authority (WHO) defined a quality assurance program in diagnostic radiology as being “ A facility to ensure that diagnostic images produced are of sufficient quality to provide adequate diagnostic information at the lowest possible cost and least risk of exposure of radiation to the patients” (IAEA, 2010). In order to accomplish this a radiological facility must ensure measurement of the ‘physical parameters of radiation generators and imaging devices’. In addition, ensure appropriate verification of ‘physical clinical factors in patient diagnoses. A good quality program would embrace such factors as: (1) good written records of procedures and their results (2) verification of calibration and dosimetry monitoring equipment (3) regular quality audits of the program. The administrative component should include the assignment of responsibility for carrying out QA actions. This to include the introduction and establishment of suitable standards and training in the appropriate equipment being used.

The UK is an example of where there have been no prescribed doses of radiation treatment; this being left to the discretion of the skilled radiologists. They are now in the process of setting out protocols that will address this by the collection of statistics that will enable protection measures on diagnostic radiology “The recommended methods of patient dose measurement are suitable for use in most types of conventional radiographic or fluoroscopic x-ray examination, although a preferred selection of types of radiograph and examination is given” (Dosimetry Working Party of the Institute of Physical Sciences in Medicine, 2009).

One approach to addressing quality assurance in a systematic manner is that adopted by a mid-west hospital in the USA. They created a ‘scorecard’ which they present to the Institute management committee on a quarterly basis. The objective being to conduct 33 different measures in 6 clinical areas “For each measure, the goal, current value of the measure, interval at which the measure is updated, date of last update, and previous value of the measure are listed.” (Lane F. Donnelly, 2010).  Each of the identified measures were analysed over time and this enabled determination of whether the departmental goals were being achieved or not. This assisted the Radiology Management team to direct corrective action to those areas that needed it the most. As such this facilitated the culture of quality improvement and focused the healthcare providers on aspects of performance, quality and improvement.

The Royal College of Radiologists and the National Patients Safety Agency (NPSA) in the UK have developed a patient safety checklist (Fig 1 refers) and this can be adapted to fit the safety standards of most radiological departments. The World Health Organization (WHO) was the first to develop a comprehensive set of standards governing surgical procedures in 2009.  It was from this initiative that the radiological checklist was established in 2010.

Conclusion

Ionizing radiation has been perhaps one of the most important influences on modern medicine. Without the ability to take X Rays, Fluoroscopy and Angiograms the physicians would be seriously hampered in their medical practices. It has not however been without a certain degree of controversy as the radiation affects on molecules can create serious biological complications like Cancer. This has been of particular concern in the exposure of radiation to Children where the risk of cancer is even greater. “Dr. David Brenner of Columbia University predicted that of the estimated 600,000 patients under age fifteen who received a CT in 2001, 500 will die from radiation-induced cancer” (Brenner, 2001). The chart illustrated in Fig 2 shows how much variation exists between that of an X Ray and the radiation carried out through a CT Scan

As such Doctors need to carefully evaluate the risks vs. benefits of committing to CT Scans. “Reducing the unnecessary use of all forms of ionizing radiation, especially CT in children, will result in fewer cancer deaths.” (Grossman, 2002). Dr Michael Herman[2] of the Mayo Clinic stated “We all must continue to be vigilant and continue to work together to develop safer, more effective use of radiation in medicine,” (Freeman, 2010)

Works Cited

Bell, A. (2011, 1). Improving Patient Safety within a Radiology Department. Retrieved 2 2, 2011, from eRadimaging: http://www.eradimaging.com/site/article.cfm?ID=7

Brenner, D. D. (2001). Radiation induced cancer. American Journal of Roentgenology.

Curtis P. Langlotz, M. P. (2011, 1). Radiology Plays Important Role in Overall Patient Safety. Retrieved 2 2, 2011, from RSNA: http://www.rsna.org/Publications/rsnanews/dec05/safetydec05.cfm

Dosimetry Working Party of the Institute of Physical Sciences in Medicine. (2009, 10 2). National Protocol for Patient Dose Measurements in Diagnostic Radiology. Retrieved 2 2, 2011, from Health Protection Agency: http://www.hpa.org.uk/Publications/Radiation/MiscellaneousRadiationPublications/rad60misc_pub_NationalProtocol/

Freeman, T. (2010, 8 13). Improving patient safety: ongoing efforts. Retrieved 2 2, 2011, from Medical Physics Web: http://medicalphysicsweb.org/cws/article/opinion/43469

Grossman, D. (2002). Patient Safety in Medical Imaging. The Provider.

IAEA. (2010). Radiation Protection in Diagnostic and Intervention Radiology. Retrieved 2 2, 2011, from IAEA: http://docs.google.com/viewer?a=v&q=cache:zTn668vFxuAJ:rpop.iaea.org/RPOP/RPoP/Content/Documents/TrainingRadiology/Lectures/RPDIR-L11_QA_WEB.ppt+Quality+Assurance+Measurement+in+Radiology+Departments&hl=en&gl=uk&pid=bl&srcid=ADGEESjBvqOBptdgNiyjw0fKrZxMfe

Lane F. Donnelly, M. (2010, 2 1). Quality Initiatives: Department Scorecard: A Tool to Help Drive Imaging Care Delivery Performance1. Retrieved 2 2, 2011, from Radiographics: http://radiographics.rsna.org/content/30/7/2029.abstract?sid=b962bc97-3e15-499e-ab5c-994ea2e2f818

[1] Ramin Khorasani, M.D., from Brigham and Women’s Hospital

[2] Michael Herman, current president of the AAPM and professor at the Mayo Clinic (Rochester, MN)