Radiation Exposure: Avoiding Repetitive Exams And Raising Patient Awareness
By Yana Yelina, Tech Writer, Oxagile
It’s no news that individuals are exposed to daily background radiation, including cosmic, terrestrial, and internal one. Fortunately, the amount is not big enough to cause real damage to the human organism.
However, medical procedures as x-ray, computed tomography, fluoroscopy, and nuclear medicine imaging — those using ionizing radiation to generate images of the body — may negatively affect the DNA. And exceeding permissible doses may lead to the development of carcinogenic tumors.
In the USA, the adverse effects of medical imaging are an increasingly important public health issue — and here are a few cases in point. The US population’s total exposure to ionizing radiation has increased twofold over the past 20 years. One in 270 females and one in 600 males who go through CT coronary angiography at the age of 40 is supposed to develop cancer. The risks are twice as high for 20- and 60-year-olds.
To improve these alarming stats, there’s a need for increased patient engagement and better control of radiation amounts. And technology might be a stepping stone to success. It can help caregivers ensure patient safety by avoiding excessive doses and repetitive exams as well as raise awareness by giving patients access to their imaging data.
The Role Of Tech In Improving Imaging Data Accuracy
Long ago radiologists had to manually record radiation doses in their software systems, which resulted in human errors and skewed reports. But the advent of PACS and the adoption of DICOM standards put an end to this burdensome process.
Physicians got automatic radiation dose structured reports (RDSRs) carrying information about the patient, equipment output, and procedure. Yet, this data was not enough to accurately estimate radiation amounts. The patient RDSR (P-RDSR) — a new DICOM object — raised the ante by allowing physicians to obtain a specific radiation dosage based on patient model demographics (age, gender, weight, and height) as well as positioning.
Some healthcare providers are going to town on developing new, enhanced mechanisms to analyze radiation exposure. For instance, Mayo Clinic implemented the DICOM Index Tracker (DIT) able to use the smallest radiation amount necessary to provide clear pictures and accurate diagnoses.
With the help of this system, medical professionals can easily control dosage levels, share imaging data across multiple departments, and get alerts when internally determined radiation levels are exceeded.
The US non-profit organization Integrating the Healthcare Enterprise (IHE) offers another solution to track and reduce radiation doses to a level “as low as (is) reasonably achievable” (ALARA) — the radiation exposure monitoring (REM) profile.
Being RDSR-compliant, the REM profile provides imaging data in an interoperable format and sends that information to a regional or national registry, enabling the comparison of procedures, devices, and hospitals across a particular area. Such a registry is touted as a key to looking at population statistics and driving change.
The Connecticut Hospital Association (CHA) is taking steps to implement a statewide data repository of how much radiation a patient is exposed to during CT scans. They partnered with Bayer to gather radiation doses from machines at the 27 hospitals in the CHA, pumping the data into the repository for further analysis. They claim their system is the first of its kind in the USA and could lead toward benchmarking appropriate levels of radiation dosage nationwide.
Do Patients Have Access To Imaging Data?
Caregivers together with custom healthcare software development experts have made great strides in finding optimal methods to track imaging information. Now let’s delve into what has been done to raise patient awareness of radiation-related risks.
In partnership with Image Wisely, the US Food and Drug Administration (FDA) came up with an idea to create an imaging record card (IRC). Such a card describes the date, type of imaging, and facility where the exam is performed.
The message of this initiative is crystal clear and right — however, there are two big buts. First, the IRC lacks radiation-absorbed dose information. Second, the card has no digital form, which means cumbersome paperwork in terms of maintaining health records.
Image Share by the Radiological Society of North America (RSNA) is another step towards raising awareness. The Image Share Network enables clinicians to share medical images and radiology reports with patients via personal health record (PHR) accounts. In turn, patients get more control over their imaging information and can share it with multiple care providers.
The bad news is that few PACS and RIS vendors have successfully completed the validation program and are ready to give access to medical reports.
In Search Of A Unified Standard
As mentioned in the previous two sections, a number of steps have been taken to better control radiation amounts and avoid repetitive exams. Still, these are mainly stand-alone initiatives that haven’t come into common use yet.
To benefit both radiologists and patients, we need a better solution, namely PACS integration with enterprise systems (EHR, EMR, or HIS).
First, such integration will enable physicians to receive well-generated reports and share them with their peers from other departments and hospitals. Second, it will be easier for patients to obtain imaging data via EHR-integrated medical portals.
Providers can also go the extra mile and engage patients with an mHealth app giving a full picture: hospitals’ and radiologists’ names, an x-ray type, radiation absorbed per procedure and during previous visits, as well as remaining permissible doses (within a calendar year).
Such an app could also have a Q&A section and provide visual aids in the form of comparison charts (absorbed doses vs background radiation), allowing patients to better understand the potential risks.
Hurdles On The Way To Success
In theory, PACS integration with EHRs can help minimize radiation exposure. But there is more than meets the eye. When putting it into practice, it’s vital to effectively address the following issues.
- Interoperability. Imaging systems are usually at odds with text-based software. But healthcare institutions together with IT vendors are making progress to solve this problem. Open APIs, FHIR initiative, VNA, and integrated PACS viewers are all set to facilitate information exchange, and success stories have not been long in coming.
- Security. Once PHI is shared among different software systems and healthcare facilities, security and privacy are taking center stage. Make sure the systems you’re working with are HIPAA-compliant. When accessing PHI via other devices (mobile phones, tablets, or laptops), use the recommendations proposed by the US Department of Health and Human Services (HHS).
- Education. Technology acceptance rates and staff education level are another determinants of success. When implementing an integrated system to track and reduce radiation doses, use a coherent training strategy to support your efforts.
Benefits Outweigh Disadvantages
PACS-EHR integration needed to collect and share accurate imaging data is neither easy nor cheap. But you’ll see it’s worth the price of the ticket given the benefits you’ll reap:
- Raised awareness
- Patient engagement
- Decreased radiation amounts
- Reduced adverse radiation effects
- Fewer repetitive tests
- Lower operational costs.
About the Author:
Yana Yelina is a Tech Journalist at Oxagile, a custom healthcare software development company based in New York. Her articles have been featured on Becker’s Hospital Review, Medical News, Healthcare Works Collective, and Medgadget, to name a few. You can reach Yana at yana.yelina@oxagile.com or connect with her via LinkedIn or Twitter.