The American Board of Radiology Foundation (ABRF) is a 501(c)3 organization focused on creating a high-functioning, well-coordinated health system in which medical imaging and radiation are used safely and appropriately to deliver all the benefits that can be realized, while minimizing risk and waste.
- National Strategy for Safe and Appropriate Medical Imaging – The ABRF convened a diverse group of stakeholders in medical imaging in 2012. This group developed the national strategy, which is meant to grow and develop as more is learned about imaging safety and appropriateness. Two conferences have been held to date, one in August 2012, and one in March 2013; and a third was planned for August 2013. This link has the components of the National Strategy and current examples and metrics.
Publishes white papers, practice guidelines, quality control guidance technical standards, patient education materials on all types of radiology services.
- Guidance document for Safe MR Practices
- Practice guideline for radiation oncology
- Position Statement on quality control and improvement, safety, infection control, and patient education. Search “position statement” on the ACR website.
- ACR White Paper on Radiation Dose in Medicine: Three Years Later (2010 update)
- Patient website sponsored by the Radiological Society of North America (RSNA) and ACR
Five Things Physicians and Patients Should Question
As part of the “Choosing Wisely” initiative, One of the recommendations includes “avoiding CT scans of head in ED patients with minor head injury at low risk.”
The American Society of Radiation Oncology has a website with resources to help patients and families better understand how doctors use radiation therapy to treat cancer safely and effectively.
- American Society of Radiation Oncology website: www.rtanswers.org
The Association’s website provides clinical practice guidelines on radiology and imaging topics such as handoff communications, site marking, moderate sedation and analgesia, and contrast-associated nephrotoxicity. Go to “Resources”, then “Practice Guidelines”.
Improper use of syringes, needles, and medication vials during routine healthcare procedures, including injections and intravascular administration of contrast media, have resulted in patient infections and more than 40 outbreaks involving multiple patients. These outbreaks have resulted from failure to follow basic infection control procedures and aseptic technique in injection safety, including reusing syringes, contaminating multi-dose vials with unclean syringes, and using single-dose vials for multiple patients. CDC has published numerous guidance documents for healthcare providers.
- CDC website on “Injection Safety Information for Providers.”
The Choosing Wisely® Campaign is an initiative of the American Board of Internal Medicine. Over 50 national organizations representing medical specialists have joined the campaign to identify tests or procedures in their fields that may be unnecessary or may even cause harm. Relevant to radiology and imaging safety, see:
- American Academy of Family Physicians
- American College of Radiology
- American Society of Clinical Oncology
- Society of Hospital Medicine – Pediatric Hospital Medicine
- Society of Nuclear Medicine and Molecular Imaging
ECRI provides resources on evidence-based research related to medical procedures, devices, drugs and processes to improve patient care, including risk assessment tools, guidance documents, alerts, educational programs and other resources and tools on patient safety topics, including radiology safety.
There are numerous U.S. laws that apply to radiation emitting products sold in the United States. There are also overlapping enforcement authorities for radiation-emitting products that include Federal Food, Drug, and Cosmetic Act, (Chapter V, Medical Devices); Radiation Control for Health and Safety Act of 1968 (now part of the Federal Food, Drug and Cosmetic Act as Chapter V, Subpart 3, Electronic product radiation control; and the mammography Quality Standards Act of 1992.
- FDA provides information on the laws, regulations, performance standards and industry guidance for radiation emitting products.
CDRH responsibilities include regulation of radiation-emitting medical and non-medical electronic products. Their special website on radiation-emitting products contains listings of products, radiation safety information, standards, regulations, news, research, and education for industry, healthcare providers, and consumers.
In November, 2010 the U.S. Food and Drug Administration (FDA) updated its initiative of February 9, 2010, to reduce unnecessary radiation exposure from three types of imaging procedures: computed tomography, nuclear medicine, and fluoroscopy. The agency aims to achieve these reductions by promoting safe use of imaging devices (e.g., stronger equipment safeguards, personnel training), supporting clinical decision-making (e.g., standardized dosage reporting, appropriate use criteria), and education patients (e.g., patient medical imaging record card).
- FDA Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging
- FDA Pediatric X-ray Imaging A website launched in May 2012 that provides information on the benefits and risks of imaging using ionizing radiation, recommendations for parents and health care providers to help reduce unnecessary radiation exposure, and information for manufacturers of X-ray imaging devices.
- FDA White Paper Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging, February, 2010.
The Image Gently Campaign is an initiative of the Alliance for Radiation Safety in Pediatric Imaging. The campaign goal is to change practice by increasing awareness of the opportunities to promote radiation protection in the imaging of children. The Image Gently website states that NQF guidance is that “when CT imaging studies are undertaken on children, “child-size” techniques should be used to reduce unnecessary exposure to ionizing radiation.”
Image Wisely is an awareness program of the American College of Radiology, the Radiological Society of North America, the American Association of Physicists in Medicine, and the American Society of Radiologic Technologists. Image Wisely’s objective is to encourage practitioners to avoid unnecessary ionizing radiation scans and to use the lowest optimal radiation dose for necessary studies. Radiologists, medical physicists, technologists, and physicians are encouraged to take the pledge to image wisely for the health and safety of their patients.
ISMP provides resources for medical error prevention and safe medication use, including newsletters, consulting, educational program and webinars, tools, and a voluntary medication error reporting program (MERP). A recent webinar addressed medication errors in the radiology suite and audiotape can be ordered on line.
The IAEA was set up in 1957 within the United Nations family work with its members and worldwide partners to promote safe nuclear technologies. A number of documents have been release in collaboration with their partners, including the World Health Organization to address occupational, public, medical, and emergency exposure situations. Selected documents:
- International basic safety standards for protection against ionizing radiation and for the safety of radiation sources
The IMRSER develops Magnetic Resonance (MR) safety materials and disseminates this information to the MR community. This is accomplished predominantly through the efforts of the Advisory Boards.
- MRI safety poster
- MRI safety guidelines
- MR Safety Papers – a selection of peer-reviewed articles, posted with permission from the Journal of Magnetic Resonance Imaging, the International Society for Magnetic Resonance in Medicine, the American Journal of Neuroradiology, the American Society of Neuroradiology, the Journal of Cardiovascular Magnetic Resonance, the Institute for Electrical and Electronics Engineers, IEEE Transactions on Magnetics, Magnetic Resonance Imaging, and Concepts in Magnetic Resonance. The majority of these papers were published by members of the Medical, Scientific, and Technology Advisory Board of the IMRSER.
Radiation overdose – sentinel event
Radiation overdose has been a reviewable sentinel event by The Joint Commission since 2005. The specific language is “Prolonged fluoroscopy with cumulative dose >1500 rads to a single field or any delivery of radiotherapy to the wrong body region or >25% above the planned radiotherapy dose.” Thirty-three radiation overdose events have been reported from 2004 through June 2013.
- Sentinel Event Alert Issue 38, Feb 14, 2008 Preventing accidents and injuries in the MRI suite.
- Sentinel Event Alert Issue, Issue 47, Aug 24, 2011 Radiation risks of diagnostic imaging
- Offers a number of courses for clinicians, including advanced radiology life support.
Medline Plus is a service of the U.S. National Library of Medicine, National Institutes of Health. They have a website of Health Topics A-Z. See Radiation Exposure at this link, with many articles on basics, treatments, and related issues:
The National Cancer Institute (NCI) is part of the National Institutes of Health (NIH). The NCI provides web resources on cancer imaging for patients. Information includes:
Cancer Imaging – A visual introduction to cancer imaging, featuring information about imaging technologies and their uses.
- Computed Tomography (CT) scans
- Digital mammography
- Image-guided brain surgery
- Magnetic Resonance Imaging (MRI)
- Nuclear imaging (PET and SPECT)
- Sentinel node mapping for breast cancer staging
- Uses of imaging
- Virtual colonoscopy
- X-Ray imaging
NCRP was chartered by the U.S. Congress in 1964 to support radiation protection by providing independent scientific analysis, information and recommendations. A few selected documents include:
- NCRP Report No. 160 – Ionizing Radiation Exposure of the Population of the United States (2009). Detailed information on exposure of the U.S. population to ionizing radiation highlighting the two major sources of contributors to exposure of the U.S. population from ionizing radiation: exposure to ubiquitous radiation and medical exposure of patients.
- NCRP Report No. 172 – Reference Levels and Achievable Doses in Medical and Dental Imaging: Recommendations for the United States (2012)
All of the NQF-endorsed Safe Practices for Better Healthcare address patient safety and a number of them specifically impact on patient safety during radiologic care, including:
- Labeling of diagnostic studies
- Contrast media-induced renal failure prevention
- Pediatric imaging
The U.S. Nuclear Regulatory Commission (NRC), created as an independent agency by Congress in 1974, to enable the nation to safely use radioactive materials for beneficial civilian purposes while ensuring that people and the environment are protected,. The NRC regulates uses of nuclear materials, such as in nuclear medicine, through licensing, inspection and enforcement of its requirements. NRC also has formal agreements with 37 states that have assumed regulatory responsibility and jointly with NRC develop new regulations and guidance.
A state agency charged with eliminating medical errors has advisories, toolkits, brochures, and education materials on radiology-related services.
- CT Contrast Media Power Injectors Can Rupture Conventional IV Sets
- Diagnostic ionizing radiation and pregnancy
- Errors in Radiation Therapy
- Medication errors occurring in radiologic services departments
- Preventing the Retention of Foreign Objects
- Safety in the MR environment
- Contrast induced nephropathy
- Management of patients undergoing contrast-related procedures
- MRI patient screening form
- Provider’s reference guide for radiation exposure
- Radiology Falls Risk Assessment Tool
This website provides information for patients. It has a “Procedures A-Z” section with information on topics such as MRI, CT Scans, PET Scans and much more. The page on MRI describes what MRI is, and how it works, and considerations to keep patients safe.
- Patient information on MRI in English and Spanish developed jointly by the Radiological Society of North America and the American College of Radiology.
The Society of Interventional Radiology has a taken a leading role in measuring and assessing radiation dosage; developing educational programs and publications on radiation safety, radiation protection and reduction of skin dosage; and promoting the safety of patients and health care professionals.
Selected documents published in the Journal of Vascular and Interventional Radiology and publicly available on the SIR website, selected documents include:
- Position Statement on Radiation Safety Interventional Fluoroscopy: Reducing Radiation Risks for Patients and Staff
- Guidelines for Patient Radiation Dose Management
- Quality Improvement Guidelines for recording patient radiation dose in the medical record
- Occupational health hazards in the interventional laboratory
- X-Rays and radiation safety (Patient information brochure)
This is the website of the University of California San Francisco, Department of Radiology and Biomedical Engineering. The website contains:
- MRI Safety Policy at UCSF
- MRI Screening Form
- MRI Pregnancy Guidelines
- Gadolinium Policy
ACR Contrast Manual – Information About Gadolinium-Based Contrast Media and NSF –
- Clinical Utility and Safety Protocol for Noncardiac and Cardiac MRI patients
(Amerian Heart Association website)
- MRI FAQ
An internet resource for radiation, nuclear, and health physics topics that includes information and resources
The U.S. Pharmacopeia’s (USP) Revised General Chapter 797 Pharmaceutical Compounding Sterile Preparations, which sets practice standards to help ensure that compounded sterile preparations are of high quality, is available in the Second Supplement to USP 31-NF 26, This revised version became official on June 1, 2008.
Complete document available for purchase at USP website.
- Excerpts from Chapter 797 on safe practices when handling hazardous drugs, radiopharmaceuticals.