March 6-13 is Patient Safety Awareness Week, sponsored by the National Patient Safety Foundation. Each day this week, we will post an entry about patient safety. Today’s topic – CT scans.
A recent New York Times article follows the tale of Dr. Salvatore J. A. Sclafani, a radiologist at SUNY Downstate Medical Center in NY. Back in 2007, Dr. Sclafani discovered that instead of getting chest x-rays, or other simple tests, numerous premature infants at his hospital had received full body scans often referred to as “babygrams.”
These babygrams are largely discredited and discouraged at SUNY Downstate due to the concerns about potential harm of radiation to infants. Additionally Dr. Sclafani discovered that CT scanners were frequently set too high for infants, coning (limiting the radiation exposure to the specific area under examination) had not been performed properly, babies were undergoing x-rays without gonadal shields (gonads are the most radiosensitive organs), and that babies were often not positioned correctly in x-ray machines.
In a prior blog post we explored the increased cancer risk caused by overuse and misuse of CT scans. Dr. Scalfani’s story highlights the particularly high risk amongst children. Like adults, children are being exposed to increasingly more radiation in recent years and because their cells divide faster, they are at even higher risk of developing cancer. The article mentions a recent study which found that by the age of 18, the average child will have received more than 7 radiologic exams. Premature infants, in addition to being the most vulnerable, are also more likely to undergo frequent scans due to their high rates of dangerous medical conditions.
The article uses Dr. Scalfani’s story to point out the lack of regulation of radiography technicians in the US. There are no national guidelines for technicians and regulations vary significantly from state to state, with some providing no standards at all. Even those states that have guidelines often do not require continued education and/or do little to reinforce their standards. When radiation professionals are not properly and regularly trained, they are likely to have trouble understanding how to use machines (especially new ones), and do not always comprehend the intricacies of radiation exposure.
Over the past 12 years the American Society of Radiologic Technologists has lobbied for a bill that would establish minimum education and certification requirements for 12 professions in medical imaging and radiation therapy. In 2006, the CARE bill, which has bipartisan support, passed in the senate. Unfortunately, Congress adjourned prior to a vote in the House and the bill was never passed.
At SUNY Downstate Dr. Scalfani and his team have made many important changes to improve the safety of radiographic imaging including: reducing the amount of radiation in CT scans in both children and adults, reducing the number of unnecessary scans, putting an end to babygrams, and requiring that all pediatric CT scans get Dr. Scalfani’s approval. While Dr. Scalfani has done a great job of addressing the issues at his own hospital, his story points out the importance of nationwide regulation and stricter guidelines for scan frequency, machine use, and technologist training.
An article in yesterday’s NY Times further demonstrates the need for guidelines, oversight and training. It looks at problems that have occurred with over-radiation at a hospital in West Virginia.
Learn more about Massachusetts legislation being supported by HCFA and the Consumer Health Quality Council that seeks to reduce and track health risks from CT scans.