Stephanie Krent, Imaging Performance Partnership
Recently, one of our members asked us about surgical "time outs" and whether they can apply to radiology. Because patient safety is a focus for so many of you but isn't a topic we often address, I wanted to share my response.
When should your radiologists take a ‘time out’?
A recent study published in Radiology journal last month finds that radiologists who interpret more screening mammograms tend to have greater breast cancer diagnostic accuracy than their counterparts. The study also finds greater diagnostic accuracy in screening mammograms among radiologists that interpret both diagnostic and screening mammograms. Surprisingly, in both cases, the increase in diagnostic accuracy is entirely driven by a reduction in the incidence rate of false-positive interpretations among high-volume radiologists; the incidence rate of false-negatives did not differ across radiologist cohorts in the study.
More Active Radiologists Have Fewer False-Positive Mammogram Reads
Over the weekend, the New York Times
ran an article
in their series, The Radiation Boom, about radiation risks from stroke scans. The article is noteworthy because the author profiles several patients and their personal stories regarding side effects from CT scans. In fact, the article is accompanied by a multimedia section, entitled The Mark of an Overdose
, with audio recordings of four patients explaining their experiences. Several photos of patients with hair loss are also included. Definitely worth a look, as the Times' work appears to be turning heads at the FDA. The article also "names names."
The review also offers insight into the way many of the overdoses occurred. While in some cases technicians did not know how to properly administer the test, interviews with hospital officials and a review of public records raise new questions about the role of manufacturers, including how well they design their software and equipment and train those who use them.
found the biggest overdoses at Huntsville Hospital -- up to 13 times the amount of radiation generally used in the test.
Officials there said they intentionally used high levels of radiation to get clearer images, according to an inquiry by the company that supplied the scanners, GE Healthcare.
Experts say that is unjustified and potentially dangerous.
"It is absolutely shocking and mind-boggling that this facility would say the doses are acceptable," said Dr. Rebecca Smith-Bindman, a radiology professor who has testified before Congress about the need for more controls over CT scans. Yet because the hospital said no mistakes were made, regulatory agencies did not investigate.
The F.D.A. was unaware of the magnitude of those overdoses until The Times brought them to the agency's attention. Now, the agency is considering extending its investigation, according to Dr. Alberto Gutierrez, an F.D.A. official who oversees diagnostic devices.
Patients who received overdoses in Huntsville say that in addition to hair loss
, they experienced headaches, memory loss
and confusion. But at such high doses, experts say, patients are also at higher risk of brain damage and cancer.
A spokesman for Huntsville Hospital, which now acknowledges that some patients received "elevated" radiation, said officials there would not comment.
The article also indicates some finger-pointing, with the hospitals in question pointing to manufacturers, and vice versa.
At Glendale Adventist Medical Center, where Mr. Reyes and nine others were overdosed, employees told state investigators that they consulted with GE last year when instituting a new procedure to get quicker images of blood flow, state records show. But employees still made mistakes.
As a result, hospital officials said, a feature that technicians thought would lower radiation levels actually raised them. Cedars-Sinai gave a similar explanation.
"There was a lot of trust in the manufacturers and trust in the technology that this type of equipment in this day and age would not allow you to get more radiation than was absolutely necessary," said Robert Marchuck, the Glendale hospital's vice president of ancillary services.
A GE spokesman, Arvind Gopalratnam, said the way scanners were programmed was "determined by the user and not the manufacturer." GE, he added, has no record of Glendale seeking its help setting up the new procedure in 2009.