Radiation exposure has become an increasingly important topic in health care — for patients and providers alike. The rules are changing and improved technology is paving the way for a safer hospital atmosphere for everyone. Dominic Siewko, clinical marketing manager for Philips’ DoseWise Solutions, told HCB News how dose monitoring has evolved, what it will look like in the future, and how hospitals can do the most for radiation safety with the least financial investment.

HCB News: Can you briefly summarize the 2015 Joint Commission rules on patient dose?
Dominic Siewko: The Joint Commission standards introduced in July 2015 require hospitals to establish stricter radiation dose management processes, and is asking health care providers to now become more aware of the radiation dose they are giving to patients diagnostically. More specifically, they are asking health care providers to pay attention to exam ordering and CT protocols, increase staff education around best practices to implement, and enact general improvements in data collection and analysis.

HCB News: What precautions can radiologists take to reduce radiation exposure?
DS: Physicians in the operating room typically receive the highest amounts of radiation in the hospital while using fluoroscopy. Other modalities such as nuclear medicine and CT also require significant levels of radiation to achieve their justified goals. Some of the best practices with high impact are: maximizing distance from the source of X-rays, collimating their images as best possible, standing on the detector-side of the table, take advantage of shielding and wear your dosimeter!

HCB News: What do you say to hospital executives who don’t think they have the financial resources necessary to improve dose monitoring?
DS: I would say, start small. The first step to improving any process is to understand what you have and where it came from. Most healthcare providers have not historically used patient radiation dose information in any meaningful way as a quality tool. Radiation dose tracking is a quality tool, and with any new tool or process there will be some ramp-up time use the data effectively and efficiently. Spending the time to gather and analyzing your dose data can quickly expose outliers and large variants in your process. Even if you tackle the three biggest sources of variation with regard to patient dose you can have a very large impact on your practice and patient care.

HCB News: How have provider attitudes about dose changed over the last few years?
DS: Health care providers have become very aware of the hazards of radiation dose over the past few years due to increased publicity and regulatory controls, not only to patients but also themselves. Today, more is known now about the effects of radiation dose and there is greater transparency within the industry. For example, the effects of radiation to the eye lens are permanent, so the damage is cumulative. Eye lens dose, as an example, is something that interventional radiologists now pay close attention to, whereas in the past not as much. Recent scientific guidance holds that threshold doses for radiation-induced cataracts is 500 mGy, even if spread out over time, suggesting that physicians can face a real, permanent eye lens cataract health hazard in only five years of working if not mitigated appropriately.

HCB News: What will dose monitoring look like in five or 10 years?
DS: Radiation dose monitoring is really just starting. Right now the industry (both manufacturers and health care providers) are busy collecting their data and setting up processes within their departments. These dose monitoring processes will become part of the hospital quality and safety programs for sustainability. In the next five to 10 years we will build dose global dose benchmarking databases and further refine best practices.

HCB News: How can DoseWise Solutions help in monitoring dose?
DS: DoseWise is the Philips solution for radiation dose management to patients and caregivers. The cornerstone of this program is the DoseWise Portal, a software solution that allows easy access to radiation dose exposure in the hospital setting for any vendor equipment and any X-ray modality. We also offer DoseAware, which is a small electronic dosimeter that physicians use in the operating room to monitor their exposure in real-time.

HCB News: What is the most important thing to keep in mind when regarding dose management?
DS: That while radiation must be respected, the benefit to the patient outweighs the risk when good practices are followed: justifying the procedure for that particular patient and optimizing the dose using the latest technology. Diagnostic radiology is enhanced when the balance is found between the diagnostic benefits and the dose required to get there.