ACR Cites Inaccuracies in TJC Sentinel Event Alert

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The American College of Radiology (ACR) has issued a statement addressing inaccuracies it contends were included in “Radiation Risks of Diagnostic Imaging”, a Sentinel Event Alert issued last Wednesday by The Joint Commission (TJC).

The alert indicates general agreement that “care should be taken to weigh the medical necessity of a given level of radiation exposure against the risks, and that steps should be taken to eliminate avoidable exposure to radiation.” According to the ACR, this message concurs with that which it has been conveying to its members, patients, and the general public for several years.

However, the ACR points out in the statement, the alert includes a statement that notes the CMS January 2012 requirement for accreditation of CT, MRI, and PET was promulgated “as a result of the potential dangers associated with ionizing radiation.” The ACR, which sponsored legislation requiring such accreditation, deems this inaccurate because the legislation is aimed primarily at ensuring a high level of quality for these modalities, including inspection and evaluation of image quality, and because MRI, a component of the accreditation requirement, produces no ionizing radiation.
A second inaccuracy contained in the alert, the statement says, is the assertion that the ACR launched its National Radiology Data Registry (NRDR) this past May. NRDR has in fact been in existence since 2008.

In May of 2011, the ACR launched its Dose Index Registry (DIR), a national registry that permits facilities to monitor dose from each CT scanner and compare those doses to national benchmarks. The TJC Alert unfortunately makes no specific mention of the existence of the DIR.

“We are pleased that TJC acknowledges that ‘experts disagree on the extent of the risks of cancer from diagnostic imaging’, but we are concerned with the recommendation for ‘awareness of the potential dangers from diagnostic radiation among organizational leadership, hospital staff, and patients’ considering that there is significant scientific disagreement on the magnitude of those dangers,” the ACR statement reads.

In general, the statement concludes, the ACR “applauds TJC’s alert for its comprehensiveness and strong recommendations regarding selection of the right procedure and the right dose, creating effective processes, ensuring safe technology, and promoting a safety culture.” The College is “particularly pleased to have already addressed, through its DIR”, recommendation 19, which endorses the creation of a national registry to track radiation doses.