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TAM-B1
Controversies in Medical Health Physics

Tuesday 02/22/2022

Room: Regency B

8:00 - 10:00

Chair(s): Cynthia McCollough, Jerry Bushberg



TAM-B1.1  08:00  Difficult Conversations About Patient Gonadal and Fetal Shielding. Milman Rebecca J.*, Colorado Anschutz   Rebecca.Milman@cuanschutz.edu

Patient gonadal and fetal shielding spent decades at the heart of radiation protection in medical imaging. In 2019, several professional organizations recommended that shielding the gonads or fetus should no longer be routine clinical practice. This topic divided the medical imaging community. There were concerns about the underlying science, patient reactions to practice changes, the perception of medical imaging and its professionals, and the ethical implications of such a change. Yet over the past three years, individuals and organizations have come together to discuss these concerns and help provide guidance about this topic. Through the work of the CARES committee and its 14 member organizations, educational and other informational materials have fostered collaboration and enabled productive, meaningful conversations across subspecialties. This presentation will discuss the past controversies about patient shielding, current conversations about the topic, and the importance of maintaining open dialogue both within and among organizations and subspecialities within medical imaging and radiation safety.


TAM-B1.2  08:20  Discusssion.    


TAM-B1.3  08:30  The use of cumulative effective dose in medical imaging decision making. Fahey Fredrick H*, Harvard; Jordan David W, University Hospitals Cleveland Medical Center   frederic.fahey@childrens.harvard.edu

The use of medical imaging in the diagnosis and management of disease is an essential component of the clinician’s armamentarium. However, several modalities including radiography, computed tomography (CT), and nuclear medicine including positron emission tomography (PET) involve the use of ionizing radiation which may present a small risk of adverse health effects for the patient. The protocol for each diagnostic procedure should be optimized to minimize its associated risk as much as possible without compromising the quality of the diagnostic information provided to the clinician. The risk of the optimized protocol should only be considered in the context of the benefit to be gleaned by the patient. Some have proposed that the cumulative effective dose should be considered in this regard for patients who have previously received multiple imaging procedures involving radiation. This presentation will review the rationale behind considering the cumulative effective dose in this regard, and will discuss if and when such consideration may be appropriate when deciding the appropriateness of medical imaging procedures.


TAM-B1.4  08:50  Discusssion.    


TAM-B1.5  09:00  Radiation Risk Estimates: Uncertainty, Use and Misuse . Dauer Lawrence T*, MSKCC   dauerl@mskcc.org

While risks from exposure to ionizing radiation are much better understood than other agents, at lower doses (e.g., <0.1-1 Gy) of low-LET radiation, the uncertainties associated with radiation epidemiology studies become increasingly large and tend to mask possible effects. Sources of uncertainty in radiation epidemiology studies often include dosimetry issues, bias, methodology issues, low statistical power, low precision, risk data modeling impacts, generalization, tissue effect latency, and overall quality of the study (amongst others). Estimates of risk requires judgments of consistency against a backdrop of these sources of uncertainty as well as ongoing scientific and policy debate. This presentation will review several uncertainties associated with risk estimates, review guidance on use and misuse of such risk estimates as currently suggested by the National Council on Radiation Protection and Measurements and the International Commission on Radiological Protection and discuss examples of how such information is often presented in the literature or employed in medical practice.


TAM-B1.6  09:20  Discusssion.    


TAM-B1.7  09:30  Understanding Extravasations Can Lead To Improved Patient Care. Berry Kendall *, Fox Chase Cancer Center; Lattanze Ron , Lucerno Dynamics   Kendall.Berry@fccc.edu

Currently, the U.S. Nuclear Regulatory Commission (NRC) is considering if significant extravasations should be reported to patients and the NRC. During this regulatory decision-making process, in the midst of public debate, and with the rapidly growing use of radiotherapeutics, there is an immediate need to increase awareness and understanding of radiopharmaceutical extravasations. Our purpose is to help educate medical health physicists on extravasations and their effects on patient care so that they are prepared to address extravasations based on their individual State’s requirements and regardless of the Federal regulatory outcome. From an extensive literature review and through the use of real patient extravasation cases, we present definitions, potential causes, methods and pitfalls of identification, pros and cons of internal dosimetry methods, latent adverse effects, potential implications to nuclear medicine studies and patient care, mitigation response, prevention, international perspectives, and reporting nuances of extravasations. We conclude that regardless of the current regulatory controversy, that medical health physicists, by increasing their understanding and through sharing of lessons learned, can help reduce the frequency of extravasations and positively affect patient care.


TAM-B1.8  09:50  Discusssion.    




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