comparable figures on mortality or morbidity from the demonstrably inappropriate or unnecessary use of ionizing radiation are available.

Efforts That Reduce Adverse Events and Inappropriate Care

Even when the error rate is low, unfortunate incidents undermine trust in the health care system and can have permanent repercussions for a patient's health and well-being. The average consumer becomes more aware of the potential for error and the serious ramifications that can occur, regardless of whether the practitioner is fully competent or inadvertently negligent.

In instances of negligence the patient has recourse through the medicolegal system. Electing this course of action does not diminish the negative consequences of the incident itself. Pursuing such actions, however, may decrease the future risk of harm (and eventually raise health care costs through defensive medicine practices). The net impact is difficult to measure.

A key factor to protecting the patient and the public from unnecessary or excessive exposure is the training of professionals who deliver quality nuclear medicine and radiotherapy services. Although a thorough analysis of this area is beyond the scope of the present study, the committee offers the following views.

The NRC should not regulate the education and training of health care personnel; the education and training of physicians and other health-related professionals (including physicists, dosimetrists, radiopharmacists, technologists, technicians, and nurses) should be regulated by professional organizations and societies and by the states. The system of education and training should, however, have greater uniformity than currently exists.

NRC licensure is currently conferred on (a) physicians who have completed specific training programs in radiology or nuclear medicine, and (b) individuals trained in different areas who have completed a requisite number of training hours for limited NRC licensure for specified usage (often organ-system specific). The committee believes that NRC regulatory licensure is imbalanced in two ways: (1) training requirements are disproportionate to actual radiation injury risks; and (2) therapeutic training is underprescribed while diagnostic training is overprescribed. In connection with that, it needs to be recognized that the risks encountered with diagnostic and therapeutic uses of radiation are distinctly different; these differences should be clearly reflected in differences in training. In addition, safety issues appear to achieve undue primacy in the NRC licensure process, in contrast to issues of clinical efficacy and competence. NRC licensure is a poor substitute for broader and more uniform regulation by the professional societies and the states. Education/training should focus on good clinical care as well as patient and employee safety, and it should not merely be an occasion for instructing providers in how to live with currently established regulations.



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