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Radiation in Medicine: A Need for Regulatory Reform
Question 6 (N = 27)
In your experience, has the evolution of radiation protection standards helped to improve patient safety and welfare? Has it influenced staff safety and welfare?
In response to this question we received 27 replies: 18 from professional associations, societies, and industry; 6 from states; and 3 from miscellaneous sources. There was a general sentiment that the evolution of radiation protection standards (as distinguished from regulations) based on recommendations of national (, NCRP) and international (International Commission on Radiological Protection, ICRP) bodies have helped to improve both patient and staff safety and welfare. Requirements regarding training of technologists and other individuals using ionizing radiation have improved patient and worker safety (Illinois). An excellent example of improved patient safety and welfare may be the change in the last 15 years in the practice of mammography (Kansas, Texas, NY-DOH).
The incorporation of NCRP recommendations has also influenced the practice of radiation safety procedures (ACMP). In particular, 10 CFR Part 20, relative to staff safety was cited, specifically the ALARA (as low as reasonably achievable) program as one that has "heightened staff awareness of the level of accumulated personal radiation exposure" (NEMA, Syncor).
Although it was generally believed that the evolution of radiation protection standards improved both patient and staff safety and welfare, the "regulations promulgated to achieve these standards are collectively excessive" (NYH-CMC). "Efforts to drive down occupational exposure limits have not resulted in improved occupational health but have resulted in substantial increases in compliance costs" (Health Physics Society). "Regulatory agencies may be crossing the line between requirements that result in an increase in paperwork without an actual safety benefit" (Illinois).
Question 7 (N = 26)
Who should bear the ultimate responsibility for devising appropriate quality assurance programs? Professional associations such as JCAHO, ACR, AAPM, etc.? State agencies? Federal agencies?
In response to this question we received 26 replies: 18 from professional associations, societies, and industry; 5 from states; and 3 from miscellaneous sources. Although the response was not unanimous, there appeared to be overwhelming consensus that the various professional associations should be entrusted with the task of devising appropriate quality assurance programs.
"I believe a professional organization such as ACR or AAPM should develop guidelines for QA programs with oversight of the programs the responsibility of JCAHO. I do not believe any federal [agency] should devise the programs" (AAPM). "It is essential that quality assurance programs be based within appropriate professional associations … state and federal agencies should establish