2012 NATIONAL HEALTHCARE SUMMIT

Safe Use in Medical Imaging: Developing a Systematic and Patient Centered Approach

Safe Use in Medical Imaging: Developing a Systematic and Patient Centered Approach will launch the ABR Foundation’s new Safe and Appropriate Use in Medical Imaging (SAUMI) initiative. This initiative will convene the stakeholders (listed below) from both the public and private sector to form a public/private professional partnership focused on identifying and addressing quality and safety gaps in medical imaging. The Summit will be held in August 2012 at the Bethesda North Marriott Hotel and Conference Center, in the Washington DC area.

SAUMI focuses squarely on two important public health and safety issues. First is the risk to patient safety and population health that results from the six-fold increase in per capita medical radiation dose to the U.S. population over the past quarter century (National Council of Radiation Protection and Measurements, Report 160), due largely to CT scanning, nuclear medicine procedures, and certain image –guided interventional procedures.  This risk comprises both an incremental long-term increase in incident cancers in the population (stochastic effects), and deterministic effects in individual patients (hair loss, skin burns, necrosis, ulcers).

The second public health issue is overuse, which results in duplication, waste, added healthcare cost, and needless irradiation.  Contributing to overutilization are perverse incentives, including current payment systems, self-referral, defensive medicine, duplicate studies/poor care coordination/poor technique, inadequate evidence base, lack of knowledge, and failure to apply appropriateness criteria

Even appropriately performed procedures pose a risk of avoidable errors in dosing due to the lack of safety controls in equipment design, uniform protocols and reference doses for clinical imaging in common conditions, common terminology for procedures and techniques, quality control, and training.  For some commonly performed CT scans, variation in estimated dose may exceed two orders of magnitude (FDA Workshop, 03/2010). Such extreme variation clearly signals the need for the type of systems approach that SAUMI offers.

Just now emerging are several major patient-centered concepts concerning imaging and irradiation. One is patient-specific cumulative radiation dose tracking, which will help to individualize decisions concerning diagnostic imaging. Another is web-based, secure, patient-directed image sharing across healthcare institutions, should help to coordinate care, eliminate waste, and advance patient autonomy.  The opportunity for the Partnership will be to sharpen the focus on these technologies and to help accelerate their adoption across the nation.

GOALS:  Through the sharing of ideas and consensus among the public-private partners, the partnership will:

• describe all steps in the safe and appropriate use of medical imaging;
• define the optimal state for each step;
• identify gaps between current and optimal states; and
• create initiatives to address elimination of the gaps in a master action plan

The stakeholders will assume specific roles in the public-private partnership. The partnership will agree on consensus approaches to address each of the gaps, and stakeholders from each domain will assume responsibility for their initiatives. The partnership will re-convene approximately every six months, and in the interim, actively update each other on their gap-closing activities via a SAUMI Web portal.

Deliver results that patients and their physicians will use to make informed decisions.

ABRF will post summary results of the conferences on its website, with links to partners’ websites to allow the public, patient groups, practitioners, and other interested parties to access the analysis of gaps, plans for addressing them, and updates on the activities of the partnership. In addition, white papers will be developed to address identified discrete problems.

Accelerate the path to best practices in medical imaging.

The partnership’s master action plan for Safe and Appropriate Use of Medical Imaging will sharpen the focus on existing and emerging technologies and help accelerate their adoption across the nation. Research and solutions to discrete problems will be disseminated.

Invited organizations include professionals from the following fields: equipment design and manufacture; regulatory; training and education; certification; accreditation; human factors engineering; quality and safety science; clinical imaging (all specialties); medical specialty societies; evidence - based medicine; informatics, including decision support, cumulative radiation dose-tracking, Web-based secure patient-directed image sharing across healthcare institutions and practitioners, and automated sentinel reporting systems; care coordination; payment reform; and health services research.           

ABOUT SAUMI AND THE ABRF:

The American Board of Radiology Foundation (ABRF), is a 501(c)3 foundation dedicated solely to accountability to the public for appropriate use of medical imaging and radiation therapy.  The SAUMI public-private partnership is a multi-faceted collaborative comprised of patient groups, healthcare providers, and key stakeholders. SAUMI will: a) provide a landscape review of the current state of medical imaging; b) create a master action plan to address the quality and safety gaps in the current medical imaging system; c) publicly report its analyses of quality and safety gaps in each domain of the system, and develop white-papers for discrete problems identified; and d) initiate targeted activities in each of the gap areas.