cancer risk in children exposed to medical radiation gebrewold_ mph capstone 2016
TRANSCRIPT
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Cancer risk in children exposed to medical radiation
Assessment of current radiation protection practices and emerging opportunities
By: Bineyam Gebrewold MPH Candidate 2016
Advisor: Paul A. Locke, JD DrPH
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To my beloved wife and our three beautiful children
To my advisor Dr. Paul Locke To JHSPH faculty and MPH office staff To my family and friends
Acknowledgement
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Background Methods Define the problem Magnitude of the problem Key determinants Stakeholders Current practices Future directions Conclusion
Outline
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Background
Why medical radiation Shooting your own foot
Personal experience in pediatric imaging
Conflicting views between radiology fellows and techs
Learned the concern in the rising trend of medical radiation exposure
Developed interest to apply public health approach to study the issue
50%
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Application of public health problem solving approach to shed light on the risk of cancer in children exposed to medical radiation.
Assessment of current radiation protection practices and emerging opportunities.
Proposing innovative solutions to reduce
the burden of radiation exposure in children.
Specific Aims
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Study population and methods
Study Population: Methods
American
children
Literature Review
Policy assessment
Stakeholder analysis
Report appraisal
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What is Medical radiation
International Radiation Commission on Radiological
Protection (ICRP,2007)
“Medical radiation exposure is as exposure incurred by patients as
part of their own medical or dental
diagnosis and treatment”.
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medical imagingBenefits vs. Risk
Non Invasive Clinical Information
Exposure risk is Cumulative
Rapid and accurate diagnosing
Better monitoring of disease
Planning treatment of complex medical problems
Exposure to Ionizing radiation
Established carcinogen
Increased risk of cancer
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Health effects from Ionizing radiation
• Dose dependent• e. g. dermatitis,
cataracts and epilationDeterministi
c
• Dose independent• e.g. Leukemia, breast
cancer, solid tumorsNon-
deterministic
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Why is radiation exposure a concern in children?
More sensitivity
Longer life expectancy
Smaller body size
Imaged on adult equipment
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Exposure to ionization radiation from medical imaging is rapidly growing in american children. A rising exposure rate and hence higher risk for cancer would be the order of the future unless the current radiation protection practice guidelines are strictly enforced and newer innovative ways to protect children are enacted.
Definition of the problem
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Magnitude of the problem
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From NCRP Report No. 160, “Ionizing Radiation Exposure of the Population of the United States” (2009)
24 %
12 % 7 % 5 %
37 %
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Magnitude of the problem
10% /year
Source: IMV Medical information division, 2012
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43% • American kids underwent imaging (8.5 million CT)
29,000 • CT related future cancers (adults)
2% • Of 1.4 million cancer cases (USA)
Magnitude of the problem
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Key DeterminantsBiological determinants
Economic determinants
Socio-cultural determinants
Political Determinants
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Consumers
Professional Societies
Payers
International Agencies
Regulatory Agencies
Equipment Manufactures
Providers
Stakeholders
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StakeholdersStakeholder Classificatio
nRole
U.S. Food and Drug Administration (FDA)
Regulatory Protect the public from harms of radiation through regulation, research and outreach
The Conference of Radiation Control Program Directors (CRCPD)
National promote consistency, encourage high standards of quality in radiation protection programs, and provide leadership in radiation safety and education
Alliance in Radiation Safety in Pediatric Imaging (ARSPI)
Professional Increasing awareness of CT dose to children. “Image Gently”
American College of Radiology (ACR)
Professional Provides appropriateness criteria
American Association of Physicists in Medicine (AAPM)
Professional Improve safety and efficacy of imaging procedures through research and setting standards
American Academy of Pediatrics (AAP)
Professional Issues policy statements, educates members and the public
The International Atomic Energy Agency (IAEA)
International Establishes and promote safety standards, provide guidance and policy recommendations
World Health Organization (WHO) International Facilitating the adoption & application of regulations, evaluate radiation medicine services, educating and training workforceMedical Imaging and Technology
Alliance (MITA)Manufactures Advocacy for fair legislative and regulatory
proposals, leads manufacturers, research & development
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development of radiation safety and protection guidelines and recommendations
will not result in possible reduction of exposure to medical radiation
poorly developed the regulatory and educational components
lagging behind the rapidly evolving technological advancement
stronger enforcement of policies and regulations
introduction of new tools well-matched with current information and instrumentation technologies are needed
Stakeholders
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Current practicesICRP
• Justification, Optimization , Dose Limits
ACR• ACR Appropriateness criteria
FDA• Initiative to Reduce Unnecessary Radiation Exposure
from Medical Imaging
EPA• Radiation Protection Guidance for Diagnostic and
Interventional X-Ray Procedures; Federal Guidance Report No. 14.
Agreement States
• certification standards for radiologic technologists, scanner inspections, and other quality assurance measures
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Future directionsClinical Decision Support System (CDS)
Dose Archiving, monitoring and reporting
NIH dose reporting requirements
The promise of the Accountable Care Organization (ACO)
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“….regulatory agencies, practitioners, manufactures and the public at large are expected to work in close collaboration to
develop balanced public health approaches that support the benefits of medical imaging while reducing the risks associated with it” .
Conclusion
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Thank You