The problem of radiation exposure is being attacked on many levels, but at the present time, much of what is being done is talk. Talk is good, but it will need some stimulus to move forward. This stimulus usually comes from the government in various forms. Two of the strongest are CMS or the Centers for Medicare and Medicaid Services and the Joint Commission (JC), whose name was recently shortened from the Joint Commission for Hospital Accreditation. The Joint Commission is a biannual exercise in horror management for everyone involved. Without accreditation, a hospital can lose its Medicare funding, and at that point, they might as well close. Whenever it is time for the visit by the JC, which is unannounced, everything gets cleaned up, and all sorts of mock exams take place. Much of the process is useful to remind people as to what best practices are. Some of the practices should have been in place years ago and reflect doctors' general cluelessness as we should have been doing it long before it was required. It's not rocket science to make sure you know exactly what you are doing on a patient before you start, but in the past, horrendous mistakes have been made. Remember the wrong leg amputations? Wrong side of the brain operations? The rumor is that the Joint Commission is going to demand some sort of patient specific radiation tracking. Ostensibly, this tracking will follow you around so that the next hospital that you go to will understand that you have already had Hiroshima levels of radiation because you just had 5 hours of fluoroscopy. Sounds easy doesn't it? In fact, it may not be possible. This is because of HIPPA and the lack of a Universal health record. For better or worse, at the present time, there is no easy way to follow a patient's care from place to place. Civil rights activists turn apoplectic when the topic comes up. We could hand you a slip of paper with your radiation level total on it, but most patients can't remember the names and doses of their drugs. Remembering your radiation number is just too much to ask. Are we ready for a registry with unique identifiers in it for everyone? Who will be responsible for it? Who and when can it be accessed? Who will monitor it? Who will pay for it? Get the point? No action is not an option. The solution starts at the beginning. When I was in training, the total number of hours that I had of radiation education was... wait for it...zero. That's right, they throw you in with a gigantic machine, and you got zero training on even how to use it. This has changed to some extent but not enough. Even the certification boards we take don't spend much time on proper radiation use. Didactic classes should be required for licensure each time we license. What's more important for me, domestic violence or radiation safety? I am not discounting domestic violence, but educational requirements should reflect the practice of what you do. Much more to come...and some solutions that are being tried.
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