Stricter training urged for imaging, radiation

Radiologists urge accreditation standards that would link Medicare pay to a practitioner's training.

By Doug Trapp — Posted March 15, 2010

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National standards are needed for the training and certification of individuals -- typically nonphysicians -- conducting medical imaging and radiation therapy, industry witnesses told a House panel during a Feb. 26 hearing.

"The benefits that we as a society have gained from these advancements are enormous," said Rep. Frank Pallone Jr. (D, N.J.), chair of the House Energy and Commerce subcommittee on health. "But we often forget the fact that we are still dealing with something that is toxic to the human body. When it is delivered correctly, a single CT scan can deliver as much radiation as 300 chest x-rays."

Experts testified that radiation overdoses at hospitals and other facilities -- as reported recently in The New York Times -- could be reduced with more consistent training, better supervision and procedures to address mechanical errors.

Imaging machines are complex, but state certification has lagged, said Sandra Hayden, a board member of the American Society of Radiologic Technologists and a radiation therapist at MD Anderson Cancer Center in Houston. "In some states, hairdressers are better regulated than people who perform medical radiation procedures."

Radiation treatments have as many as 100 steps, said Eric E. Klein, PhD, a clinical medical physicist and a professor of radiation oncology at Washington University in St. Louis. Patients are sometimes injured when standard operating procedures fail.

The panel heard testimony from James Parks, whose son Scott died in 2007 at age 43 in a New York City hospital. Scott's father said his son received an overdose of radiation from a linear accelerator during a treatment for tongue cancer in 2005. Scott's last wish was for his death to raise awareness of medical radiation errors.

Some subcommittee members said they don't want new regulations to reduce access to lifesaving technology. "The problem is that if we don't deal with this, we will scare both practitioners and people away from it," said Rep. Gene Green (D, Texas).

The number of patients who received MRI, CT, PET or other scans during outpatient physician and hospital visits more than tripled between 1996 and 2007, according to a federal report released in February. Medical imaging has virtually ended exploratory surgery and has helped greatly increase cancer survival rates, said E. Stephen Amis Jr., MD, past president of the American College of Radiology and chair of the ACR's Task Force on Radiation Dose in Medicine.

Higher standards for imaging technologists and radiation therapists are on the way, but they should be expanded, Dr. Amis said. Legislation adopted in 2008 requires practitioners to be accredited by Jan. 1, 2012, to receive the Medicare technical component payment for MRI, CT, PET and nuclear medicine services. Hospitals are exempted from this standard, but they should not be, he said.

Also, the Food and Drug Administration announced on Feb. 9 its intention to require manufacturers of CT scanners and certain other radiologic equipment to incorporate greater safeguards into their machines and to provide safety training.

A bill introduced by Rep. John Barrow (D, Ga.) would require the Health and Human Services secretary to work with industry experts to create national training and certification standards for nonphysician imaging technologists. Noncertified practitioners would forgo Medicare pay starting Jan. 1, 2013.

American Medical Association policy supports efforts to work with specialty medical societies on the feasibility of quantifying the cumulative radiation exposure patients experience in medical settings. AMA policy also supports educating physicians on methods to limit this exposure.

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Proposed training standards for nonphysicians

A measure sponsored by Rep. John Barrow (D, Ga.) would create minimum national training and certification standards for certain nonphysicians conducting MRI, CT, PET or other high-radiation scans or radiation therapy. The bill would:

  • Require the Health and Human Services secretary to consult experts and develop minimum certification standards for individuals who perform or plan medical imaging and radiation therapy. The standards would vary by discipline and allow practicing staff to be certified based on their experience.
  • Direct the HHS secretary to designate organizations to certify individuals who have been trained to meet the standards.
  • Exempt physicians, physician assistants and nurse practitioners from the certification requirements.
  • Allow states to establish more extensive certification requirements.
  • Prohibit Medicare pay for medical imaging and radiation therapy services provided on or after Jan. 1, 2013, by people who are not certified.

Source: The Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy Act of 2009

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