The Americas’ Regional Report by Christopher Steelman
Communicating Advances in Radiation Education for Shielding (CARES) Committee
releases “Patient Gonadal and Fetal Shielding in Diagnostic Imaging Frequently Asked Questions”
In April of 2019, the American Association of Physicists in Medicine (AAPM) released a position statement outlining the reasons for discontinuing the routine use of fetal and gonadal shielding in medical imaging. The AAPM is a scientific and professional organization, founded in 1958, composed of more than 8000 scientists whose clinical practice is dedicated to ensuring accuracy, safety and quality in the use of radiation in medical procedures such as medical imaging and radiation therapy.
Recognizing that considering changes to patient shielding practices represent a substantial shift in clinical practice, AAPM formed a committee to develop guidance documents and coordinate communication with imaging professionals, patients, and parents. The purpose of the Communicating Advances in Radiation Education for Shielding (CARES) Committee is to bring together professionals from different sectors to facilitate discussions regarding diverse opinions and perspectives, discuss potential changes to clinical practice and to offer sample policies and procedures for use in clinical facilities. Representatives from ASRT, ARRT, AEIRS, and JRCERT are currently working together to present a unified message to CARES and presentations related to this topic may be held during the 2020 ASRT Education Symposium.
In December of 2019, the AAPM-led CARES committee released a series of FAQs to help healthcare professionals and patients understand the reasoning behind updated recommendations to discontinue routine shielding of patients during medical imaging exams. The document was developed in collaboration with several radiological organizations, including: The American College of Radiology (ACR), Association of Educators in Imaging and Radiological Sciences (AEIRS),American Society of Radiologic Technologists (ASRT), Canadian Organization of Medical Physicists (COMP), Conference of Radiation Control Program Directors (CRCPD), Health Physics Society (HPS), Image Gently, Image Wisely, and the Radiological Society of North America (RSNA).
The document “contains three sections, each with a different target audience. The first addresses questions and concerns of healthcare professionals, including, but not limited to, radiologic technologists, physicians, advanced practice providers, medical physicists, radiation safety officers, and nurses. This section also includes some suggested wording that can be used when discussing patient shielding with patients and parents or other caregivers of paediatric patients. The second section addresses common concerns among patients and is best suited for adult patient populations. The third section is intended for parents and other caregivers of paediatric patients”
The CARES committee recommends that “facilities that choose to limit the routine use of patient fetal and gonadal shielding use this document, in part or in whole, to help establish a guideline or policy that meets the needs of their individual practice.”
American Association of Physicists in Medicine (AAPM) Position Statement on the Use of Patient Gonadal and Patient Shielding https://www.aapm.org/org/policies/details.asp?id=468&type=PP
Patient Gonadal and Fetal Shielding in Diagnostic Imaging Frequently Asked Questions
Communicating Advances in Radiation Education for Shielding (CARES) Social Media:
CARES@aapm.org, Twitter: @aapmCARES, Facebook: aapmhqCARES)
Groups Publish Statements on CT Contrast Use in Patients with Kidney Disease
According to new consensus statements from the American College of Radiology (ACR) and the National Kidney Foundation (NKF) the risk of administering modern intravenous iodinated contrast media in patients with reduced kidney function has been overstated.
The Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation was developed to improve and standardize the care of patients with impaired kidney function who may need to undergo exams that require intravenous iodinated contrast media to provide the clearest images and allow for the most informed diagnosis.
The report outlines the key differences between contrast-induced acute kidney injury (CI-AKI) and contrast-associated acute kidney injury (CA-AKI). In CI-AKI, a causal relationship exists between contrast media and kidney injury, whereas in CA-AKI, a direct causal relationship has not been demonstrated. The authors suggest that studies that have not properly distinguished the two have contributed to the overstatement of risk. The statements answer key questions and provide recommendations for use of intravenous contrast media in treating patients with varying degrees of impaired kidney function.
Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation