Download AMERICAN COLLEGE OF EMERGENCY PHYSICIANS

PLEASE NOTE: THIS RESOLUTION WILL BE DEBATED AT THE 2012 COUNCIL MEETING. RESOLUTIONS ARE NOT
OFFICIAL UNTIL ADOPTED BY THE COUNCIL AND THE BOARD OF DIRECTORS (AS APPLICABLE).
RESOLUTION:
27(12)
SUBMITTED BY:
Pennsylvania Chapter
SUBJECT:
Radiation Exposure in the Emergency Department Patient
PURPOSE: Work with the American College of Radiology (ACR) to develop a comprehensive white paper
recommending policy on radiation exposure for the care of patients in the emergency department.
FISCAL IMPACT: $6,000
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WHEREAS, The CDC classifies radiation as a known carcinogen; and
WHEREAS, It has been established by FDA physicists that increased radiation leads to increased risk of
cancers and The New England Journal of Medicine reportedly estimated 1-2 % of cancers in the US in 2007 were
related to computed tomography (CT) scans; and
WHEREAS, One University of Michigan Health System study published in 2011 showed 330% increase
between 1996 and 2007 in emergency department CT scans and 1 in 7 emergency department patients in 2007 got
a CT scan; and
WHEREAS, About 25% of all CT scans done in the US are performed/ordered by emergency
departments; and
WHEREAS, There are a percentage of patients that utilize the emergency department frequently and are
subsequently exposed to more imaging; and
WHEREAS, ACEP is the leading voice in emergency medicine; therefore be it
RESOLVED, That ACEP develop with the American College of Radiology (ACR) a comprehensive
“white paper” recommending policy on radiation exposure for the care of patients in the emergency department.
Background
This resolution calls for the College to work with the American College of Radiology (ACR) to develop a
comprehensive white paper recommending policy on radiation exposure for the care of patients in the emergency
department (ED).
ACEP is a supporting organization for the Image Wisely campaign, a joint initiative of the American College of
Radiology, the Radiological Society of North America, the American Association of Physicists in Medicine and the
American Society of Radiologic Technologists. Image Wisely seeks to raise awareness among imaging providers,
referring practitioners and patients of opportunities to eliminate unnecessary exams and to reduce the amount of
radiation used to only the level needed to produce diagnostic medical images. In addition ACEP supports the Image
Gently campaign, which aims to raise awareness and provide education for the imaging community regarding the
need to adjust radiation dose when imaging children.
Image Wisely and Image Gently maintain proprietary websites (www.imagewisely.org and www.imagegently.org)
providing educational resources and news for all stakeholders in medical imaging. Referring practitioners can find
Resolution 27(12) Radiation Exposure in the ED
Page 2
resources including downloadable brochures on radiation and imaging that can be provided to patients, frequently
asked questions about radiation, and links to credible outside sources of information.
In June 2012, the ACR released a study concluding that nine out of ten ED patients who received CT scans were
classified as clinically complex and that utilization of advanced medical imaging in the ED setting serves many
valuable roles. For example, CTs of the abdomen and pelvis have been shown to decrease waiting times, decrease
hospital lengths of stay and reduce the need for exploratory surgery. The ACR white paper on Radiation Dose in
Medicine states: “Influencing referral patterns from emergency departments, for example, poses a major challenge.
Patients arriving at emergency departments are acutely ill or injured, may have incomplete medical records, and
may not be able to communicate their medical histories accurately.” Additionally, the white paper states,
“Emergency department physicians are aware that computed tomography can provide quick, reliable answers to
many clinical questions. The Emergency Medical Treatment and Labor Act and other concerns regarding medical
liability, along with the known clinical efficacy of CT scans, have been significant drivers of CT referrals.” As a
result, ACR recognized that: “…educational programs for emergency physicians regarding the radiation risks
associated with computed tomography is likely to do little to alter their referral patterns. Rather, the ACR should
proactively sponsor a summit meeting between leaders of radiology and emergency medicine to address the
growing issue of increasing radiation exposure to patients due to the overutilization of medical imaging.”
ACEP participated in ACR’s Foundation 2009 Summit: “Medical Imaging Addressing Overutilization in the Era of
Healthcare Reform” and attended the August 23-24, 2012 Summit: “Safe Use in Medical Imaging: Developing a
Systematic and Patient Centered Approach.”
In 2010, ACEP participated in a workshop sponsored by the National Council on Radiation Protection and
Measurements on “Computed Tomography in Emergency Medicine Ensuring Appropriate Use” and in the
development of a consensus paper on “Clinical Decisions Guidelines for Applications of Computed Tomography in
Emergency Medicine.”
The Annals of Emergency Medicine has published numerous articles on radiation exposure affecting patients and
physicians. In July 2011, Annals published “Patient Perceptions of CT Imaging and Their Understanding of
Radiation Risk and Exposure” and in January 2007, published an article on “Radiation Risk Associated with CT
and High Frequency Emergency Department Users.”
ACEP Strategic Plan Reference
Improve Quality, Patient Safety, and Efficiency
Fiscal Impact
Approximately $6,000 and includes the expenses associated (travel, meals, conference calls, and production and
promotion costs) with convening a task force to develop a white paper.
Prior Council Action
None
Prior Board Action
None
Background Information Prepared By: Marilyn Bromley, RN
Emergency Medicine Practice Director
Reviewed by: Marco Coppola, DO, FACEP, Speaker
Kevin Klauer, DO, EJD, FACEP, Vice Speaker
Dean Wilkerson, JD, MBA, CAE, Council Secretary and Executive Director