Rules and Regulations Relating to Roles of Nonphysician Providers in Radiology Practices.

Nonphysician providers (NPPs) in radiology practices include nurse practitioners, physician assistants, and radiologist assistants. The number of NPPs has been increasing both within and outside of radiology departments. In order for leaders in radiology departments to incorporate NPPs effectively into their practice, they require nuanced knowledge of appropriate coding and billing for services these professionals render. Furthermore, the existing body of literature suggests that with a defined and appropriate scope of practice and proper supervision, NPPs can provide care that is at least equivalent to that provided by attending physicians for narrowly defined tasks. A broader understanding of the rapidly evolving NPP workforce both within radiology practices and throughout other health care specialties will inform practice leaders who are adapting to a health care system that is moving rapidly toward value-based incentive payment models. ©RSNA, 2018.

Governmental regulations and radiation exposure.

BACKGROUND: The use of radiation for medical purposes falls under the purview of the Food and Drug Administration (FDA) and individual states. Enhanced regulations are in place to promote the right exam for the right reason at the right time for every patient exposed to medical x-rays. METHODS: The February 2010 FDA initiative to reduce unnecessary radiation exposure from fluoroscopy, CT, and nuclear medicine studies is reviewed along with regulations currently in place. RESULTS: Facilities granting privileges to physicians performing fluoroscopic procedures need to ensure appropriate education so they can assess individual patient risk and benefit on a case-by-case basis. These are guidelines with individual states controlling requirements. CONCLUSION: Regulation of education, training, and credentialing for physician operators of fluoroscopic equipment is currently controlled by individual states and is not uniform. There are strong indications that the FDA and or the Joint Commission will become increasingly involved to increase documentation of patient exposure and safety.

[Typical patient radiation doses in diagnostic imaging]. / Ordre de grandeur des doses délivrées en radiodiagnostic.

Radiologists should be able to appreciate the radiation dose delivered to patients for routine diagnostic procedures. The radiology report should include data necessary to calculate the patient dose in Gray. Using the effective dose, it is possible to compare with other source of radiation exposure. Simple formulas, taking into account different anatomical regions, derived from dose-area product (conventional radiography) or dose-length product (CT) are provided to calculate the effective dose in Sievert. For conventional (non-interventional) radiography, the effective dose for a given exam is inferior or equal to the yearly background radiation. For CT, the effective dose corresponds to 1 to 10 years of yearly background radiation.

[The radiologist's responsibilities for the radiation protection of patients]. / Obligations du radiologue pour la radioprotection des patients.

The obligations of the radiologist for the radiation protection of patients include a review of the appropriateness of the examination and optimization of the protocol. Both internal and external quality assurance programs are mandatory. The specific tasks and their frequency are defined by the AFSSAPS. The radiology report of procedures performed over radiosensitive regions must include the delivered dose. The imaging technique must be optimized based on published guidelines or law for the most frequent examinations. All radiologists should be familiar with radiation protection. Incidents should be reported to the Nuclear Safety Authority.

Assessing radiation protection knowledge in diagnostic radiography in the Republic of Cyprus. A questionnaire survey.

INTRODUCTION: Radiation protection knowledge is essential for medical personnel in ensuring that the possible risks do not outweigh the benefits of diagnostic imaging. This study aimed to assess the radiation protection knowledge of radiographers in Cyprus. METHODS: A cross-sectional study was carried out among radiographers in Cyprus through the Cyprus Society of Registered Radiologic Technologists & Radiation Therapy Technologists. The study was a quantitative descriptive analysis, using a questionnaire with 22 multiple-choice questions. Analysis of the data was done using the statistical software Stata, by performing mean knowledge score comparisons by different participants' characteristics, using t-test and analysis of variance test. Statistical significance was assumed as a p-value < 0.05. RESULTS: The answers provided for each question indicate that some areas of radiation protection are less known compared to others, as there is quite a wide range of correct-to-incorrect ratios. The analysis based on participant characteristics in relation to overall radiation effects knowledge, identified important determinants, namely the workplace of the participant (p = 0.006), the type of work licence the participant held at the time of the questionnaire (p = 0.024), and the years of clinical experience of the participant (p = 0.021). CONCLUSION: The study showed that the levels of knowledge in radiation protection are of a very good standard. However, work is needed to clarify the specifics of dose limits and the national radiation protection legislation with regards to informing patients about the possible effects of ionising radiation. IMPLICATIONS FOR PRACTICE: The study results indicate the importance of educating radiographers about the requirements of national radiation protection legislation and how this new knowledge can be linked with practise.

Mala praxis: a study of malpractice claims and litigation in the field of radiology.

Risk management plays an integral role in the mitigation of malpractice claims in the radiology environment. This holds true for the radiologist and professional association as well as the facility that supports the radiologic service. The radiologist and the radiology department or imaging center are separate entities which have a symbiotic relationship. Radiologists may function as an independent contractor, yet their function is dependent on the facility with which it contracts. The function of the radiology department is directly related to the radiologist's performance, staff competency, and equipment performance. Mammography poses particular concern with regard to medical malpractice, as there is an inherent subjectivity in the differential diagnosis with regard to breast cancer in mammography.

Clinical justification of dental radiology in adult patients: a review of the literature.

Although the radiological doses used by dentists are low individually, patients are often exposed to many repeat dental radiographic examinations. The "routine" use of dental radiography, such as screening of all patients using dental panoramic radiography (DPRs) or a random decision to take a dental radiograph, will inevitable lead to unnecessary patient exposure. The use of Radiographic Referral Criteria has now become a legal requirement for all practitioners following the adoption of European Legislation. All exposures to x-rays should be clinically justified and each exposure should be expected to give the patient a positive net benefit. Recently the European Commission has published guidelines on radiation protection in dental radiology. Guidelines have previously been available in a number of European countries and also within the United States. At the present time, no specific guidelines have been published within Spain. The aim of this review article is to provide the Spanish dentist with guidance as to the appropriateness of different radiographic techniques for a variety of clinical conditions and also the frequency with which they should be taken. It is hoped that this document will act as a useful work tool in daily dental practice.

Medical malpractice in the age of technology: how specialty societies can make a difference.

In the United States, medical malpractice litigation, and the rising cost of malpractice insurance, is a crisis that threatens to restrict patient access to high-risk services, especially obstetrics and certain surgical procedures. Radiation Oncology, though a small specialty, is very technologically oriented. Because the history of product liability and malpractice litigation in this country parallels the technologic revolution, practitioners of this specialty are clearly at risk for litigation. Because legislative relief is unlikely to be forthcoming in the near future, many specialty societies have assumed the responsibility for devising means to protect members from frivolous law suits, without compromising a patient's right to due process. To date, Radiation Oncology societies have not taken a leadership role in this movement, preferring instead to cede this responsibility to the American College of Radiology. Opportunities exist for specialty societies to define standards of care and establish guidelines for expert witness testimony. To date, the courts have been supportive of these efforts. Herein, we summarize some of the salient issues of the malpractice crisis facing Radiation Oncology and offer suggestions for change within the specialty to better address the malpractice problem.

A history and overview of the certification exam for medical dosimetrists.

During the last century, the creation and implementation of board certification has had a powerful impact on the medical community. Board certification has helped to shape the scope and practice of medical professionals and the care they provide, as well as to influence the way the health insurance industry sets standards for reimbursement. One profession that offers board certification to its members is medical dosimetry. The Medical Dosimetrist Certification Board exam has been administered since 1988 and its content covers a broad spectrum of information from the radiation therapy sciences. The exam has strict application requirements and is rather difficult to pass. Those who pass the exam can then call themselves Certified Medical Dosimetrists. For data purposes of this study, several members of the dosimetry community were solicited to participate in a survey regarding the exam's content and history, and to provide relevant statistical data. Currently 2,177 medical dosimetrists are board certified, with an additional 1,500 estimated to be working without certification. Although board certification is not currently required to practice medical dosimetry, new legislation known as the CARE Bill could change this. The CARE Bill, if passed, would mandate nationwide compulsory licensure and/or certification for medical dosimetrists and other medical professionals who want to work in radiation-related health care. Health maintenance organizations and other insurance carriers may likewise require certification for reimbursement purposes.

Linguistic and cultural competency.

The U.S. population is becoming more diverse and cultural and linguistic barriers may adversely affect the quality of health care for some individuals. Cultural and linguistic competencies are now a high priority for national health policy. Research commissioned by the American Society of Radiologic Technologists indicates that diversity among patients is a leading health care trend that will have an impact on radiologic technologists in the immediate future.

Medical Ethics and Law in Radiologic Technology.

At every stage of their careers, radiologic technologists and student technologists must adhere to high ethical standards, obey the law, and consistently conduct themselves with professionalism. This article explains how modern health care ethics evolved, focusing on 8 important theorists. It also describes the ethical responsibilities of health care providers and the rights of patients. Important civil rights laws are discussed, focusing on the rights of health care workers as employees. A brief overview of the U.S. legal system follows, including the causes of action that most commonly involve health care professionals. Finally, this article discusses professionalism and its implications for radiologic technologists.