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18812

Image Optimally: A Program to Optimize Pediatric Radiation Safety In Patients with Chronic Congenital Urological Conditions

Saturday, October 20, 2012
Grand Ballroom A/B (Hilton Riverside)
Pramod P. Reddy, MD1, Steven Kraus, MD2, William DeFoor, MD1, John Racadio, MD2, Eugene Minevich, MD1 and Brian Coley, MD2, (1)Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (2)Department of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Purpose:

Advances in medicine and multidisciplinary care have resulted in increased life expectancy and improved quality of life for patients with chronic congenital urological conditions (CUC).  Current survival into adulthood approaches 80%.  These patients are often followed with multiple serial radiographic studies to monitor their health and improve clinical outcomes.  We created an inter-disciplinary improvement program to optimize the utilization of diagnostic imaging (DI) for patients with CUC, i.e. patients with Spina Bifida (SB) and Posterior Urethral Valves (PUV). In this study we present the baseline data on cost and dosimetry associated with DI in this patient population during their care in a Pediatric Hospital.

Methods:

A collaborative study was undertaken to review DI practices to determine utilization of DI resources, patient dosimetry, and cost to the healthcare system. IRB approval was obtained.  A cohort of patients with CUC treated from birth to age 21 years was identified and DI data abstracted from their medical record.  Costs reflect actual average collections, not charges.  Radiation estimates were derived from current departmental averages and literature estimates.

 

Results:

The number of DI studies performed is presented in the table as mean and range.  The cost of birth to adulthood DI testing, approximate radiation exposure in mSv, and the equivalent duration of background radiation is presented. 

Spina Bifida

PUV

Total Diagnostic Imaging studies performed

Mean = 96 (62-130)

(Mean Cost - $47,673.88)

Mean = 72 (69-74)

(Mean Cost - $34,180.53)

Ionizing Radiation DI studies

Mean = 53 (44-62)

Mean = 34 (33-34)

Ultrasound and MRI studies

Mean = 43 (18-68)

Mean = 38 (36-40)

GU related DI Studies

Mean =55 (16-93)

Mean = 47 (44-50)

Non- GU related DI studies

Mean = 42 (37-46)

Mean = 25 (19-30)

Radiation Dose Estimate

Mean 66.5 mSv

Mean 43.6 mSv

Equivalent Duration of Background Radiation

20 years and 6 months

10 years and 1 month

Conclusions:

True clinical integration and collaboration in the creation of this ‘Image Optimally' program is an example of “disruptive innovation” that will positively impact patients with CUC.  The current practice of imaging with radiation doses ‘as low as reasonably achievable' (ALARA) does not always take into to account costs of DI and the needs of patients with chronic health conditions and their long-term cumulative radiation exposures. This baseline data is being prospectively used to construct optimized ‘Best Practice' diagnosis specific imaging protocols. These will serve to reduce potential patient harm from radiation, while allowing for optimal care with reduced cost to the healthcare system.