Special Submission ELEVENTH ANNUAL WARREN K. SINCLAIR KEYNOTE ADDRESS Q&A
Questions for Dr. Bushberg Q: Is “Boiceinium” fissionable? Bushberg: Not yet, but we are working on it. Q: NCRP and Measurements—measurements are often omitted. Your slide showing the abundance of disciplines in NCRP activities does not include radiochemistry. This is the background of many of the disciplines. Why has NCRP omitted radiochemistry? Or measurement in general? Bushberg: The slide was just a sample of disciplines and not meant to be comprehensive. Radiochemistry and radiation measurements are, of course, critical disciplines. Q: How does the NCRP better engage the public? Bushberg: The first step will be to improve our web presence so that it not only has the features one expects to see in a modern website but has additional content that will make it a more useful resource for the public, the media, and radiation protection professionals. Development of a social media presence is another priority for NCRP. We need to be where the questions are being asked, and we want to enhance our ability to fulfill the public interest obligation in our Congressional charter. Additional initiatives include the recent establishment of the NCRP Program Area Committee (PAC 7), Radiation Education, Risk Communication, Outreach, and Policy, which (among other missions) will serve as a resource for the development of NCRP’s content on the web and social media. Q: After Fukushima, emergency evacuations of nonambulatory patients led to several deaths (hundreds) from the evacuations. Has NCRP made any recommendations regarding evacuation guidelines? Bushberg: Decisions regarding if, when, and how to evacuate a population are, of course, multifactorial. NCRP has made recommendations in Report No. 168 that should help decision makers evaluate the relative merits of sheltering in place compared to evacuation. Evacuation of nonambulatory patients in a hospital are a special case that does not necessarily follow from the recommendations made for
0017-9078/15/0 Copyright © 2014 Health Physics Society
the general ambulatory population. The best people to make those decisions are the healthcare providers at each facility in accordance with the assessment and decision made by the hospital incident commander. Q: It seems like your ALADA puts the onus on the diagnostic technology and the physician. How about ALAEM—as low as epidemiologically measurable? Bushberg: In my view, the onus should be on the diagnostic technology and the imaging team to make sure that the dose is optimized and, thus, sufficient (not more or less than necessary) to produce an exam suitable for the diagnostic question at hand. In the future, we will no doubt have more robust epidemiological studies with enough statistical power to improve our understanding of the relationship between low dose radiation exposure and cancer risk. We will likely have substantial uncertainty about the dose–response relationship in the low dose region for some time to come. Thus we should endeavor to optimize medial radiation exposures rather than tie them to the limits of our current epidemiological investigations, which would improperly imply there is no risk below that which is currently demonstrable. Q: We heard of the numerous computed tomography (CT) scans that occur every day in the United States; should the medical guidelines be changed to reduce the number of CT scans? Bushberg: There is no doubt that there is room for improvement with both the appropriateness of the CT exams ordered and dose optimization of those that are performed. Dr. Swenson provided an overview at this conference of the Image Gently, Image Wisely (and other) Campaigns that have been rolled out over the last few years devoted to improving awareness of appropriateness and optimization opportunities both in the United States and internationally. While there is anecdotal evidence that these initiatives have had a positive impact, more robust dose and utilization monitoring will be necessary to objectify this view. Medical guidelines for the best use of many CT and other radiological exams currently exist. In the United States, they are referred to as “Appropriateness Criteria” and are developed by interdisciplinary teams of imaging professionals and other specialties under the auspices of the American College of Radiology (ACR). In the United Kingdom, they are referred to as “referral guidelines,” which have been developed by the Royal College of Radiologists since 1989.
DOI: 10.1097/HP.0000000000000247
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www.health-physics.com
124
Copyright © 2014 Health Physics Society. Unauthorized reproduction of this article is prohibited.
Questions for Dr. Bushberg Q: Is “Boiceinium” fissionable? Bushberg: Not yet, but we are working on it. Q: NCRP and Measurements—measurements are often omitted. Your slide showing the abundance of disciplines in NCRP activities does not include radiochemistry. This is the background of many of the disciplines. Why has NCRP omitted radiochemistry? Or measurement in general? Bushberg: The slide was just a sample of disciplines and not meant to be comprehensive. Radiochemistry and radiation measurements are, of course, critical disciplines. Q: How does the NCRP better engage the public? Bushberg: The first step will be to improve our web presence so that it not only has the features one expects to see in a modern website but has additional content that will make it a more useful resource for the public, the media, and radiation protection professionals. Development of a social media presence is another priority for NCRP. We need to be where the questions are being asked, and we want to enhance our ability to fulfill the public interest obligation in our Congressional charter. Additional initiatives include the recent establishment of the NCRP Program Area Committee (PAC 7), Radiation Education, Risk Communication, Outreach, and Policy, which (among other missions) will serve as a resource for the development of NCRP’s content on the web and social media. Q: After Fukushima, emergency evacuations of nonambulatory patients led to several deaths (hundreds) from the evacuations. Has NCRP made any recommendations regarding evacuation guidelines? Bushberg: Decisions regarding if, when, and how to evacuate a population are, of course, multifactorial. NCRP has made recommendations in Report No. 168 that should help decision makers evaluate the relative merits of sheltering in place compared to evacuation. Evacuation of nonambulatory patients in a hospital are a special case that does not necessarily follow from the recommendations made for
0017-9078/15/0 Copyright © 2014 Health Physics Society
the general ambulatory population. The best people to make those decisions are the healthcare providers at each facility in accordance with the assessment and decision made by the hospital incident commander. Q: It seems like your ALADA puts the onus on the diagnostic technology and the physician. How about ALAEM—as low as epidemiologically measurable? Bushberg: In my view, the onus should be on the diagnostic technology and the imaging team to make sure that the dose is optimized and, thus, sufficient (not more or less than necessary) to produce an exam suitable for the diagnostic question at hand. In the future, we will no doubt have more robust epidemiological studies with enough statistical power to improve our understanding of the relationship between low dose radiation exposure and cancer risk. We will likely have substantial uncertainty about the dose–response relationship in the low dose region for some time to come. Thus we should endeavor to optimize medial radiation exposures rather than tie them to the limits of our current epidemiological investigations, which would improperly imply there is no risk below that which is currently demonstrable. Q: We heard of the numerous computed tomography (CT) scans that occur every day in the United States; should the medical guidelines be changed to reduce the number of CT scans? Bushberg: There is no doubt that there is room for improvement with both the appropriateness of the CT exams ordered and dose optimization of those that are performed. Dr. Swenson provided an overview at this conference of the Image Gently, Image Wisely (and other) Campaigns that have been rolled out over the last few years devoted to improving awareness of appropriateness and optimization opportunities both in the United States and internationally. While there is anecdotal evidence that these initiatives have had a positive impact, more robust dose and utilization monitoring will be necessary to objectify this view. Medical guidelines for the best use of many CT and other radiological exams currently exist. In the United States, they are referred to as “Appropriateness Criteria” and are developed by interdisciplinary teams of imaging professionals and other specialties under the auspices of the American College of Radiology (ACR). In the United Kingdom, they are referred to as “referral guidelines,” which have been developed by the Royal College of Radiologists since 1989.
DOI: 10.1097/HP.0000000000000247
■■
www.health-physics.com
124
Copyright © 2014 Health Physics Society. Unauthorized reproduction of this article is prohibited.
