Cancer risk in children exposed to medical radiation

Assessment of current radiation protection practices and emerging opportunities

By: Bineyam Gebrewold MPH Candidate 2016

Advisor: Paul A. Locke, JD DrPH

To my beloved wife and our three beautiful children

To my advisor Dr. Paul Locke To JHSPH faculty and MPH office staff To my family and friends

Acknowledgement

Background Methods Define the problem Magnitude of the problem Key determinants Stakeholders Current practices Future directions Conclusion

Outline

Background

Why medical radiation Shooting your own foot

Personal experience in pediatric imaging

Conflicting views between radiology fellows and techs

Learned the concern in the rising trend of medical radiation exposure

Developed interest to apply public health approach to study the issue

50%

Application of public health problem solving approach to shed light on the risk of cancer in children exposed to medical radiation.

Assessment of current radiation protection practices and emerging opportunities.

Proposing innovative solutions to reduce

the burden of radiation exposure in children.

Specific Aims

Study population and methods

Study Population: Methods

American

children

Literature Review

Policy assessment

Stakeholder analysis

Report appraisal

What is Medical radiation

International Radiation Commission on Radiological

Protection (ICRP,2007)

“Medical radiation exposure is as exposure incurred by patients as

part of their own medical or dental

diagnosis and treatment”.

medical imagingBenefits vs. Risk

Non Invasive Clinical Information

Exposure risk is Cumulative

Rapid and accurate diagnosing

Better monitoring of disease

Planning treatment of complex medical problems

Exposure to Ionizing radiation

Established carcinogen

Increased risk of cancer

Health effects from Ionizing radiation

• Dose dependent• e. g. dermatitis,

cataracts and epilationDeterministi

c

• Dose independent• e.g. Leukemia, breast

cancer, solid tumorsNon-

deterministic

Why is radiation exposure a concern in children?

More sensitivity

Longer life expectancy

Smaller body size

Imaged on adult equipment

Exposure to ionization radiation from medical imaging is rapidly growing in american children. A rising exposure rate and hence higher risk for cancer would be the order of the future unless the current radiation protection practice guidelines are strictly enforced and newer innovative ways to protect children are enacted.

Definition of the problem

Magnitude of the problem

From NCRP Report No. 160, “Ionizing Radiation Exposure of the Population of the United States” (2009)

24 %

12 % 7 % 5 %

37 %

Magnitude of the problem

10% /year

Source: IMV Medical information division, 2012

43% • American kids underwent imaging (8.5 million CT)

29,000 • CT related future cancers (adults)

2% • Of 1.4 million cancer cases (USA)

Magnitude of the problem

Key DeterminantsBiological determinants

Economic determinants

Socio-cultural determinants

Political Determinants

Consumers

Professional Societies

Payers

International Agencies

Regulatory Agencies

Equipment Manufactures

Providers

Stakeholders

StakeholdersStakeholder Classificatio

nRole

U.S. Food and Drug Administration (FDA)

Regulatory Protect the public from harms of radiation through regulation, research and outreach

The Conference of Radiation Control Program Directors (CRCPD)

National promote consistency, encourage high standards of quality in radiation protection programs, and provide leadership in radiation safety and education

Alliance in Radiation Safety in Pediatric Imaging (ARSPI)

Professional Increasing awareness of CT dose to children. “Image Gently”

American College of Radiology (ACR)

Professional Provides appropriateness criteria

American Association of Physicists in Medicine (AAPM)

Professional Improve safety and efficacy of imaging procedures through research and setting standards

American Academy of Pediatrics (AAP)

Professional Issues policy statements, educates members and the public

The International Atomic Energy Agency (IAEA)

International Establishes and promote safety standards, provide guidance and policy recommendations

World Health Organization (WHO) International Facilitating the adoption & application of regulations, evaluate radiation medicine services, educating and training workforceMedical Imaging and Technology

Alliance (MITA)Manufactures Advocacy for fair legislative and regulatory

proposals, leads manufacturers, research & development

development of radiation safety and protection guidelines and recommendations

will not result in possible reduction of exposure to medical radiation

poorly developed the regulatory and educational components

lagging behind the rapidly evolving technological advancement

stronger enforcement of policies and regulations

introduction of new tools well-matched with current information and instrumentation technologies are needed

Stakeholders

Current practicesICRP

• Justification, Optimization , Dose Limits

ACR• ACR Appropriateness criteria

FDA• Initiative to Reduce Unnecessary Radiation Exposure

from Medical Imaging

EPA• Radiation Protection Guidance for Diagnostic and

Interventional X-Ray Procedures; Federal Guidance Report No. 14.

Agreement States

• certification standards for radiologic technologists, scanner inspections, and other quality assurance measures

Future directionsClinical Decision Support System (CDS)

Dose Archiving, monitoring and reporting

NIH dose reporting requirements

The promise of the Accountable Care Organization (ACO)

“….regulatory agencies, practitioners, manufactures and the public at large are expected to work in close collaboration to

develop balanced public health approaches that support the benefits of medical imaging while reducing the risks associated with it” .

Conclusion

Thank You