Forty-Third Annual Meeting Program Advances in Radiation Protection in Medicine April 16-17, 2007 Crystal Forum Crystal City Marriott 1999 Jefferson Davis Highway Arlington, Virginia Co-sponsors American College of Radiology Reston, Virginia Xoran Technologies Ann Arbor, Michigan Introduction Advances in Radiation Protection in Medicine Forty-Third Annual Meeting of the National Council on Radiation Protection and Measurements (NCRP) During the past two decades remarkable increased the radiation exposure of both progress has been made in the development patients and medical practitioners. Special and application of new medical technologies concerns have been raised regarding use of that utilize radiation for the early detection the newer radiation modalities in pediatric and effective treatment of cancer and other radiology and in imaging and radiotherapy diseases. These advances, however, are procedures with pregnant women. accompanied by many questions about how NCRP’s 2007 Annual Meeting features to maximize medical benefits to patients, presentations by physicians, medical physi- while controlling and reducing their risks cists, and experts in radiation health effects from exposure to ionizing radiation. These who will discuss the rapid growth in use of issues are the theme of the 2007 NCRP relatively new medical radiation diagnostic Annual Meeting. and therapeutic procedures, and the current Although the many advances in medical state of understanding of radiation doses radiation technology have represented sig- received by patients and the associated nificant gains in the prognosis for early dis- health risks. Topical areas of focus at the ease detection and therapy, there are issues meeting will include diagnostic radiology, regarding the safety of these new radiation nuclear medicine, interventional radiology, modalities that are of current interest and radiation oncology, and interdisciplinary concern to the medical community. Among issues such as the implications of radiation these are the administration of higher radia- dose-response models for the prediction of tion doses to patients from imaging modali- long-term patient responses to irradiation ties such as computed tomography than from diagnostic and therapeutic procedures. from conventional radiography. Similarly, The 2007 meeting is the third in a series of combined modality imaging and nuclear NCRP Annual Meetings on the subject of medicine procedures used in cardiology and radiation protection in medicine. The first other diagnostic procedures are associated two meetings were held in 1992 and 1999, with relatively high patient doses. In addi- and the proceedings can be obtained at the tion, the increased use of image-guided website http://NCRPpublications.org. interventional therapeutic procedures has 3 Program Summary Monday, April 16, 2007 11:25 am Capturing Patient Doses from Fluoroscopically-Based Diagnostic and Interventional Systems Opening Session Stephen Balter 8:00 am Welcome Columbia University Medical Center Thomas S. Tenforde, President National Council on Radiation Protection 11:50 am Lunch and Measurements Interdisciplinary Issues 8:15 am Fourth Annual Warren K. Sinclair Linda A. Kroger, Session Chair Keynote Address Use and Misuse of Radiation in Medicine 1:30 pm Update on Linear Nonthreshold James A. Brink Dose-Response Model and Implications Yale University for Diagnostic Radiology Procedures R. Julian Preston Diagnostic Radiology I U.S. Environmental Protection Agency Cynthia C. Cardwell, Session Chair David J. Brenner Columbia University 9:15 am Magnitude of Radiation Uses and Doses in the United States: NCRP 1:55 pm Research Involving Human Subjects Scientific Committee 6-2 Analysis Richard L. Morin of Medical Exposures Mayo Clinic Fred A. Mettler, Jr. New Mexico Federal Regional Medical 2:20 pm Radiation and Pregnancy Center Claire Cousins Cambridge University, UK 9:40 am Dose in Computed Tomography: How to Quantitate, How to Reduce 2:45 pm Break Cynthia H. McCollough Mayo Clinic Nuclear Medicine Edwin M. Leidholdt, Session Chair 10:05 am Break 3:10 pm Operational Radiation Safety for PET, 10:35 am Pediatric Dose Reduction in Computed PET/CT, and Cyclotron Facilities Tomography Pat Zanzonico Donald P. Frush Memorial Sloan-Kettering Cancer Center Duke University Health Systems 3:35 pm Combined Imaging Modalities: 11:00 am Diagnostic Reference Levels for PET/CT and SPECT/CT Medical Imaging with Ionizing Alan H. Maurer Radiation: ICRP Guidance Temple University School of Medicine Marvin Rosenstein ICRP Committee 3 (Protection in 4:00 pm PANEL DISCUSSION Medicine) Julie E.K. Timins, Moderator 5 Program Summary 4:40 pm Break 10:20 am Developments in Mammography Martin J. Yaffe Thirty-First Lauriston S. Sunnybrook Health Sciences Centre, University of Toronto Taylor Lecture on Radiation Protection 10:45 am Trends in Utilization and Collective Doses from Medical Procedures and Measurements Mythreyi Bhargavan American College of Radiology 5:00 pm Introduction of the Lecturer Raymond Guilmette 11:10 am Cone-Beam Imaging in Dentistry Stuart C. White The Quest for Therapeutic University of California, Los Angeles Actinide Chelators Patricia W. Durbin 11:35 am Lunch Lawrence Berkeley National Laboratory Interventional Procedures 6:00 pm Reception in Honor of the Lecturer Charles E. Chambers, Session Chair 1:00 pm Overview of Contemporary Tuesday, April 17, 2007 Interventional Procedures Donald L. Miller 8:00 am Business Session National Naval Medical Center 9:00 am Break 1:25 pm Patient and Personnel Safety in Interventional Fluoroscopy Procedures Diagnostic Radiology II Louis K. Wagner University of Texas Thomas Ohlhaber, Session Chair 1:50 pm Technical Advances of Interventional 9:30 am Exposure Reduction Through Quality Fluoroscopy and Flat-Panel Image Assurance for Diagnostic X-Ray Receptor Procedures Pei-Jan P. Lin Jill A. Lipoti Beth Israel Deaconess Medical Center New Jersey Department of Environmental Protection 2:15 pm Break 9:55 am State of Art: Computed Radiography and Digital Radiography J. Anthony Seibert University of California Davis Medical Center 6 Program Summary Radiation Oncology 3:35 pm Patient Susceptibility to Radiation-Induced Cancer and Theodore L. Phillips, Session Chair Second Cancers Following Radiotherapy Procedures 2:45 pm New Technologies in Radiation James M. Allan Therapy: Ensuring Patient Safety, University of York, UK Radiation Safety, and Regulatory Issues in Radiation Oncology 4:00 pm Panel Discussion Howard L. Amols Stephanie K. Carlson, Moderator Memorial Sloan-Kettering Cancer Center 4:40 pm Closing Remarks Thomas S. Tenforde, President 3:10 pm Dose to Normal Tissues Outside the National Council on Radiation Therapy Patient’s Treated Radiation Protection and Volume: A Review of Different Measurements Radiation Therapy Techniques James A. Purdy University of California Davis Medical Center 7 Abstracts of Presentations Monday, April 16, 2007 Opening Session 8:00 am Welcome Thomas S. Tenforde, President National Council on Radiation Protection and Measurements 8:15 am Fourth Annual Warren K. Sinclair Keynote Address Use and Misuse of Radiation in Medicine James A. Brink Yale University While radiation is used in many branches of particular patient. However, by eliminating the medicine for worthwhile diagnostic and thera- need for this consultation, the responsibility of peutic purposes, the potential for misuse the radiologist as the “keeper of the keys” to seems greatest in diagnostic imaging. And potentially harmful medical imaging is elimi- among imaging tests that use ionizing radia- nated. As a result, utilization soars and diag- tion, the potential impact of misuse is greatest nostic yield plummets. In addition to the poten- with computed tomography (CT). tially harmful effects on individual patients, technical and professional imaging resources “I am an adult and a physician! I don’t need are strained by the added work burden, and your approval for CT scans that are necessary patients with appropriate medical indications for my patients!” Such statements reflect the may be underserved owing to the high volume growing frustration among healthcare profes- of relatively unnecessary imaging studies that sionals who struggle with appropriate utiliza- must be performed. tion of medical imaging tests that use relatively high doses of ionizing radiation. In an era The potential benefit that comes with medical focused on “pay for performance,” it is easy imaging in patients with known diagnoses must to focus on the radiation dose associated with be weighed against the risks of ionizing radia- a particular examination. There are numerous tion, taking into account the patient’s age, gen- technical factors that may be manipulated, der and body part to be examined. In most pri- modulated or filtered to produce a dose that mary clinical circumstances, the benefits out- is as low as reasonably achievable. However, weigh the risks, particularly given the potential appropriate utilization of these tests is a more for diagnoses yet unfound. However, the serial difficult issue to address. In our own hospital, evaluation of known clinical conditions for inter- the physician responsible for this quote is val change may represent “low hanging fruit” in charged with improving the quality of our the war on over-utilization of potentially harmful emergency services by maximizing throughput imaging tests. Intensive educational efforts and minimizing length of stay. Having carte must be directed at the medical community at