AUA News January 2012 - (Page 18)
18 January 2012 Concerns About Radiation Exposure ▼ Continued from page 17
radiation. When appropriate, substitution of these studies will have an immediate impact on dose administration. If nonionizing options are not acceptable, then proper study selection (ie plain x-ray instead of CT) or low dose CT should be considered. Historically, CT doses are up to 5 times greater for the same procedures being performed today but improved technology and a better understanding of how to produce quality images with reduced exposure have led to signiﬁcantly decreased doses at many institutions. It is reasonable to check with your local radiation centers to conﬁrm that they are tracking and reducing radiation levels when possible. Furthermore, an awareness of the associated exposures with an intent to minimize dose has been shown to reduce overall patient exposures. Two studies have shown that incorporation of standardized ﬂuoroscopic protocols, and tracking and reporting of individual physician radiation dose administration during ureteroscopic procedures will lead to signiﬁcant reduction in dose delivery.4,5 While radiation exposure is associated with some risks, the rewards gained by accurate and timely diagnosis often outweigh the minor risks. Through judicious use of studies, alternative imaging techniques, being cognizant of the risks and practicing the principles of ALARA, we can conﬁdently provide excellent and safe care to our patients. ◆
1. Mettler FA Jr, Thomadsen BR, Bhargavan M et al: Medical radiation exposure in the U.S.
in 2006: preliminary results. Health Phys 2008; 95: 502. 2. Brenner DJ and Hall EJ: Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007; 357: 2277. 3. Berrington de González A, Mahesh M, Kim KP et al: Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 2009; 169: 2071. 4. Greene DJ, Tenggadjaja CF, Bowman RJ et al: Comparison of a reduced radiation ﬂuoroscopy protocol to conventional ﬂuoroscopy during uncomplicated ureteroscopy. Urology 2011; 78: 286. 5. Ngo TC, Macleod LC, Rosenstein DI et al: Tracking intraoperative ﬂuoroscopy utilization reduces radiation exposure during ureteroscopy. J Endourol 2011; 25: 763.
FROM THE Ofﬁce of Education
Accreditation for Ultrasound Use in the Practice of Urology
Dr. Pat F. Fulgham Chairman, Urologic Diagnostic and Therapeutic Committee Dallas, Texas
The Urologic Ultrasound Task Force, a subcommittee of the Urologic Diagnostic and Therapeutic Imaging Committee, has worked with the leadership of the American Institute of Ultrasound in Medicine (AIUM) to develop a program whereby urology practices may seek accreditation for the performance of urological ultrasound. This is a voluntary program developed so that urology practices can demonstrate
ONE-DAY HANDS-ON UROLOGIC ULTRASOUND
Friday, May 18, 2012
Georgia World Congress Center
through an objective third party (AIUM) that high quality imaging is being performed in a safe environment by trained providers. The collaboration between the AUA and AIUM resulted in 2 highly signiﬁcant developments. 1) For the ﬁrst time urological ultrasound has been recognized as a speciﬁc category of ultrasound imaging, similar to the categories of gynecological or musculoskeletal imaging. 2) Speciﬁc guidelines have been approved for performing renal, scrotal and prostate ultrasound in the context of urological practice. The guidelines establish the basic indications for performing these studies, and delineate the technique and basic ﬁndings that should be documented. The key features of the accreditation program speciﬁc to urology are summarized. Facilities AIUM Standards and Guidelines for the Accreditation of Ultrasound Practices specify the requirements for the safety, maintenance and calibration of equipment; staff performance; reports; record keeping; and quality assurance for clinical practices where studies are performed. Training Physicians performing and/or interpreting diagnostic examinations should meet at least 1 of the following criteria: 1) completion of an approved
urological residency, including training in ultrasound since July 1, 2009 (the year that reporting ultrasound was required by the residency review committee) and board certiﬁcation by the American Board of Urology or board eligibility, or 2) Board certiﬁcation in urology before July 1, 2009, and submission of an attestation of experience and training in urological ultrasound. Experience and training will include a minimum of 12 hours of AMA PRA Category I Credits™ and Level 2 course(s) by satisfactorily meeting all speciﬁed learning objectives for the Level 2 classiﬁcation course in accordance with AMA guidelines for Continuing Medical Education on New Procedures and Skills (http://www.ama-assn.org/ama/ pub/education-careers/continuingmedical-education/physicians-recognition-award-credit-system/cme-help/ guidance-new-procedure-cme.page). Continuing Medical Education must be AUA Ofﬁce of Education or AIUM approved courses, and include didactic and hands-on ultrasound training. Case/Volume Requirements for Interpreting Physicians If the practice is applying for accreditation in ultrasound in the practice of urology, each interpreting physician must attest that he/she participated in 100 genitourinary ultrasound examinations for the initial accreditation. For re-accreditation the physician must attest that he/she participated in 150 genitourinary ultrasound examinations in the prior 3 years. Physicians who do not meet the minimum volume of ultrasound procedures on an annual basis can participate in a quality assurance program, set up by their own practices, designed to increase
exposure to ultrasound examinations and ensure quality ultrasound care. Accreditation/Re-accreditation No site visits should be anticipated. Four cases selected by the practice must be submitted for review by a urologist on behalf of the AIUM. The cost of practice accreditation begins at $1,000 for a 3-year accreditation, depending on the number of ultrasound machines and ofﬁce locations. The AIUM Standards and Guidelines for the Accreditation of Ultrasound Practices provide a template to document the components (equipment, training and volume) of high quality ultrasound imaging. There is still much to be done as urologists and other imaging providers continue to attempt to deﬁne what constitutes effective use of imaging for the management of disease. It is expected that practices required to demonstrate training and quality imaging for third parties or institutions will most likely apply for accreditation. AUA participation in this initiative demonstrates a commitment to quality and safety in imaging on behalf of urologists and urology. The accreditation program was approved by the AUA Board of Directors and by the AIUM Board of Directors. It will be available beginning January 1, 2012. For more information about the program visit www.aium.org. For a full listing of the ultrasound courses offered please visit the AUA Educational Calendar (http://www. auanet.org/content/education-andmeetings/educational-opportunities. cfm). ◆
Come to the Annual Meeting a day early for this special one-day course.
Visit AUAnet.org/HOUUMay2012 for course details or to register.
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