A report from the AAPM Subcommittee on Guidelines for Competency Evaluation for Clinical Medical Physicists in Radiation Oncology.

The goal of this report is to provide a framework from which an institution can develop a competency and credentialing program. It is not intended to be adopted as written, but rather as a list of suggestions from which the institution develops their program. A clear distinction should be made between the initial evaluation of the competency of new staff (credentialing) and the ongoing verification of the competency of existing staff. Furthermore, whenever new technologies are imple-mented, the entire staff would be subject to the credentialing process. Competencies involve the ongoing verification of the performance of a procedure according to the established policies and procedures at a facility. This can be done by audits of work product, direct observation of performance, self-evaluation, or testing. PACS number(s): 87.10.-e, 87.90.+y

Improved spatial resolution and lower-dose pediatric CT imaging: a feasibility study to evaluate narrowing the X-ray photon energy spectrum.

This feasibility study has shown that improved spatial resolution and reduced radiation dose can be achieved in pediatric CT by narrowing the X-ray photon energy spectrum. This is done by placing a hafnium filter between the X-ray generator and a pediatric abdominal phantom. A CT system manufactured in 1999 that was in the process of being remanufactured was used as the platform for this study. This system had the advantage of easy access to the X-ray generator for modifications to change the X-ray photon energy spectrum; it also had the disadvantage of not employing the latest post-imaging noise reduction iterative reconstruction technology. Because we observed improvements after changing the X-ray photon energy spectrum, we recommend a future study combining this change with an optimized iterative reconstruction noise reduction technique.

Radiation protection in the era of helical CT: practical patient based programs for decreasing patient exposure.

Practical methods are described in this review for the practicing radiologist to minimize radiation dose to patients particularly with reference to multidetector helical computed tomography. Technical, educational, and management methods are outlined in detail as well as their rationale. Preliminary results of this comprehensive program are also outlined after the first year of its institution.

Radiation safety in the era of helical CT: a patient-based protection program currently in place in two community hospitals in New Hampshire.

PURPOSE: To describe a patient-based radiation safety program currently in place in 2 community hospitals in southern New Hampshire and the patients identified and managed by this program. METHODS: The rationale, components, and early results of a patient-based radiation safety program are summarized and reviewed. The patient populations who may be affected by frequent exposure to helical CT scanning are identified both prospectively and retrospectively via a threshold approach using the number of studies the patient has had rather than attempting to directly measure radiation dose. This was arbitrarily defined as 5 studies of the neck, chest, abdomen, pelvis, or abdomen/pelvis in patients under 40 years of age with benign diagnoses, whose estimated exposure might approach 50 mSv. The mechanisms that can be put into place to prevent further exposure in these patients are discussed and outlined. RESULTS: Fifty-four patients were initially identified over a 3-year period who had over 5 helical CT studies of the neck, chest, abdomen, pelvis, or abdomen/pelvis for benign diagnoses. An additional 104 patients were identified over a 12-year period by retrospectively "data mining" our radiology information system. A detailed program is outlined for the management of these patients, the future identification of patients, and the education of patients and providers. CONCLUSION: Frequent exposure to possibly carcinogenic levels of ionizing radiation from helical CT scanning is a potentially large public health issue for the medical community. The identification and management of potentially at-risk patients is feasible.

American College of Radiology white paper on radiation dose in medicine.

The benefits of diagnostic imaging are immense and have revolutionized the practice of medicine. The increased sophistication and clinical efficacy of imaging have resulted in its dramatic growth over the past quarter century. Although data derived from the atomic bomb survivors in Japan and other events suggest that the expanding use of imaging modalities using ionizing radiation may eventually result in an increased incidence of cancer in the exposed population, this problem can likely be minimized by preventing the inappropriate use of such imaging and by optimizing studies that are performed to obtain the best image quality with the lowest radiation dose. The ACR, which has been an advocate for radiation safety since its inception in 1924, convened the ACR Blue Ribbon Panel on Radiation Dose in Medicine to address these issues. This white paper details a proposed action plan for the college derived from the deliberations of that panel.

Communicating with communities about emergency research.

The challenge of effectively communicating with communities about research is particularly salient for investigators who are conducting emergency research with an exception from informed consent. The authors discuss the ethical basis for the community consultation requirement and describe the nature and extent of the consultative process required to achieve these ethical purposes. The findings of the consensus conference are summarized as follows. 1) The requirements for community consultation and public disclosure for exception from informed consent studies serve important ethical purposes and should be retained. 2) Community consultation allows investigators and institutional review boards to obtain input from the community regarding planned research. The process serves to facilitate understanding, promote trust, ensure justice, and protect research participants. 3) Community consultation is a process that requires active participation by community members; however, it does not require their approval, consent, or consensus. The practical challenges involved in conducting meaningful community consultation are also discussed: defining the community and its appropriate representatives, methods to actively engage the community, the lack of uniformity among institutional review boards in required community consultation activities, and the lack of measures to evaluate the adequacy and appropriateness of community consultation. The recommendations of the consensus conference regarding future research about community consultation are summarized. Priorities include identifying best practices; defining effectiveness and developing measures to evaluate community consultation; evaluating alternative models and potential infrastructures to facilitate, conduct, and/or oversee effective community consultation processes; and developing educational modules for community members to empower their active participation in discussions about emergency research in their communities.