4. CT Radiation Dose

With recent articles in the New England Journal of Medicine indicating many CT studies expose patients to an unnecessary risk of cancer, and a report in October that Cedars-Sinai Medical Center in Los Angeles accidentally used extremely high radiation doses during CT stroke scans on more than 200 patients, the risks of CT scanning have become a major concern. In the United States alone, CT is thought to be responsible for about 6,000 additional cancers a year.

To avoid potential risks:

• Make sure the expected benefits of a CT study outweigh the radiation risks.

• In most modern systems, the dose can be reduced by up to 80 percent. Adjust CT acquisition parameters to allow the required clinical information to be obtained with the lowest possible dose.
• CT precations are especially important for pediatric patients – for whom the cancer risk is as much as triple that for a 30-year-old – and pregnant women.
• Ensure that technologists performing CT exams are trained specifically for CT and that they maintain their training and certification.

5. Retained Devices and Unretrieved Fragments

Another frequent source of reports to ECRI and the U.S. Food and Drug Administration are items left inside patients following treatment. These take the form of retained devices, where an entire device is unknowingly left behind, and unretrieved device fragments in which a portion of a device breaks away and remains inside the patient. While often benign, if a patient later undergoes magnetic resonance examination, retained metal can heat or migrate, resulting in burns or worse.

To prevent risks:

• Inspect devices before use. If a device appears damaged, don't use it.
• Be alert for significant resistance during device removal, which could indicate that the device is trapped and at risk of breaking.
• Inspect devices as soon as they are removed from the patient.

ECRI offers the complete list of top 10 hazards as a downloadable PDF on their site (see sidebar for link).