On January 9, 2015, the Joint Commission published significantly updated imaging standards for accredited hospitals, critical access hospitals, and ambulatory care centers. These new standards, which primarily impact facilities performing MRI, CT and NM/PET services, take effect on July 1, 2015 and mandate a broad range of quality and safety activities and practices. Joint Commission accredited facilities will be expected to comply with these new standards in addition to any other applicable state or federal regulations, or applicable ACR or IAC accreditation standards. The new standards consist of 25 new Elements of Performance (EP’s) that address the following general areas:
- Imaging equipment quality control and maintenance
- Medical physicist credentialing
- Technologist continuing education
- Patient radiation exposure
- Staff radiation exposure
- MRI safety
Among the numerous specific requirements in the new standards are the following:
- Annual measurement of CT radiation dose by a medical physicist
- Annual performance evaluation of CT, MRI, and NM/PET units by a medical physicist
- Performance of lead shielding designs by a qualified physicist upon equipment installation, upgrade or renovation
- Performance of radiation protection surveys by a qualified physicist after such activity
- Annual radiation dose optimization training for CT technologists
- Annual MRI safety training for MRI technologists
- Recording of patient CT radiation doses on every diagnostic CT study in the medical record and in the interpretive report
- Consideration of patient age and recent imaging exams when deciding on the most appropriate type of imaging exam
- Consideration of clinical indication, contrast administration, age, patient size and body habitus, and expected dose range in establishing CT protocols
- Periodic review of CT imaging protocols with the radiologist, technologist and medical physicist
- Compilation and analysis of patient CT dose incidents in comparison to dose benchmarks
- MRI access control, incident tracking, supervision and signage
West Physics has unique expertise and experience to help facilities comply with ALL of these new standards and we have developed a set of services for individual facilities as well as networks to efficiently and quickly address the standards. Whether you require assistance with only those new requirements that specifically require a medical physicist, or you prefer a turn-key integrated solution (to include all required staff training, policies and procedures, dose tracking program setup, etc.), West Physics is willing and able to meet your needs.
Ensure complete success during your next Joint Commission accreditation inspection by selecting a medical physics provider that not only has a reputation as the premier provider of medical physics services in the nation, but also has intimate knowledge of the new standards and how to effectively and efficiently comply with them. Our physicists look forward to helping you meet the new standards in a simple, stress-free and cost-effective manner.
Please contact us today for a no-obligation quote.