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Radiology and Nuclear Medicine Changes: CMS Revises the Guidelines

The Centers for Medicare and Medicaid Services recently published an important memo that every hospital should know about: a revision of the interpretive guidelines for radiology and nuclear medicine.

AHC Media will conduct a webinar on these changes to the radiology and nuclear medicine on Thursday, Sept. 10, from 1-3 pm Eastern. Watch for details soon at

In the past several years there has been a focus on ensuring the safety in the use of ionizing radiation. Exposure to ionizing radiation has doubled in the past 20 years. Increasing exposure has been shown to increase cancer risks. CMS also noted studies finding problems with quality control, training of staff, and overutilization. There have been reports of patients receiving radiation overdoses associated with CT scans for evaluation of stroke.

Some of the new changes and issues in the radiology interpretive guidelines include:

  • Radiology services, no matter where they are performed throughout the hospital, must follow approved standards for safety and all staff must be qualified.
  • The hospital must have policies and procedures for radiology safety and to ensure staff are qualified and these must be consistently applied throughout the organization.
  • The P&P must be consistent with accepted professional standards for radiologic services, including the FDA, American College of Radiology, Radiological Society of North America, Alliance for Radiation Safety in Pediatric Imaging (Image Gently), American Society of Radiologic Technologists, the American College of Cardiology, the American College of Neurology, and the American College of Physicians.
  • Radiography, CT, and fluoroscopy utilize ionizing radiation can damage DNA and cause cancer as opposed to MRI or ultrasound. The literature shows risk of cancer from CT is 1:1000.
  • Risks to patient and staff depend on the modality used, length of the procedure or study, size of the patient, device being used, and other factors.
  • Scope of diagnostic radiologic services available must be specified in writing.
  • Radiology services can be provided by hospital staff or through contracted services but the hospital must still make sure all the radiology standards are met.
  • Interpretation of the radiologic study can be remotely via teleradiology as long as practitioner is privileged according to the board and medical staff section.
  • The surveyor may ask the hospital how it meets the needs of its patients.
  • The surveyor will ensure that if the hospital has an emergency department that radiology services support the ED at all times.
  • Principle for ionizing radiation is ALARA (As Low As Reasonably Achievable), which is defined by the EPA.
  • Radiation dosage and radiation doses to patients should always be optimized and exceeding dose limits should prompt a review of the practices at the hospital.
  • Policies and procedures must identify patients at high risk for adverse events and where study might be contraindicated, such as pregnant women, patients with allergies to contrast, and patients with implanted devices having a MRI.