Patient Safety

Care to Care, a Multi-Specialty Management company, is proud to participate in Patient Safety Awareness Week on March 12-18th, 2017, marking a dedicated time and platform to increase awareness about patient safety among health professionals and the public. As a Radiologist and Chief Medical Officer of Care to Care, I hope to educate the public and health professionals on the importance of Radiation Safety.

 

Radiation is energy that travels through space as either waves or high speed particles. It is a daily part of our lives as it exists all around us. It is in our homes as part of our radios and microwave ovens, and we experience extremely low levels every moment from our natural environment. There are two types of radiation: non-ionizing radiation and ionizing radiation. Non-ionizing radiation does not have as much energy as ionizing radiation and is thus, generally less harmful. In contrast, ionizing radiation has enough energy to cause serious damage to tissues and cells, and the amount of damage depends on the amount and duration of ionizing radiation exposure. By damaging the genetic material (DNA) contained in the body’s cells, radiation can cause cancer. Fortunately, our bodies are extremely efficient at repairing cell damage.

 

Not all ionizing radiation is bad. Ionizing radiation is frequently used in the medical field for imaging, for example X-rays, Computed Tomography (CT), or treatment as in the case of cancer radiation. Whether it comes from the ground, the sky, or medical treatment, humans are constantly exposed to ionizing radiation from the world around them. According to the American Nuclear Society the average person is exposed to a dose of approximately 620 mrem per year. To put this in perspective, the international safety standard for healthcare workers is up to 5,000 mrem per year, a dose that is considered to be safe and not significantly increase the risk for radiation-related health effects. A single chest X-ray or dental X-ray, both of which are considered to be medically safe, exposes a patient to only 10mrem of radiation.

 

The potential harms of ionizing radiation include the development of malignant cancer, benign tumors, cataracts, and potentially harmful genetic changes. The risks of radiation exposure for children and adolescents are greater than for adults when given equal radiation doses. Children grow quickly, and their cells are more sensitive to radiation. Since effects of radiation take years to develop, children, who generally have a longer life expectancy than adults, have a larger window of opportunity for expressing radiation damage, most notably the development of cancer. As adults age, radiation exposure becomes less of a concern. The body tissues of older patients are less sensitive to the effects of radiation.

 

It is important to realize that medical imaging can be an essential medical tool, necessary for diagnosing and treating disease. If your healthcare provider thinks that you, a family member or friend may have a significant medical condition, a diagnostic examination should not be refused because of the fear of radiation exposure. The risk associated with these tests is very small compared to the benefits provided by the imaging test. Before you have an exam that uses radiation, ask your physician two questions: What do we expect to learn from this x-ray examination and will decisions about my healthcare be determined from my imaging exam? You and your healthcare provider must work together to decide what is necessary and best for you. Since no amount of radiation should be considered absolutely safe, only necessary CT examinations should be performed.

 

For any additional information regarding radiation safety for patients, please visit RadiologyInfo.org.

Rachel Title, MD

Chief Medical Officer

Care to Care LLC

Cervical Cancer Awareness

This January, Care to Care is proud to participate in National Cervical Health Awareness Month. Cervical cancer was once one of the most common causes of cancer death for women. However, the cervical cancer death rate has gone down by more than 50% over the last 40 years, mainly due to the increased use of the Pap test for screening and early detection. This amazing screening tool can find changes in the cervix before cancer ever develops, enabling doctors to treat pre-cancerous states. Unfortunately, not all women are getting screened. In 2012, 10% of US women ages 21-65 reported they had not been screened for cervical cancer in the last 5 years. According to the American Cancer Society (ACS), there will be an estimated 12,820 new cases of invasive cervical cancer diagnosed in 2017, with an estimated 4,210 deaths from the disease.

Another important fact that many may not know is that most cervical cancers are preventable! Nearly all cases of cervical cancers are caused by human papillomavirus (HPV) infection, with approximately 70% due to HPV types 16 and 18. In addition to causing cervical cancer, HPV is also a common cause of anal cancer, mouth/throat cancer, and cancers of the vulva, vagina, and penis. The HPV vaccine, which became available in 2006, offers the best protection against the virus. However, the vaccine is only effective if administered before exposure to the virus, which is why vaccination must be given before one becomes sexually active, in the preteen years.

To prevent more cervical cancer deaths, screening and vaccination efforts must increase! The ACS and the Centers for Disease Control and Prevention recommend routine HPV vaccination for females and males starting at age 11 or 12. The ACS recommends all women begin cervical cancer screening at age 21. Women between 21 and 29 should have a Pap test every 3 years. Women between ages 30-65 should have both a Pap test and an HPV test every 5 years. Women over age 65 who have had regular screenings with normal results do not require screening, but those who have been diagnosed with cervical pre-cancer should continue to be screened. Women who have had the HPV vaccine should still follow the screening guidelines for their age group.

With a vaccine to prevent the cancer causing HPV infection and with the sensitive Pap screening test to detect the disease in a pre-cancerous state, no woman should die of cervical cancer! It is our job as clinicians to help women understand what screening tests are best for them and help parents know the best time to immunize their children against HPV.

Rachel Title, MD

Chief Medical Officer

Care to Care LLC

Why is Compliance and Ethics important in Medicine?

National Compliance and Ethics Week offers a great opportunity to shine a spotlight on the importance of compliance and ethics at Care to Care and in the entire healthcare system at large. The culture of compliance is at the core of medicine.

This begins for doctors with the mandatory Hippocratic oath which is frequently recited at the beginning of medical school and again at its culmination, when the medical degree is received. The Hippocratic oath states the obligations and proper conduct of doctors, laying the groundwork for a career devoted to the care of others through strict adherence to medical ethics and compliance to government laws, hospital regulations, and specialty society guidelines. It is this strict obedience to an unyielding moral code that makes the physician worthy of the trust that the patient bestows on him, a trust that is essential in the physician-patient relationship.

Physicians are entrusted with the most personal information by their patients and are obligated to maintain complete privacy and security of this health care information. Our compliance with federal HIPAA laws is only one way that compliance plays an integral role in the physicians’ daily responsibilities.

Here at Care to Care, the medical directors and physician reviewers are dedicated to maintaining the highest degree of compliance and are committed to upholding the oath we took many years ago.

Rachel Title, MD
Chief Medical Officer

Breast Cancer Awareness Month

This October, Care to Care is proud to participate in National Breast Cancer Awareness Month. Breast Cancer is the second most common cancer in women, affecting 1 in 8 U.S. women over the course of her lifetime. In 2016, there are more than 2.8 million U.S. women with a history of breast cancer. Breast cancer is a disease that affects women of all ages, races, and ethnicities. The most significant risk factors for breast cancer are gender (being a woman) and age (risk of breast cancer increases with age). Although a woman’s risk of breast cancer almost doubles if she has a first-degree relative with breast cancer, it is important to know that an overwhelming majority (85%) of breast cancers occur in women who have no family history.

The goal of Breast Cancer Awareness Month is to increase understanding and awareness of the disease, encourage women to take the lifesaving steps to detect the disease in its early stages, and inspire others to do the same. Most women can survive breast cancer if it is found and treated early. Early detection with annual screening mammogram has been the main reason why the breast cancer death rate has decreased by 36% since 1989. The American College of Radiology (ACR) and Society of Breast Imaging (SBI) recommend that women at average risk of breast cancer get yearly mammograms starting at age 40. Women at high risk (greater than 20% lifetime risk) of breast cancer may need to begin annual screening mammogram at an earlier age and should also include annual screening Breast MRI as an adjunct to screening mammography. All women should become familiar with both the appearance and feel of their breasts and report any changes promptly to their physician. Most importantly, talk to your doctor about your risk for breast cancer and your appropriate screening plan. Early detection is your best protection!

Rachel Title, MD
Chief Medical Officer

Limiting Radiation Exposure to Children

As a Radiologist and Senior Medical Director at Care to Care, I find it my moral responsibility and professional obligation to explain the importance of a prior-authorization requirement for advanced imaging, and specifically CT examinations, for the pediatric population. Children are considerably more sensitive to radiation exposure than adults, as demonstrated by epidemiologic studies of exposed populations.

Since children have a longer life expectancy than adults, they have a larger window of opportunity for expressing radiation damage, most notably the development of cancer. As a result, the risk for developing a radiation-related cancer can be several times higher for a young child compared with an adult exposed to an identical CT scan.

A study published in the Lancet on June 7, 2012 described a clear dose-response relationship for both brain tumors and leukemia. The study found that the amount of radiation exposure from an estimated 2 to 3 head CT scans given to a child can triple the risk of brain cancer, and an estimated 5 to 10 head scans can triple the risk of leukemia.

Major national and international organizations responsible for evaluating radiation risks agree that no amount of radiation should be considered absolutely safe and that only necessary CT examinations should be performed. For these reasons, it is of utmost importance to make sure that only appropriate CT scans are being performed on children. A prior-authorization requirement will help ensure the appropriate use of CT imaging and limit its inherent harmful radiation.

Rachel Title, MD
Chief Medical Officer