Healthcare Inspection Radiation Safety in Veterans Health Administration Facilities

We evaluated program oversight and quality assurance processes for diagnostic and therapeutic radiation procedures at Veterans Health Administration (VHA) facilities. The review focused on four areas associated with the greatest potential for harm to veterans—radiation therapy (RT), computed tomography (CT), fluoroscopy, and nuclear medicine. To evaluate RT care, we queried 32 VHA facilities about processes pertaining to physician peer review and conducted onsite inspections at 26 facilities. To evaluate CT, fluoroscopy, and nuclear medicine procedures, we reviewed VHA documents and interviewed VHA radiology and nuclear medicine leaders. VHA has disseminated information in an effort to reduce CT dose variability, but we found no oversight of actual doses being delivered. Our review of patients with the highest cumulative radiation doses from CT scans found that neither patients nor providers had data about cumulative radiation exposure available to them at the time of clinical decision making. We also found that patients were not informed that CT scans may cause cancer. VHA has been developing guidance regarding the use of fluoroscopy. In nuclear medicine, VHA monitors data provided by all facilities and proficiency assessments are accomplished annually. We recommended that the Under Secretary for Health: (1) clarify the current expectations for frequency of physician peer review in RT, (2) develop a process for monitoring delivered radiation dose to ensure that patients do not receive excessive doses from CT scans, (3) develop risk-based criteria for informed consent prior to CT scans, (4) plan for the development of a mechanism by which patients and providers have information about prior radiation exposure available to them at the time of clinical decision making, and (5) ensure that the fluoroscopy handbook is implemented.