#jacr transcript · littenberg #jacr greetings from vermont. i'm ben littenber. i'm not a...

#JACR transcript

Healthcare Social Media Transcript

From: Wed Mar 26 9:00:00 PDT 2014To: Thu Mar 27 10:00:00 PDT 2014

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What is #JACR? Who were the influencers during this time period? #JACR analytics

Healthcare Conference - Healthcare Tweet Chats - Healthcare Analytics

kristinahoque RT @RadiologyACR: Curious to see the top 2013 #JACR articles? Well, you're in luck. You can view the 10 most requested here: http://t.co/op…Wed Mar 26 10:08:42 PDT 2014

aetrradiologia RT @RadiologyACR: Hey @radsdocdancer! Join us on Thur at 12 ET for the #JACR tchat on radiation dose! Wed Mar 26 12:32:09 PDT 2014

radiologywriter RT @MattHawkinsMD: #JACR Tchat on Thurs 3/27 12pEST -- #Radiation dose. Join #radiologists as we talk about this hugely important topic. … Wed Mar 26 12:59:37 PDT 2014

ucradsafety @berkeleyprc Hi Joel, we're looking for more ways to use Twitter. Going to participate in the #JACR Tweet Chat tom. at 9am PST. Other ideas? Wed Mar 26 17:07:36 PDT 2014

ucradsafety RT @MattHawkinsMD: #JACR Tchat on Thurs 3/27 12pEST -- #Radiation dose. Join #radiologists as we talk about this hugely important topic. … Wed Mar 26 17:08:19 PDT 2014

radioncbotjp RT @aapmHQ: #JACR Tweet Chat March 27, 2014: Join guest moderator Mahadevappa Mahesh in a live tweet chat at Noon EDT March... http://t.c…Thu Mar 27 2:47:44 PDT 2014

ruthcarlosmd #JACR tweet chat on imaging radiation. How 2 talk abt risks/benefits? Today 3/27 12PM ET. @cancergeek @nursefriendly @pfanderson @joycleeThu Mar 27 5:55:07 PDT 2014

of 32#JACR - Healthcare Social Media Transcript

3/27/2014http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=03%2F26%2F2014&s...

nursefriendly RT @ruthcarlosmd: #JACR tweet chat on imaging radiation. How 2 talk abt risks/benefits? Today 3/27 12PM ET. @cancergeek @nursefriendly @p… Thu Mar 27 6:04:17 PDT 2014

cancergeek RT @ruthcarlosmd: #JACR tweet chat on imaging radiation. How 2 talk abt risks/benefits? Today 3/27 12PM ET. @cancergeek @nursefriendly @p… Thu Mar 27 6:14:55 PDT 2014

ruthcarlosmd 15 minutes to #JACR tchat on radiation. @Littenberg guestmod from VT, pt engagement expert. see you on http://t.co/eso3PmB3oK @ACRRFSThu Mar 27 6:20:38 PDT 2014

radiologywrites RT @ruthcarlosmd: #JACR tweet chat on imaging radiation. How 2 talk abt risks/benefits? Today 3/27 12PM ET. @cancergeek @nursefriendly @p… Thu Mar 27 6:35:12 PDT 2014

pfanderson RT @ruthcarlosmd: #JACR tweet chat on imaging radiation. How 2 talk abt risks/benefits? Today 3/27 12PM ET. @cancergeek @nursefriendly @p… Thu Mar 27 6:39:36 PDT 2014

radiologywrites Come tweet with us at 12 EDT! The #JACR tweet chat is on radiation dose with .@mmahesh1Thu Mar 27 6:55:36 PDT 2014

ruthcarlosmd #JACR tchat on CT radiation. Are we really giving ourselves #cancer? guestmod @mmahesh1. today 3/27 12PM ET @Groz_P @fischmd @meganranneyThu Mar 27 7:04:06 PDT 2014

lodoxsystems RT @ruthcarlosmd: #JACR tchat on CT radiation. Are we really giving ourselves #cancer? guestmod @mmahesh1. today 3/27 12PM ET @Groz_P @fisc… Thu Mar 27 7:24:38 PDT 2014

mghimaging We are looking forward to joining the @RadiologyACR #JACR tchat on #radiationdose today at noon ET! Thu Mar 27 7:55:37 PDT 2014

ruthcarlosmd #JACR tchat on CT radiation. How docs and pts should talk about risks, benefits, dose. @NatriceR @brettsnodgrass1 @drsteph @stupidcancerThu Mar 27 8:02:27 PDT 2014

radiologywriter #JACR tchat in 50 minutes! Be there! Thu Mar 27 8:11:35 PDT 2014

sumirpatelmd RT @ruthcarlosmd: #JACR tchat on CT radiation. How docs and pts should talk about risks, benefits, dose. @NatriceR @brettsnodgrass1 @drste… Thu Mar 27 8:25:51 PDT 2014

radhelper RT @ruthcarlosmd: #JACR tchat on CT radiation. Are we really giving ourselves #cancer? guestmod @mmahesh1. today 3/27 12PM ET @Groz_P @fisc… Thu Mar 27 8:28:30 PDT 2014



scannerside Looking forward to the discussion on radiation dose tracking jacr #jacrThu Mar 27 8:39:00 PDT 2014

kristinahoque @ACRRFS get excited #JACR tweet chat on imaging radiation. How 2 talk abt risks/benefits? Today 3/27 12PM ET. Come Join! Thu Mar 27 8:52:37 PDT 2014

radsdoc82 RT @KristinaHoque: @ACRRFS get excited #JACR tweet chat on imaging radiation. How 2 talk abt risks/benefits? Today 3/27 12PM ET. Come Joi… Thu Mar 27 8:56:59 PDT 2014

radsdoc82 RT @ruthcarlosmd: #JACR tchat on CT radiation. Are we really giving ourselves #cancer? guestmod @mmahesh1. today 3/27 12PM ET @Groz_P @fisc… Thu Mar 27 8:57:28 PDT 2014

radiologyboy1 RT @ruthcarlosmd: #JACR tchat on CT radiation. Are we really giving ourselves #cancer? guestmod @mmahesh1. today 3/27 12PM ET @Groz_P @fisc… Thu Mar 27 8:58:31 PDT 2014

radiologyboy1 RT @KristinaHoque: @ACRRFS get excited #JACR tweet chat on imaging radiation. How 2 talk abt risks/benefits? Today 3/27 12PM ET. Come Joi… Thu Mar 27 8:59:03 PDT 2014

radiologyacr Welcome to the monthly #JACR tweet chat. Big thanks to guest tweeter @mmahesh1, radiology prof and chief physicist .@JohnsHopkinsThu Mar 27 9:00:11 PDT 2014

cancergeek Apologize to my tweeps, about to blow up feed due to #JACR chat session on radiation dose. Please join! Thu Mar 27 9:00:36 PDT 2014

radiologyacr A few rules of the road: Please introduce yourself. All tweets are assumed to be your own #JACRThu Mar 27 9:00:38 PDT 2014

mmahesh1 #JACR Thanks @ruthcarlosmd looking forward to the chat Thu Mar 27 9:00:48 PDT 2014

ucradsafety RT @RadiologyACR: Welcome to the monthly #JACR tweet chat. Big thanks to guest tweeter @mmahesh1, radiology prof and chief physicist .@John… Thu Mar 27 9:00:57 PDT 2014

radsdoc82 RT @RadiologyACR: Welcome to the monthly #JACR tweet chat. Big thanks to guest tweeter @mmahesh1, radiology prof and chief physicist .@John… Thu Mar 27 9:00:58 PDT 2014

radiologyacr Please use T1 etc. to indicate which topic you’re addressing #JACRThu Mar 27 9:01:14 PDT 2014

ucradsafety



RT @CancerGeek: Apologize to my tweeps, about to blow up feed due to #JACRchat session on radiation dose. Please join! Thu Mar 27 9:01:18 PDT 2014

mmahesh1 #JACR My name is Dr M. Mahesh - I am from Johns Hopkins Hospital and I will be moderating this chat Thu Mar 27 9:01:31 PDT 2014

kristinahoque Hi All - Radiology resident at USC- looking forward to a great chat #JacrThu Mar 27 9:01:52 PDT 2014

ruthcarlosmd Hello everyone and big welcome to our guest mods @mmahesh1, uber physicist who talks to pts & @Littenberg, MD pt engagemt specialist #jacrThu Mar 27 9:01:58 PDT 2014

wilsonjoshm #JACR DI Medical Physicist at Duke, looking forward to the radiation dose tchat Thu Mar 27 9:02:39 PDT 2014

mmahesh1 #JACR Todays conversation follows Special edition of #JACR on #RadiationDoseedited by Dr Smith-Bindman and Dr Boone of #UCSF @UCRadSafetyThu Mar 27 9:03:01 PDT 2014

littenberg #jacr Greetings from Vermont. I'm Ben Littenber. I'm not a radiologist, but I do hang out with them when I'm not doing Internal Med Thu Mar 27 9:03:09 PDT 2014

ruthcarlosmd Hi to @KristinaHoque @cancergeek & @radiologyacr @wilsonjoshm. old friends and new, talking about radiation, risk, benefit and dose #jacrThu Mar 27 9:03:21 PDT 2014

ruthcarlosmd A few ground rules. Please use T1, T2 etc to help us follow conversations. #jacrThu Mar 27 9:03:49 PDT 2014

mmahesh1 #JACR #RadiationDose in medical imaging is an important issue that garnered great attention from last decade Thu Mar 27 9:03:58 PDT 2014

ruthcarlosmd We assume that your tweets are your own. #jacrThu Mar 27 9:04:11 PDT 2014

cancergeek Andy in WI. Builder of cancer ctrs. Creator of patient experiences. Global marketer. #jacrThu Mar 27 9:04:16 PDT 2014

cancergeek RT @ruthcarlosmd: A few ground rules. Please use T1, T2 etc to help us follow conversations. #jacrThu Mar 27 9:04:23 PDT 2014

radiologyacr Let’s get started! T1: 1. How do you discuss the risks and benefits of imaging with your patients or referring physicians? #JACR



Thu Mar 27 9:05:10 PDT 2014

scannerside Hi all regarding patient interation we have involvng patients with some success #jacrThu Mar 27 9:05:21 PDT 2014

ruthcarlosmd thanks to those who started with intros. #jacrThu Mar 27 9:05:22 PDT 2014

cancergeek RT @RadiologyACR: Let’s get started! T1: 1. How do you discuss the risks and benefits of imaging with your patients or referring physicians… Thu Mar 27 9:05:24 PDT 2014

mmahesh1 #JACR We can start todays conversation on T1-#Radiation Dose in Medical Imaging Thu Mar 27 9:05:33 PDT 2014

ucradsafety Hi all, this is Rebecca Smith-Bindman & project manager Nicole Wilson helping me out. We're from UCSF. Excited for this conversation! #JACRThu Mar 27 9:05:47 PDT 2014

littenberg @scannerside: tell us how you do that #JACRThu Mar 27 9:05:51 PDT 2014

mmahesh1 #JACR We can start with Q1: How do you discuss the risks and benefits of imaging with your patients or referring physicians? Thu Mar 27 9:06:08 PDT 2014

pfanderson Starting NOW the #JACR chat on radiation from diagnostic imaging. Going to be education and exciting. Thu Mar 27 9:06:10 PDT 2014

drsxr #JACR Hello - Stephen here from FL. Thu Mar 27 9:06:18 PDT 2014

mmahesh1 #JACR T1- Any discussion on #radiationdose should be counter balanced with discussion on medical imaging benefits Thu Mar 27 9:06:42 PDT 2014

radhelper greetings from Detroit. glad to be part of discussion. #JACRThu Mar 27 9:06:56 PDT 2014

scannerside So we have experimented and found simple patient printouts seem to work...emails...apps links dont really #jacrThu Mar 27 9:07:15 PDT 2014

cancergeek T1: We have coaches that educate the patient on the exam, average dose, & then follow up post exam to educate on their specific dose #jacrThu Mar 27 9:07:15 PDT 2014



pfanderson RT @mmahesh1: #JACR We can start with Q1: How do you discuss the risks and benefits of imaging with your patients or referring physicians? Thu Mar 27 9:07:19 PDT 2014

ruthcarlosmd T1: As radiologists, we don't "see" the patients, so we work with the referring providers to balance risk and benefit of the exam. #jacrThu Mar 27 9:07:29 PDT 2014

littenberg T1 As a referring doc, I almost never get any guidance from radiologists on any aspect of test selection. They seem invisible. #jacrThu Mar 27 9:07:34 PDT 2014

radiologyacr RT @mmahesh1: #JACR T1- Any discussion on #radiationdose should be counter balanced with discussion on medical imaging benefits Thu Mar 27 9:07:36 PDT 2014

kristinahoque @mmahesh1 #JACR should the radiologist be primarily communicating with the patient or referring MD? Thu Mar 27 9:07:41 PDT 2014

wilsonjoshm @mmahesh1 #JACR but how to "discuss" the benefits and risks--how take explain to the pt? Thu Mar 27 9:07:44 PDT 2014

radsdoc82 #Jacr Jonathan Flug signing in from NYC. Looking forward to discuss this challenging and often frustrating topic Thu Mar 27 9:07:55 PDT 2014

cancergeek T1: If it additional questions or concerns, we have radiologist explain to pt/families. #jacrThu Mar 27 9:07:56 PDT 2014

radhelper T1 does anybody communicate relative risk of cancer for procedure to pts? #JACRThu Mar 27 9:08:31 PDT 2014

ruthcarlosmd T1: Q to patients--do we need informed consent for each exam, like we do for invasive procedures? #jacrThu Mar 27 9:08:41 PDT 2014

wilsonjoshm @ruthcarlosmd #JACR T1 are referrings knowledgeable enough on radiation dose to adequately educate? should it be left to them? Thu Mar 27 9:08:46 PDT 2014

pfanderson It is so difficult to communicate risk. I've been excited about the new RWJF/UMich site "Visualizing Health" http://t.co/CjQ8Rpuv8m #jacrThu Mar 27 9:08:57 PDT 2014

mmahesh1 #JACR T1-To communicate properly on radiation dose it is important that we are familiarize ourselves about the topic Thu Mar 27 9:09:00 PDT 2014



tirathpatelmd #JACR Joining the tweet chat on this rainy day in Ohio. Looking forward to a good discussion. Thu Mar 27 9:09:03 PDT 2014

scannerside With printouts the message has to be something along the lines of we track dose and ideally if it is branded thats better #jacrThu Mar 27 9:09:17 PDT 2014

cancergeek T1: Have rads reach out to referring physicians to discuss exam, best exam choice, & be a true consultant. #jacrThu Mar 27 9:09:18 PDT 2014

acrrfs RT @KristinaHoque: @ACRRFS get excited #JACR tweet chat on imaging radiation. How 2 talk abt risks/benefits? Today 3/27 12PM ET. Come Joi… Thu Mar 27 9:09:21 PDT 2014

littenberg @wilsonjoshm @ruthcarlosmd I am a referring and I don't have that knowledge. #JACRThu Mar 27 9:09:22 PDT 2014

acrrfs RT @ruthcarlosmd: 15 minutes to #JACR tchat on radiation. @Littenbergguestmod from VT, pt engagement expert. see you on http://t.co/eso3…Thu Mar 27 9:09:24 PDT 2014

ucradsafety T1: We often get asked, what is a "good dose" and find this to be a tricky question. Anyone else get asked this? #JACRThu Mar 27 9:09:57 PDT 2014

pfanderson T1: Iconarray http://t.co/TYLpS9dQAY is another great tool for communicating risk #jacrThu Mar 27 9:09:58 PDT 2014

mmahesh1 #JACR It is understandable that it is not that straight forward to provide all the answers about #radiation dose - we are still learning Thu Mar 27 9:10:01 PDT 2014

kristinahoque @radhelper #JACR - only for interventional procedures - wish I had more of a direct line to pts for diagnostic studies Thu Mar 27 9:10:02 PDT 2014

ruthcarlosmd T1: great question...so I view imaging care as a partnership and an opportunity to enhance pt care. educ two way. @wilsonjoshm #jacrThu Mar 27 9:10:18 PDT 2014

pfanderson RT @Littenberg: T1 As a referring doc, I almost never get any guidance from radiologists on any aspect of test selection. They seem invisib… Thu Mar 27 9:10:21 PDT 2014

tirathpatelmd @Littenberg @wilsonjoshm @ruthcarlosmd My concerns exactly. Referrers not knowledgeable about what eg 0.5 mSv means. #JACRThu Mar 27 9:10:29 PDT 2014



drsxr #JACR T1: We follow ALARA on each study individually. But when multiple studies are considered summed together, are we doing as well? Thu Mar 27 9:10:41 PDT 2014

mmahesh1 @UCRadsafety #JACR A good dose is one that provides the best image quality Thu Mar 27 9:10:44 PDT 2014

acrrfs #RadRes pay attention When studying physics for boards - can help you understand rad dose for career #JACRThu Mar 27 9:11:07 PDT 2014

pfanderson But of course, to use those risk tools, you have to already know the numbers. That's a different question #jacrThu Mar 27 9:11:13 PDT 2014

ruthcarlosmd T1: Ben, we GLOW! just follow the reading rm light. Seriously, how do you want rads to be involved? @Littenberg #jacrThu Mar 27 9:11:18 PDT 2014

littenberg @mmahesh1 @UCRadsafety Not just image quality, but was the test worth the dose (and cost and risks) at all? #JACRThu Mar 27 9:11:26 PDT 2014

mmahesh1 #JACR One can refer to #Radiologyinfo.org which has useful information on radiation dose Thu Mar 27 9:11:35 PDT 2014

wilsonjoshm @mmahesh1 @UCRadsafety #JACR T1 a good dose provides the minimum necessary image quality. excessive quality = excessive dose. Thu Mar 27 9:11:38 PDT 2014

mghimaging @RadiologyACR #JACR tchat on #radiationsafety T1 We use decision support to guide referring physicians. Thu Mar 27 9:11:40 PDT 2014

radhelper T1 rads should be involved when they think an exam is unnecessarily exposing patients to radiation #JACRThu Mar 27 9:11:53 PDT 2014

tirathpatelmd @ruthcarlosmd T1: Balancing risk/benefit requires knowing full clinical picture. Despite EHR, still time-consuming to obtain. #JACRThu Mar 27 9:11:57 PDT 2014

pfanderson ALARA = As Low As Reasonably Achievable http://t.co/NY63qI4BgL #jacrThu Mar 27 9:12:09 PDT 2014

littenberg @MGHImaging @RadiologyACR How do you do the dercision support? #JACRThu Mar 27 9:12:11 PDT 2014

radhelper



i've recommend either conversion to ultrasound/mri or no imaging to patients #JACRThu Mar 27 9:12:14 PDT 2014

kristinahoque RT @mmahesh1: #JACR One can refer to #Radiologyinfo.org which has useful information on radiation dose Thu Mar 27 9:12:32 PDT 2014

cancergeek T1: In a world in which we are all connected electronically, we have found that a call works best in building the education/support #jacrThu Mar 27 9:12:40 PDT 2014

radsdoc82 @TirathPatelMD @Littenberg @wilsonjoshm @ruthcarlosmd on the flip side, how in touch are we with the full clinical picture #jacrThu Mar 27 9:12:40 PDT 2014

natemargolismd #RadRes familiarize yourself w CT protocols, dose index registry and take the lead in dose reduction #imaging3 #JACRThu Mar 27 9:12:41 PDT 2014

jpil @pfanderson Thanks for sharing http://t.co/cREIsyTOtD http://t.co/1ES4nqhL16 - great tools for communicating natural frequencies! #jacrThu Mar 27 9:12:46 PDT 2014

scannerside We give all our sites real time benchmarking based on a national database so techs have numbers. #jacrThu Mar 27 9:12:47 PDT 2014

ucradsafety @mmahesh1 T1: As low as reasonably achievable for the best image quality required for the clinical question... It becomes difficult! #JACRThu Mar 27 9:12:54 PDT 2014

tirathpatelmd @radhelper T1 Agreed, but knowledge of full clinical picture is mandatory for this assessment, which is not always possible #JACRThu Mar 27 9:13:11 PDT 2014

pfanderson RT @TirathPatelMD: @Littenberg @wilsonjoshm @ruthcarlosmd My concerns exactly. Referrers not knowledgeable about what eg 0.5 mSv means. #JA… Thu Mar 27 9:13:19 PDT 2014

ruthcarlosmd T1: @TirathPatelMD, yes, IT has tools, not always the perfect solution. Shared responsibility to manage need to test #jacrThu Mar 27 9:13:28 PDT 2014

mmahesh1 @radhelper @Littenberg #JACR well that may limit the benefits to patients - recommend to use #ACR appropriateness criteria Thu Mar 27 9:13:31 PDT 2014

cancergeek T1: In some facilities Ive recommended a dose leader position to ensure communication btw pts/HCP's is top of mind & process in place #jacrThu Mar 27 9:13:44 PDT 2014



radiologyboy1 RT @UCRadSafety: @mmahesh1 T1: As low as reasonably achievable for the best image quality required for the clinical question... It becomes … Thu Mar 27 9:13:45 PDT 2014

littenberg @TirathPatelMD @radhelper To get the full picture, the ref MD and the rad need to talk sometimes! #JACRThu Mar 27 9:13:47 PDT 2014

kristinahoque @NateMargolisMD #JACR completely agree! We need to be proactive leaders - not a passive participant in patient care Thu Mar 27 9:14:04 PDT 2014

pfanderson @jpil They are so helpful. Using them for blogposts that mention relative risk also #jacrThu Mar 27 9:14:08 PDT 2014

wilsonjoshm #JACR T1 communicating to patient, straddle illustrating risk, not minimizing or maximizing message Thu Mar 27 9:14:14 PDT 2014

radiologyacr RT @Radsdoc82: @TirathPatelMD @Littenberg @wilsonjoshm @ruthcarlosmd on the flip side, how in touch are we with the full clinical picture #… Thu Mar 27 9:14:14 PDT 2014

radiologyacr RT @Littenberg: @TirathPatelMD @radhelper To get the full picture, the ref MD and the rad need to talk sometimes! #JACRThu Mar 27 9:14:23 PDT 2014

radhelper @tirathpatelmd i'm a little spoiled because i get to deal with pediatric patients for the most part. easier to convince parents. #JACRThu Mar 27 9:14:24 PDT 2014

scannerside How and what is the best way to incorporate referrers ? #jacrThu Mar 27 9:14:45 PDT 2014

mmahesh1 @Littenberg @TirathPatelMD @radhelper #JACR Agree WE not only need to talk to the choir but have the conversation where imaging is ordered Thu Mar 27 9:14:47 PDT 2014

radiologyboy1 RT @Littenberg: @TirathPatelMD @radhelper To get the full picture, the ref MD and the rad need to talk sometimes! #JACRThu Mar 27 9:14:48 PDT 2014

mbetvfu RT @mmahesh1: #JACR T1- Any discussion on #radiationdose should be counter balanced with discussion on medical imaging benefits Thu Mar 27 9:14:50 PDT 2014

jpil @mmahesh1 perhaps worded as the best required image quality based on clinical assessment, not increased dose for prettier pictures? #jacrThu Mar 27 9:14:55 PDT 2014



natemargolismd RT @KristinaHoque: @NateMargolisMD #JACR completely agree! We need to be proactive leaders - not a passive participant in patient care Thu Mar 27 9:14:56 PDT 2014

wilsonjoshm #JACR T1 could frame it as "1 in 10K pts" at risk, or equivalent to a flight from JFK to LAX. Thu Mar 27 9:15:09 PDT 2014

mghimaging @Littenberg #JACR We developed a system called Radiology Order Entry with decision support which is a forerunner to ACR Select. Thu Mar 27 9:15:14 PDT 2014

tirathpatelmd @ruthcarlosmd T1: Of course. Maybe use of ACR Appropriateness Criteria could help. #JACRThu Mar 27 9:15:21 PDT 2014

pfanderson Awesome website on calculating radiation risk from professional society (ASRT) http://t.co/w8vXwzq9BU #jacrThu Mar 27 9:15:45 PDT 2014

tirathpatelmd RT @radhelper: @tirathpatelmd i'm a little spoiled because i get to deal with pediatric patients for the most part. easier to convince par… Thu Mar 27 9:15:48 PDT 2014

ruthcarlosmd @TirathPatelMD T1: and #imaging3.0 for value- based not volume-based imaging #jacrThu Mar 27 9:16:21 PDT 2014

acrrfs RT @KristinaHoque: @NateMargolisMD #JACR completely agree! We need to be proactive leaders - not a passive participant in patient care Thu Mar 27 9:16:23 PDT 2014

cancergeek T1: @RadiologyACR Recommended someone appointed by the RSO, w appropriate training/education, & ability to communicate. right person #jacrThu Mar 27 9:16:30 PDT 2014

radhelper ACR Select is an excellent start. However, the communication of risk to referring doc or pt is still very nebulous and difficult. #JACRThu Mar 27 9:16:31 PDT 2014

pfanderson If you want to print off a reference for radiation risk from individual procedures, this might help http://t.co/TqXvZAVDhm #jacrThu Mar 27 9:16:33 PDT 2014

acrrfs RT @CancerGeek: T1: In some facilities Ive recommended a dose leader position to ensure communication btw pts/HCP's is top of mind & proces… Thu Mar 27 9:16:33 PDT 2014

acrrfs RT @NateMargolisMD: #RadRes familiarize yourself w CT protocols, dose index registry and take the lead in dose reduction #imaging3 #JACRThu Mar 27 9:16:50 PDT 2014



mmahesh1 @wilsonjoshm #JACR Can use multiple ways to communicate to patients but need to be stress that benefits far outweighs the risk Thu Mar 27 9:17:14 PDT 2014

natemargolismd RT @ACRRFS: #RadRes pay attention When studying physics for boards - can help you understand rad dose for career #JACRThu Mar 27 9:17:39 PDT 2014

cancergeek T1: Rads need to be comfortable w having a dialogue w patients & referring MD's. They need your expertise to communicate rationale. #jacrThu Mar 27 9:17:39 PDT 2014

radsdoc82 @wilsonjoshm t1 for an inappropriate exam even that risk is too high. #jacrThu Mar 27 9:17:40 PDT 2014

pfanderson American Nuclear Society has a tool for environmental radiation risk http://t.co/jKpz1B0bdR #jacrThu Mar 27 9:17:41 PDT 2014

scannerside @pfanderson too many variables involved to get a generic reference...giving pts a ref may scare them. #jacrThu Mar 27 9:17:55 PDT 2014

mmahesh1 @radhelper #JACR Both clinician provider and radiologist share the responsibility of communication with patients and families and caregivers Thu Mar 27 9:17:55 PDT 2014

littenberg @mmahesh1 @wilsonjoshm Do the benefits ALWAYS outweigh the risks? #JACRThu Mar 27 9:17:58 PDT 2014

tirathpatelmd @UCRadSafety @mmahesh1 I'm all about transparency, but hesitant when harm can rise. Are referrers & pts knowledgeable abt doses? #JACRThu Mar 27 9:17:59 PDT 2014

brettsnodgrass1 RT @KristinaHoque: @NateMargolisMD #JACR completely agree! We need to be proactive leaders - not a passive participant in patient care Thu Mar 27 9:18:00 PDT 2014

mmahesh1 @Littenberg @wilsonjoshm #JACR It comes to the question of appropriateness of a particular study Thu Mar 27 9:18:27 PDT 2014

natemargolismd RT @CancerGeek: T1: Rads need to be comfortable w having a dialogue w patients & referring MD's. They need your expertise to communicate ra… Thu Mar 27 9:18:28 PDT 2014

scannerside @mmahesh1 @radhelper yes but how does radiologist get involved #jacrThu Mar 27 9:18:34 PDT 2014

cancergeek



@TirathPatelMD T1: I would say no, they are not informed on #raddose That is why they need rads to speak up & lead discussion. #jacrThu Mar 27 9:18:43 PDT 2014

natemargolismd RT @CancerGeek: T1: In some facilities Ive recommended a dose leader position to ensure communication btw pts/HCP's is top of mind & proces… Thu Mar 27 9:18:47 PDT 2014

ruthcarlosmd RT @CancerGeek: T1: Rads need to be comfortable w having a dialogue w patients & referring MD's. They need your expertise to communicate ra… Thu Mar 27 9:18:59 PDT 2014

natricer RT @ruthcarlosmd: #JACR tchat on CT radiation. How docs and pts should talk about risks, benefits, dose. @NatriceR @brettsnodgrass1 @drste… Thu Mar 27 9:19:00 PDT 2014

radhelper I would venture to say that radiologists are not educated or trained to fully discuss risk/benefit of procedures we perform. #JACRThu Mar 27 9:19:12 PDT 2014

natricer Hi thanks for invite - late and lurking ;) #JACRThu Mar 27 9:19:36 PDT 2014

radsdoc82 @mmahesh1 @Littenberg @wilsonjoshm use medical school education to begin planting the seeds of appropriateness #jacrThu Mar 27 9:19:36 PDT 2014

mmahesh1 @TirathPatelMD @Littenberg @wilsonjoshm @UCRadSafety #JACR Not sure-everyone gets info from web - you know how difficult to pick right one Thu Mar 27 9:19:39 PDT 2014

wilsonjoshm @Littenberg @mmahesh1 #JACR T1 arguably we don't have adequate metrics of risk to compare the benefit against Thu Mar 27 9:19:48 PDT 2014

natricer RT @mmahesh1: @radhelper #JACR Both clinician provider and radiologist share the responsibility of communication with patients and families… Thu Mar 27 9:19:48 PDT 2014

ucradsafety RT @MGHImaging: @Littenberg #JACR We developed a system called Radiology Order Entry with decision support which is a forerunner to ACR Sel… Thu Mar 27 9:19:54 PDT 2014

jpil @radhelper Not a #radres I would venture to say that perhaps they should be #jacrThu Mar 27 9:20:00 PDT 2014

kristinahoque @radhelper #JACR leading the discussion on risk/benefits of a study should be part of residency training Thu Mar 27 9:20:08 PDT 2014



tirathpatelmd @KristinaHoque @ruthcarlosmd We've been preaching to choir abt ACR Appr Criteria. We must get word out to congregation. #JACRThu Mar 27 9:20:11 PDT 2014

cancergeek MT Really? @radhelper: Id venture to say that rads are not educated or trained to discuss risk/benefit of procedures we perform. #JACRThu Mar 27 9:20:12 PDT 2014

mmahesh1 @Radsdoc82 @Littenberg @wilsonjoshm #JACR - there is some conversation to have a uniform discussion about radiation to medical students Thu Mar 27 9:20:20 PDT 2014

scannerside @KristinaHoque @radhelper it should be a part of protocol training #jacrThu Mar 27 9:20:31 PDT 2014

ruthcarlosmd @TirathPatelMD @KristinaHoque T1: we're trying to reach a whole 'nuther church! #jacrThu Mar 27 9:20:40 PDT 2014

wilsonjoshm @mmahesh1 @TirathPatelMD @Littenberg @UCRadSafety #JACR T1 my RSO office's advice "assume everyone has already googled their question" Thu Mar 27 9:20:41 PDT 2014

kristinahoque RT @TirathPatelMD: @KristinaHoque @ruthcarlosmd We've been preaching to choir abt ACR Appr Criteria. We must get word out to congregation. … Thu Mar 27 9:20:54 PDT 2014

ruthcarlosmd RT @wilsonjoshm: @mmahesh1 @TirathPatelMD @Littenberg @UCRadSafety#JACR T1 my RSO office's advice "assume everyone has already googled the… Thu Mar 27 9:20:57 PDT 2014

scannerside @wilsonjoshm @mmahesh1 @TirathPatelMD @Littenberg @UCRadSafety likely before the scan haha yes #jacrThu Mar 27 9:21:08 PDT 2014

mmahesh1 @Radsdoc82 @Littenberg @wilsonjoshm #JACR At #JohnsHopkins medical students have option to rotate in #Radiology where radiation is taught Thu Mar 27 9:21:12 PDT 2014

natemargolismd @CancerGeek @TirathPatelMD huge audience for voice of radiologist, need to inform risk/ dispel myths of rad dose to public #jacrThu Mar 27 9:21:20 PDT 2014

littenberg @Scannerside @KristinaHoque @radhelper I love the idea of a standardized curriculum on how to discuss risks of rads. #JACRThu Mar 27 9:21:21 PDT 2014

tirathpatelmd RT @ruthcarlosmd: @TirathPatelMD @KristinaHoque T1: we're trying to reach a whole 'nuther church! #jacrThu Mar 27 9:21:23 PDT 2014



cancergeek T1: Rads are the experts. Need to consider the dialogue needed to educate. If you aren't a part, others will do it for you. #jacrThu Mar 27 9:21:32 PDT 2014

pfanderson @Scannerside True, but it depends on the patient. There is this struggle to come up w/ generic info for communicating risk widely #jacrThu Mar 27 9:21:41 PDT 2014

cancergeek RT @NateMargolisMD: @CancerGeek @TirathPatelMD huge audience for voice of radiologist, need to inform risk/ dispel myths of rad dose to pub… Thu Mar 27 9:21:42 PDT 2014

scannerside @CancerGeek yes #jacrThu Mar 27 9:21:46 PDT 2014

ruthcarlosmd Get ready for T2: What information should be communicated to patients about radiation dose? #jacrThu Mar 27 9:21:50 PDT 2014

radhelper agree @CancerGeek. #JACRThu Mar 27 9:22:00 PDT 2014

ucradsafety @Littenberg @mmahesh1 @wilsonjoshm If there are other tests available to answer the clinical question, why take unnecessary risk? #JACRThu Mar 27 9:22:01 PDT 2014

ctsinclair RT @mmahesh1: @radhelper #JACR Both clinician provider and radiologist share the responsibility of communication with patients and families… Thu Mar 27 9:22:02 PDT 2014

mmahesh1 @Littenberg @Scannerside @KristinaHoque @radhelper #JACR it is timely that we have this conversation-hope it leads to standardization Thu Mar 27 9:22:02 PDT 2014

tirathpatelmd RT @wilsonjoshm: @mmahesh1 @TirathPatelMD @Littenberg @UCRadSafety#JACR T1 my RSO office's advice "assume everyone has already googled the… Thu Mar 27 9:22:06 PDT 2014

cancergeek @NateMargolisMD I completely agree. Ive heard admins say why would we want a Rad speak to pts. I had to inform them as to why. Sad. #jacrThu Mar 27 9:22:13 PDT 2014

radiologyboy1 T1: Seems "secret" to proper dose is communicating with ref physicians and implementing reliable decision support @ACRselect #Imaging3 #JACRThu Mar 27 9:22:14 PDT 2014

kristinahoque RT @mmahesh1: @Littenberg @Scannerside @KristinaHoque @radhelper#JACR it is timely that we have this conversation-hope it leads to standar… Thu Mar 27 9:22:35 PDT 2014



natricer RT @ruthcarlosmd: Get ready for T2: What information should be communicated to patients about radiation dose? #jacrThu Mar 27 9:22:46 PDT 2014

wilsonjoshm #JACR T2 Give them the numbers, give them the scan parameters, and then try to contextualize it Thu Mar 27 9:22:48 PDT 2014

kristinahoque RT @RadiologyBoy1: T1: Seems "secret" to proper dose is communicating with ref physicians and implementing reliable decision support @ACRse… Thu Mar 27 9:22:53 PDT 2014

tirathpatelmd @mmahesh1 @Radsdoc82 @Littenberg @wilsonjoshm Same at our institution. Radiology rotation IMO should be required for all students #JACRThu Mar 27 9:22:59 PDT 2014

littenberg T2: Let's not tell patients anything about physics! #JACRThu Mar 27 9:23:08 PDT 2014

radiologyacr RT @CancerGeek: T1: Rads are the experts. Need to consider the dialogue needed to educate. If you aren't a part, others will do it for you.… Thu Mar 27 9:23:11 PDT 2014

pfanderson RT @UCRadSafety: @Littenberg @mmahesh1 @wilsonjoshm If there are other tests available to answer the clinical question, why take unnecessar… Thu Mar 27 9:23:11 PDT 2014

radhelper @RadiologyBoy1 Decision support is no secret. There is no incentive to use it in fee for service #JACRThu Mar 27 9:23:12 PDT 2014

natemargolismd RT @CancerGeek: @NateMargolisMD I completely agree. Ive heard admins say why would we want a Rad speak to pts. I had to inform them as to w… Thu Mar 27 9:23:18 PDT 2014

mmahesh1 @wilsonjoshm #JACR that is one way but the conversation should start informing why a particular study is done and how it would benefit Thu Mar 27 9:23:29 PDT 2014

pfanderson RT @RadiologyBoy1: T1: Seems "secret" to proper dose is communicating with ref physicians and implementing reliable decision support @ACRse… Thu Mar 27 9:23:30 PDT 2014

cancergeek T2: What the exam is, what is the typical dose & relative to real world example, benefits/risks. Then post exam what real dose was/why #jacrThu Mar 27 9:23:48 PDT 2014

kristinahoque @wilsonjoshm #JACR the key is to do it with cultural competence in the patients native language Thu Mar 27 9:23:54 PDT 2014



mmahesh1 T2: #JACR Agree with Graff's article on patient perspectives "Medicine is a team sport and patient is an integral member of the team" Thu Mar 27 9:23:56 PDT 2014

wilsonjoshm #JACR T2 the dose numbers for their log, the parameters in case there are better models in the future, and context/justification/benefit Thu Mar 27 9:24:09 PDT 2014

pfanderson @RadiologyBoy1 @ACRselect Is there a decision support tool? Life time risk, what's cumulative, short term/long term, what else? #jacrThu Mar 27 9:24:14 PDT 2014

radhelper In many rad rotations, the med students do not get this type of information let alone any dedicated didactics. #JACRThu Mar 27 9:24:22 PDT 2014

tirathpatelmd @CancerGeek @NateMargolisMD Why would you not!? Rads more knowledgeable abt #raddose vast majority of physicians #JACRThu Mar 27 9:24:29 PDT 2014

pfanderson RT @mmahesh1: @wilsonjoshm #JACR that is one way but the conversation should start informing why a particular study is done and how it wou… Thu Mar 27 9:24:35 PDT 2014

cancergeek T2: If you can give them a report to take home on dose even better. Explain in simple terms. #jacrThu Mar 27 9:24:39 PDT 2014

drsxr #JACR T2: communicate facts but emphasize that we (Rad+referrer) belive that benefits outweigh risks & study is appropriate. Thu Mar 27 9:24:49 PDT 2014

mmahesh1 @KristinaHoque @wilsonjoshm Agree #JACR - @Radiologyinfo.org has topics in other languages also Thu Mar 27 9:24:57 PDT 2014

tirathpatelmd RT @mmahesh1: T2: #JACR Agree with Graff's article on patient perspectives "Medicine is a team sport and patient is an integral member of t… Thu Mar 27 9:25:01 PDT 2014

natricer RT @CancerGeek: T2: If you can give them a report to take home on dose even better. Explain in simple terms. #jacrThu Mar 27 9:25:09 PDT 2014

cancergeek @TirathPatelMD @NateMargolisMD I completely agree. #jacrThu Mar 27 9:25:10 PDT 2014

natemargolismd .@CancerGeek next generation of #RadRes are ready to talk to pts about dose but need buy in from dept leaders #jacr #imaging3Thu Mar 27 9:25:15 PDT 2014



radiologyacr T2: What information should be communicated to patients about radiation dose? #JACRThu Mar 27 9:25:16 PDT 2014

radiologywriter RT @mmahesh1 T2: #JACR Agree with Graff's article on patient perspectives"Medicine is a team sport and patient is an integral member... Thu Mar 27 9:25:24 PDT 2014

cancergeek RT @NateMargolisMD: .@CancerGeek next generation of #RadRes are ready to talk to pts about dose but need buy in from dept leaders #jacr #im… Thu Mar 27 9:25:25 PDT 2014

kristinahoque RT @mmahesh1: @KristinaHoque @wilsonjoshm Agree #JACR - @Radiologyinfo.org has topics in other languages also Thu Mar 27 9:25:28 PDT 2014

pfanderson @Scannerside In other fields, a big improvement resulted from engaging patients in disseminating info to PCP. Not sure that works here #jacrThu Mar 27 9:25:33 PDT 2014

wilsonjoshm #JACR T2 sorry, misinterpreted Q, these are items to be communicated post-exam Thu Mar 27 9:25:38 PDT 2014

scannerside @KristinaHoque @wilsonjoshm which is why generic sheets and verbiage isnt helpful...its site specific #jacrThu Mar 27 9:25:38 PDT 2014

mmahesh1 @CancerGeek #JACR - The bigger picture is what we say radiation dose in imaging - is an estimation only with great uncertainty Thu Mar 27 9:25:55 PDT 2014

pfanderson RT @mmahesh1: T2: #JACR Agree with Graff's article on patient perspectives "Medicine is a team sport and patient is an integral member of t… Thu Mar 27 9:25:56 PDT 2014

cancergeek @NateMargolisMD Amen!! IME I think most rads are happy to talk to pts, just not asked to do so. #jacrThu Mar 27 9:25:58 PDT 2014

radhelper SPR created dedicated radiation risk lectures for med school audience. Very good way to disseminate this info to med students. #JACRThu Mar 27 9:25:59 PDT 2014

littenberg @Littenberg: T2: I doubt that dosing parameters will be wanted by many pts. #JACRThu Mar 27 9:26:10 PDT 2014

mghimaging @radhelper #JACR In some markets use of decision support obviates the need for pre-authorization. @ACRselectThu Mar 27 9:26:11 PDT 2014



scannerside @pfanderson we arent either...our strategy so far has been empower techs with knowledge and let patients ask questions #jacrThu Mar 27 9:26:25 PDT 2014

tirathpatelmd @RadiologyACR T2 Not simply just dose, but comparisons to real context (background radiation, stochastic & deterministic risks) #JACRThu Mar 27 9:26:39 PDT 2014

tirathpatelmd RT @radhelper: SPR created dedicated radiation risk lectures for med school audience. Very good way to disseminate this info to med studen… Thu Mar 27 9:26:55 PDT 2014

cancergeek RT @TirathPatelMD: @RadiologyACR T2 Not simply just dose, but comparisons to real context (background radiation, stochastic & deterministic… Thu Mar 27 9:26:57 PDT 2014

scannerside @UCRadSafety @Littenberg @KristinaHoque @radhelper yes but we all gotta start somewhere #jacrThu Mar 27 9:26:58 PDT 2014

kristinahoque @Scannerside @wilsonjoshm #JACR agree and discussion should be in person not printed sheets- too much room 4 misinterpretation Thu Mar 27 9:27:02 PDT 2014

tirathpatelmd RT @drsxr: #JACR T2: communicate facts but emphasize that we (Rad+referrer) belive that benefits outweigh risks & study is appropriate. Thu Mar 27 9:27:16 PDT 2014

mmahesh1 @Scannerside @pfanderson #JACR Technologists are a great source to implement factors that reduces radiation dose in imaging Thu Mar 27 9:27:20 PDT 2014

acrselect RT @RadiologyBoy1: T1: Seems "secret" to proper dose is communicating with ref physicians and implementing reliable decision support @ACRse… Thu Mar 27 9:27:28 PDT 2014

acrselect RT @MGHImaging: @radhelper #JACR In some markets use of decision support obviates the need for pre-authorization. @ACRselectThu Mar 27 9:27:38 PDT 2014

radiologyacr RT @mmahesh1: @CancerGeek #JACR - The bigger picture is what we say radiation dose in imaging - is an estimation only with great uncertainty Thu Mar 27 9:27:40 PDT 2014

radiologyacr RT @CancerGeek: @NateMargolisMD Amen!! IME I think most rads are happy to talk to pts, just not asked to do so. #jacrThu Mar 27 9:27:48 PDT 2014

scannerside @KristinaHoque @wilsonjoshm yes...we offer the printouts only if tech discusses in person w pt first #jacrThu Mar 27 9:27:52 PDT 2014



pfanderson @MGHImaging @radhelper @ACRselect Examples please? That sounds ... potentially confusing. #jacrThu Mar 27 9:28:09 PDT 2014

kristinahoque RT @mmahesh1: @Scannerside @pfanderson #JACR Technologists are a great source to implement factors that reduces radiation dose in imaging Thu Mar 27 9:28:11 PDT 2014

ruthcarlosmd RT @mmahesh1: @CancerGeek #JACR - The bigger picture is what we say radiation dose in imaging - is an estimation only with great uncertainty Thu Mar 27 9:28:13 PDT 2014

pfanderson RT @CancerGeek: @NateMargolisMD Amen!! IME I think most rads are happy to talk to pts, just not asked to do so. #jacrThu Mar 27 9:28:21 PDT 2014

littenberg T2: It seems the comparator ought to be the risks of NOT doing the study. Not just radiation, but all the downstream pros & cons #JACRThu Mar 27 9:28:30 PDT 2014

scannerside @KristinaHoque @wilsonjoshm but we have to think about efficiency as well...all this can take up ALOT of time at scanner #jacrThu Mar 27 9:28:34 PDT 2014

cancergeek T2A: It's a story. Exam allows us to see inside, to do it takes radiation less than "blank" like being on plane/in sun. #jacrThu Mar 27 9:28:45 PDT 2014

pfanderson @CancerGeek @NateMargolisMD In my experience, I never see the rad until AFTER the scan. The tech is who I'd have to ask #jacrThu Mar 27 9:28:52 PDT 2014

ucradsafety @Scannerside @Littenberg @KristinaHoque @radhelper Scannerside's approach is interesting- I hope it's embraced clinically! #JACRThu Mar 27 9:29:22 PDT 2014

radhelper @Scannerside @KristinaHoque @wilsonjoshm should be done before pt at scanner (ideally before order placed) #JACRThu Mar 27 9:29:33 PDT 2014

cancergeek T2B: which allows us to see whats wrong. Prepare MD to treat you appropriately. Stories. It is all about the story. #jacrThu Mar 27 9:29:48 PDT 2014

tirathpatelmd @NateMargolisMD @CancerGeek #JACR Agree! But rad depts' emphasis on 'productivity' inhibits talking to patients. Thu Mar 27 9:29:51 PDT 2014

cancergeek RT @TirathPatelMD: @NateMargolisMD @CancerGeek #JACR Agree! But rad depts' emphasis on 'productivity' inhibits talking to patients. Thu Mar 27 9:30:05 PDT 2014



tirathpatelmd RT @mmahesh1: @Scannerside @pfanderson #JACR Technologists are a great source to implement factors that reduces radiation dose in imaging Thu Mar 27 9:30:08 PDT 2014

ruthcarlosmd eg. incidentalomas @Littenberg: T2: comparator ought to be risks of NOT doing study. Not just radiation, but all dwnstrm pros & cons #JACRThu Mar 27 9:30:15 PDT 2014

aussiclydesdale @pfanderson @MGHImaging @radhelper @ACRselect MGH docs get pass from PA if using #decisionsupport. Same for Medicaid in WI & MN. #JACRThu Mar 27 9:30:33 PDT 2014

tirathpatelmd RT @MGHImaging: @radhelper #JACR In some markets use of decision support obviates the need for pre-authorization. @ACRselectThu Mar 27 9:30:33 PDT 2014

littenberg @CancerGeek I like the story idea as a communications model. #JACRThu Mar 27 9:30:38 PDT 2014

tirathpatelmd RT @ruthcarlosmd: eg. incidentalomas @Littenberg: T2: comparator ought to be risks of NOT doing study. Not just radiation, but all dwnstrm … Thu Mar 27 9:30:49 PDT 2014

cancergeek @TirathPatelMD @TirathPatelMD IMO that is being short sighted. More dialogue = more market share. Productivity will follow. #jacrThu Mar 27 9:30:52 PDT 2014

cancergeek RT @Littenberg: @CancerGeek I like the story idea as a communications model. #JACRThu Mar 27 9:31:03 PDT 2014

cancergeek @Littenberg Thanks. I have one or two moments of brilliance. That may be it for today. :) #jacrThu Mar 27 9:31:27 PDT 2014

tirathpatelmd RT @radhelper: In many rad rotations, the med students do not get this type of information let alone any dedicated didactics. #JACRThu Mar 27 9:31:28 PDT 2014

scannerside @radhelper @KristinaHoque @wilsonjoshm yes we agree #jacrThu Mar 27 9:31:45 PDT 2014

pfanderson RT @ruthcarlosmd: eg. incidentalomas @Littenberg: T2: comparator ought to be risks of NOT doing study. Not just radiation, but all dwnstrm … Thu Mar 27 9:32:19 PDT 2014

radiologyacr RT @CancerGeek: T2A: It's a story. Exam allows us to see inside, to do it takes radiation less than "blank" like being on plane/in sun. #j… Thu Mar 27 9:32:25 PDT 2014



cancergeek T2: Real question I have is as pts cross more than one healthcare system, how do rads manage lifetime radiation dose? #jacrThu Mar 27 9:32:31 PDT 2014

colinsegovis Rad dose is a complex issue and exposure concerns can be given inappropriate weight hindering care. Rads needs to be involved. #JACRThu Mar 27 9:32:37 PDT 2014

mmahesh1 #JACR - How often do your patients asks about radiation dose? Thu Mar 27 9:32:43 PDT 2014

wilsonjoshm #JACR T2 if benefits outweigh risk 99% for a patient; then address medical risk for pt. in front of you, rad dose risk on population basis? Thu Mar 27 9:32:53 PDT 2014

pfanderson @ruthcarlosmd @Littenberg Yes! The pros & cons, the context, the risks of doing it w/ risks of not doing it. #jacrThu Mar 27 9:33:01 PDT 2014

natricer RT @CancerGeek: T2: Real question I have is as pts cross more than one healthcare system, how do rads manage lifetime radiation dose? #jacrThu Mar 27 9:33:03 PDT 2014

ruthcarlosmd Time for personal dosimeters? @CancerGeek: T2: pts cross more than one health system, how do rads manage lifetime radiation dose? #jacrThu Mar 27 9:33:39 PDT 2014

cancergeek T2: As more people begin to pay more for their care, will be ever more important to have a story on importance of exam, safety, etc. #jacrThu Mar 27 9:33:45 PDT 2014

radhelper @mmahesh1 get about 1 patient a month that is concerned #JACRThu Mar 27 9:34:02 PDT 2014

littenberg @wilsonjoshm If you are choosing tests for patients, what does it mean "manage rad soe" for pop? #JACRThu Mar 27 9:34:06 PDT 2014

scannerside @mmahesh1 its actually pretty rare but always in back of their mind #jacrThu Mar 27 9:34:07 PDT 2014

mmahesh1 @ruthcarlosmd #JACR @CancerGeek We have to be very careful about patient dosimeters - can get lot of bad data Thu Mar 27 9:34:11 PDT 2014

tirathpatelmd @mmahesh1 Many times, radiologists not involved in such conversation. Usu occurs in hosp room or clinic with referring MD #JACRThu Mar 27 9:34:12 PDT 2014

natricer



RT @CancerGeek: T2: As more people begin to pay more for their care, will be ever more important to have a story on importance of exam, saf… Thu Mar 27 9:34:28 PDT 2014

cancergeek @ruthcarlosmd Perhaps not personal dosimeters, but why not give exam dose to patients when leave? Make an app? Something? #jacrThu Mar 27 9:34:38 PDT 2014

pallimed If anyone at the #jacr #hospmed14 #ahcj14 conferences has tweets related to hospice or palliative med feel free to add #hpm. Keep tweeting! Thu Mar 27 9:34:40 PDT 2014

pfanderson @CancerGeek Need to also connect risk/benefit/costs #jacrThu Mar 27 9:34:47 PDT 2014

wilsonjoshm @CancerGeek #JACR T2 not just different systems, different modalities! metrics vary among CT, Xray, Fluoro, and how those doses are modeled. Thu Mar 27 9:34:50 PDT 2014

mmahesh1 @Scannerside #JACR Especially when there are news articles about radiation - that's when we get asked about radiation Thu Mar 27 9:34:56 PDT 2014

ruthcarlosmd @CancerGeek T2: pts paying retail focus on final out of pocket cost--potential for underuse even if rad dose is not issue. #jacrThu Mar 27 9:35:04 PDT 2014

radsdoc82 @CancerGeek t2 patients don't understand risk. How often do you hear "do everything" #jacrThu Mar 27 9:35:04 PDT 2014

radhelper @CancerGeek T2: when they pay more for health care they expect more to be done. how do we say 'no' #JACRThu Mar 27 9:35:26 PDT 2014

drsxr T2 also real question @CancerGeek : Realistically what's more important practically: lifetime dose or annual dose?#JACRThu Mar 27 9:35:26 PDT 2014

cancergeek T2: If rads are not part of the discussion, & allow referring MD to have it, then Rads need to change the process/dialogue. #jacrThu Mar 27 9:35:32 PDT 2014

rlmorin02 @ruthcarlosmd @CancerGeek #jacr Lifetime Dose Thu Mar 27 9:36:06 PDT 2014

cancergeek @Radsdoc82 IMO this is changing. Balance is shifting from do everything to wait and tell me why you are doing this. #jacrThu Mar 27 9:36:11 PDT 2014



scannerside @mmahesh1 yeah same here wish media would scare ppl less... #jacrThu Mar 27 9:36:18 PDT 2014

kristinahoque RT @mmahesh1: T2: #JACR Agree with Graff's article on patient perspectives "Medicine is a team sport and patient is an integral member of t… Thu Mar 27 9:36:36 PDT 2014

tirathpatelmd @ruthcarlosmd @CancerGeek #JACR Integrating dose/exposure w/ regional image-sharing networks is one possible avenue. Thu Mar 27 9:36:41 PDT 2014

radiologyboy1 RT @CancerGeek: T2: If rads are not part of the discussion, & allow referring MD to have it, then Rads need to change the process/dialogue.… Thu Mar 27 9:36:44 PDT 2014

mmahesh1 @TirathPatelMD #JACR It is beneficial to let your referring docs know where they can reach for answers on such questions Thu Mar 27 9:36:50 PDT 2014

kristinahoque @CancerGeek @Radsdoc82 #JACR agree proactive education is the new gold standard Thu Mar 27 9:37:12 PDT 2014

ucradsafety @wilsonjoshm @CancerGeek Short answer is that no one tracks cumulative or lifetime doses. #jacr T2 Thu Mar 27 9:37:13 PDT 2014

radhelper T2: Any increase patient response for California dose reporting requirements? #JACRThu Mar 27 9:37:18 PDT 2014

cancergeek @radhelper IME people are open to given options & rationale. Its a joint effort w patient moving towards being their CEO of care. #jacrThu Mar 27 9:37:21 PDT 2014

ruthcarlosmd T2: Seems like communication should be a reimbursable activity to align incentives. @cancergeek @tirathpatelmd #jacrThu Mar 27 9:37:34 PDT 2014

tirathpatelmd RT @mmahesh1: @TirathPatelMD #JACR It is beneficial to let your referring docs know where they can reach for answers on such questions Thu Mar 27 9:37:40 PDT 2014

scannerside @colinsegovis rads are involved heavily with protocolling low dose studies #jacrThu Mar 27 9:37:50 PDT 2014

mmahesh1 @UCRadSafety @wilsonjoshm @CancerGeek #JACR tracking cumulative dose can often be misused Thu Mar 27 9:37:58 PDT 2014



pfanderson @aussiclydesdale @MGHImaging @radhelper @ACRselect Thanks for explaining more #jacrThu Mar 27 9:38:02 PDT 2014

tirathpatelmd RT @ruthcarlosmd: T2: Seems like communication should be a reimbursable activity to align incentives. @cancergeek @tirathpatelmd #jacrThu Mar 27 9:38:10 PDT 2014

cancergeek @wilsonjoshm Very true. However, this is the reason why a dialogue needs to take place w Rads leading the discussion. Process, etc. #jacrThu Mar 27 9:38:22 PDT 2014

wilsonjoshm @UCRadSafety @CancerGeek #JACR T2 of course, starting in July, per TJC, some rad doses will be dictated into report Thu Mar 27 9:38:26 PDT 2014

scannerside @CancerGeek its doable our network spans 10 states and we are working on matching dicom header parameters to get lifetime #jacrThu Mar 27 9:38:31 PDT 2014

mmahesh1 @UCRadSafety @wilsonjoshm @CancerGeek #JACR Keeping track of studies as @ImageGently recommends helps to avoid repetitions Thu Mar 27 9:38:38 PDT 2014

tirathpatelmd @ruthcarlosmd @cancergeek @tirathpatelmd #JACR. Too much disincentive to discuss dose & risk/benefit with patient. #ChangeTheModelThu Mar 27 9:38:52 PDT 2014

radsdoc82 @radhelper t2 patients don't always think the radiologist is the expert. They think referring doc may know more. #JACRThu Mar 27 9:38:59 PDT 2014

radiologyboy1 RT @CancerGeek: @wilsonjoshm Very true. However, this is the reason why a dialogue needs to take place w Rads leading the discussion. Proce… Thu Mar 27 9:39:01 PDT 2014

littenberg @ruthcarlosmd @cancergeek @tirathpatelmd Under population mgt (ACO), there is incentive to communicate rather than just do procedures #JACRThu Mar 27 9:39:14 PDT 2014

mmahesh1 @wilsonjoshm @UCRadSafety @CancerGeek #JACR this is similar to California radiation bill that requires certain dose descriptors in pat chart Thu Mar 27 9:39:30 PDT 2014

scannerside @UCRadSafety @wilsonjoshm @CancerGeek yes we do at a single institution automatically #jacrThu Mar 27 9:39:32 PDT 2014

pfanderson @radhelper @MGHImaging @ACRselect Trying to understand relationship between decision support and pre-authorization, who does what #jacrThu Mar 27 9:39:56 PDT 2014



tirathpatelmd @Radsdoc82 @radhelper More basic issue: Many patients don't know radiologist is a 'doctor.' We must dispel the myth. #JACRThu Mar 27 9:39:59 PDT 2014

cancergeek @ruthcarlosmd IMO viewing communication as reimbursable is shortsighted. Long term the dialogue builds more creditability/mkt share #jacrThu Mar 27 9:40:09 PDT 2014

mmahesh1 #JACR We also have to recognize that from past decade manufacturers have done excellent job in lowering radiation dose in imaging Thu Mar 27 9:40:20 PDT 2014

cancergeek RT @Scannerside: @CancerGeek its doable our network spans 10 states and we are working on matching dicom header parameters to get lifetime … Thu Mar 27 9:40:20 PDT 2014

tirathpatelmd RT @mmahesh1: #JACR We also have to recognize that from past decade manufacturers have done excellent job in lowering radiation dose in ima… Thu Mar 27 9:40:30 PDT 2014

radiologyboy1 @CancerGeek @wilsonjoshm #JACR Excellent point about rads needing to be an integral part of the healthcare team. It's about value not volume Thu Mar 27 9:40:38 PDT 2014

scannerside @UCRadSafety @wilsonjoshm @CancerGeek multi site is hard we will keep working on it #jacrThu Mar 27 9:40:44 PDT 2014

pfanderson @radhelper @MGHImaging @ACRselect Wondering if this is "checklist" concept, level of patient customization, FDA authorization, etc #jacrThu Mar 27 9:40:49 PDT 2014

natricer RT @TirathPatelMD: @Radsdoc82 @radhelper More basic issue: Many patients don't know radiologist is a 'doctor.' We must dispel the myth. #JA… Thu Mar 27 9:40:49 PDT 2014

mmahesh1 @TirathPatelMD @Radsdoc82 @radhelper #JACR Certainly #ACR is working on this Thu Mar 27 9:40:50 PDT 2014

pfanderson RT @TirathPatelMD: @Radsdoc82 @radhelper More basic issue: Many patients don't know radiologist is a 'doctor.' We must dispel the myth. #JA… Thu Mar 27 9:41:06 PDT 2014

kristinahoque RT @TirathPatelMD: @Radsdoc82 @radhelper More basic issue: Many patients don't know radiologist is a 'doctor.' We must dispel the myth. #JA… Thu Mar 27 9:41:30 PDT 2014

natricer RT @RadiologyBoy1: @CancerGeek @wilsonjoshm #JACR Excellent point about rads needing to be an integral part of the healthcare team. It's ab… Thu Mar 27 9:41:30 PDT 2014



shmlive RT @Pallimed: If anyone at the #jacr #hospmed14 #ahcj14 conferences has tweets related to hospice or palliative med feel free to add #hpm. … Thu Mar 27 9:41:31 PDT 2014

scannerside @mmahesh1 @TirathPatelMD yes communication is key #jacrThu Mar 27 9:41:32 PDT 2014

pfanderson @TirathPatelMD @Radsdoc82 @radhelper In libraries, public thinks desk assistant is the librarian. Bet many believe tech is the rad #jacrThu Mar 27 9:41:53 PDT 2014

radhelper @mmahesh1 #JACR will we have this discuss 5 or 10 years down the road with changes in technology? Thu Mar 27 9:41:54 PDT 2014

tirathpatelmd RT @Scannerside: @mmahesh1 @TirathPatelMD yes communication is key #jacrThu Mar 27 9:41:57 PDT 2014

ucradsafety @mmahesh1 @wilsonjoshm @CancerGeek #JACR T2: We've had great success with reporting mandate. First dictated, now auto-filled by eXposure. Thu Mar 27 9:41:58 PDT 2014

wilsonjoshm @mmahesh1 #JACR T2 agree that manufacturers have done a great job providing tools to reduce dose. unfortunately, not everyone uses all tools Thu Mar 27 9:42:03 PDT 2014

mmahesh1 @Scannerside @TirathPatelMD #JACR We also have to remember that there are lot of uncertainty inherent to radiation dose estimation Thu Mar 27 9:42:25 PDT 2014

ruthcarlosmd Get ready for T3: How do you know if your radiation dose is in the right range? Who is responsible for ensuring the correct dose? #jacrThu Mar 27 9:42:30 PDT 2014

littenberg @radhelper @mmahesh1 Yes. There are always risks and benefits! #JACRThu Mar 27 9:42:44 PDT 2014

scannerside @TirathPatelMD @Radsdoc82 @radhelper if they go to tech first thats fine they can be the face if necessary #jacrThu Mar 27 9:42:47 PDT 2014

tirathpatelmd @UCRadSafety @mmahesh1 @wilsonjoshm @CancerGeek Any changes in behavior by referrers as a consequence of new requirement? #JACRThu Mar 27 9:42:50 PDT 2014

kristinahoque RT @RadiologyBoy1: @CancerGeek @wilsonjoshm #JACR Excellent point about rads needing to be an integral part of the healthcare team. It's ab… Thu Mar 27 9:42:52 PDT 2014

pfanderson



Usually, when I've been having a scan, I see a tech, never see the rad, ask questions, told to ask my doc. "We're not allowed to" #jacrThu Mar 27 9:43:00 PDT 2014

wilsonjoshm @Scannerside @UCRadSafety @CancerGeek #JACR T2 tools like ACR dose index registry #DIR is a good early model Thu Mar 27 9:43:14 PDT 2014

tirathpatelmd @mmahesh1 @Scannerside Very true. #jacrThu Mar 27 9:43:15 PDT 2014

cancergeek T2: Tech & process are levers, but people make the real impact. Appropriate dose protocols, pt selection, exam, dialogue. People=story #jacrThu Mar 27 9:43:17 PDT 2014

mmahesh1 @wilsonjoshm #JACR this falls into the category of continuing education - knowing all the bells and whistles of technology is key Thu Mar 27 9:43:21 PDT 2014

tirathpatelmd RT @RadiologyBoy1: @CancerGeek @wilsonjoshm #JACR Excellent point about rads needing to be an integral part of the healthcare team. It's ab… Thu Mar 27 9:43:27 PDT 2014

natricer RT @ruthcarlosmd: Get ready for T3: How do you know if your radiation dose is in the right range? Who is responsible for ensuring the corre… Thu Mar 27 9:43:27 PDT 2014

cancergeek RT @ruthcarlosmd: Get ready for T3: How do you know if your radiation dose is in the right range? Who is responsible for ensuring the corre… Thu Mar 27 9:43:31 PDT 2014

scannerside @mmahesh1 yes kudos well deserved how about the media write about that #jacrThu Mar 27 9:43:36 PDT 2014

littenberg T3: This is a very scary issue to me. Who is checking the dosing numbers? #JACRThu Mar 27 9:43:49 PDT 2014

kristinahoque @radhelper @mmahesh1 #JACR topic is not something to revisit periodically but rather to continually reevaluate as tech rapidly changes Thu Mar 27 9:44:04 PDT 2014

ucradsafety @wilsonjoshm @mmahesh1 #JACR T2: Dose monitoring software also seems to be underutilized. Thu Mar 27 9:44:07 PDT 2014

mmahesh1 @CancerGeek #JACR #AAPM is doing an excellent job on publishing CT protocols across platforms-list is small but useful Thu Mar 27 9:44:11 PDT 2014

scannerside @radhelper @mmahesh1 hope not #jacr



Thu Mar 27 9:44:17 PDT 2014

tirathpatelmd RT @ruthcarlosmd: Get ready for T3: How do you know if your radiation dose is in the right range? Who is responsible for ensuring the corre… Thu Mar 27 9:44:35 PDT 2014

cancergeek T3: Begins w governance team. Leads to protocol development/mgmt. Review exam/daily/mo/yearly. Part of reviews for all in rad dept. #jacrThu Mar 27 9:44:45 PDT 2014

kristinahoque @Littenberg #JACR it is always the radiologist responsibility to check dose numbers- every time Thu Mar 27 9:45:03 PDT 2014

mmahesh1 @UCRadSafety @wilsonjoshm #JACR With regulatory requirements we see many players in this field - but standardization on dose is needed Thu Mar 27 9:45:06 PDT 2014

pfanderson RT @CancerGeek: T2: Tech & process are levers, but people make the real impact. Appropriate dose protocols, pt selection, exam, dialogue. P… Thu Mar 27 9:45:10 PDT 2014

scannerside @pfanderson i know its a productivity model but whoever you see should be educated properly on dose #jacrThu Mar 27 9:45:12 PDT 2014

wilsonjoshm @TirathPatelMD @UCRadSafety @mmahesh1 @CancerGeek #JACR T2 I'd expect Qs when referrings start seeing CTDIvol, DLP, etc in rad reports Thu Mar 27 9:45:21 PDT 2014

pfanderson RT @mmahesh1: @Scannerside @TirathPatelMD #JACR We also have to remember that there are lot of uncertainty inherent to radiation dose estim… Thu Mar 27 9:45:23 PDT 2014

tirathpatelmd RT @KristinaHoque: @radhelper @mmahesh1 #JACR topic is not something to revisit periodically but rather to continually reevaluate as tech r… Thu Mar 27 9:45:34 PDT 2014

radiologyboy1 RT @KristinaHoque: @radhelper @mmahesh1 #JACR topic is not something to revisit periodically but rather to continually reevaluate as tech r… Thu Mar 27 9:45:45 PDT 2014

scannerside @mmahesh1 @TirathPatelMD yes there always will be but our job to see through this and optimize dowe when possible #jacrThu Mar 27 9:45:59 PDT 2014

cancergeek T3: It is shared responsibility btw patients to tell proper info, techs to select right protocols, Rads to manage/verify. Team effort. #jacrThu Mar 27 9:46:14 PDT 2014

mmahesh1



@KristinaHoque @Littenberg #JACR - We are bringing this to our residents - radiation dose display - check out http://t.co/z97oN0lqSQThu Mar 27 9:46:40 PDT 2014

radiologyacr RT @CancerGeek: T3: It is shared responsibility btw patients to tell proper info, techs to select right protocols, Rads to manage/verify. T… Thu Mar 27 9:47:17 PDT 2014

pfanderson @Scannerside Not sure, but I suspect it's concern for how to ensure patient understands, & who's responsible if patient misunderstands #jacrThu Mar 27 9:47:19 PDT 2014

jpil T2: Ordering docs should take ownership of communicating risk/benefit of scans, but radiology can step into leadership/education role #jacrThu Mar 27 9:47:21 PDT 2014

mmahesh1 #JACR Check out online resource center #Radiationdose optimization in CT http://t.co/bOheGt6jatThu Mar 27 9:47:38 PDT 2014

cancergeek T3: If cover more than single facility, protocols same across network? Are people/process in place to manage/verify/iterate/change. #jacrThu Mar 27 9:47:40 PDT 2014

rlmorin02 @ruthcarlosmd #jacr T3 Participating in the Dose Index Registry addresses that . The responsibility should be a team - Rad,RT, Physicist Thu Mar 27 9:47:51 PDT 2014

littenberg T3: How good are we at keeping inside the specification limits? #JACRThu Mar 27 9:47:59 PDT 2014

wilsonjoshm #JACR T3: dose is right if minimum diagnostic image quality is achieved. pts come to rad for diagnosis, not radiation Thu Mar 27 9:48:17 PDT 2014

pfanderson @CancerGeek Patients may have memory issues resulting from illness/stress. Is there a tool to help them manage right info? #jacrThu Mar 27 9:48:34 PDT 2014

kristinahoque RT @mmahesh1: @KristinaHoque @Littenberg #JACR - We are bringing this to our residents - radiation dose display - check out http://t.co/z97…Thu Mar 27 9:48:36 PDT 2014

mmahesh1 @jpil #JACR I disagree - it is radiologists and medical physicists should take the ownership - even though it is not straightforward Thu Mar 27 9:48:37 PDT 2014

radiologyboy1 RT @mmahesh1: #JACR Check out online resource center #Radiationdoseoptimization in CT http://t.co/bOheGt6jatThu Mar 27 9:48:44 PDT 2014



tirathpatelmd @wilsonjoshm @UCRadSafety @mmahesh1 @CancerGeek I would 'expect' Qs too, but there's perception of "it's rads' problem." #TurfTheIssue #JACRThu Mar 27 9:48:53 PDT 2014

cancergeek T3: @Litenberg IME it comes to a governance issue. Is there a team in place making it a priority to manage routinely & follow up. #jacrThu Mar 27 9:49:05 PDT 2014

ucradsafety @jpil T2: No one better than radiologists to lead their institutions in dose optimization efforts. #JACRThu Mar 27 9:49:11 PDT 2014

natricer Have a good day. Thanks for letting me listen in #jacrThu Mar 27 9:49:15 PDT 2014

mmahesh1 @wilsonjoshm #JACR Agree - this is what we need to stress and convey to patients Thu Mar 27 9:49:21 PDT 2014

cancergeek @NatriceR you too. Always nice to see you. (virtually) #jacrThu Mar 27 9:49:37 PDT 2014

cancergeek RT @UCRadSafety: @jpil T2: No one better than radiologists to lead their institutions in dose optimization efforts. #JACRThu Mar 27 9:49:46 PDT 2014

mmahesh1 @NatriceR #JACR Thanks. Hope you visit #JACR website and http://t.co/bOheGt6jatThu Mar 27 9:49:55 PDT 2014

pfanderson Radiology Data Registries http://t.co/Fr9YbMIz7E Dose Index Registry http://t.co/gODqbd389j DIR https://t.co/bX3oOXvelf #jacrThu Mar 27 9:50:22 PDT 2014

tirathpatelmd RT @mmahesh1: #JACR Check out online resource center #Radiationdoseoptimization in CT http://t.co/bOheGt6jatThu Mar 27 9:50:33 PDT 2014

ucradsafety @mmahesh1 @jpil T2: Rads & physicists need to reach agreement on risks, dose metrics, before any meaningful communication can happen. #jacrThu Mar 27 9:50:39 PDT 2014

cancergeek T3: Governance team: RSO, Rads, physicist, tech, pt, admin, referring MD. Ensure all stakeholder represented to address all topics. #jacrThu Mar 27 9:50:48 PDT 2014

robertmackeymd Imaging gently and wisely is an easy and important way to improve #quality of patient care #radiology #JACRThu Mar 27 9:50:52 PDT 2014



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mmahesh1 @ruthcarlosmd #JACR - A team that includes Radiologists, Medical Physicists and Technologists need to examine imaging protocols Thu Mar 27 9:51:00 PDT 2014

kristinahoque RT @UCRadSafety: @jpil T2: No one better than radiologists to lead their institutions in dose optimization efforts. #JACRThu Mar 27 9:51:15 PDT 2014



#jacr transcript · littenberg #jacr greetings from vermont. i'm ben littenber. i'm not a...

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