Radiation-based procedures are increasing in frequency with all the associated inherent risks. A new expert consensus document from the American College of Cardiology (ACC), Heart Rhythm Society, North American Society for Cardiovascular Imaging, Society for Cardiovascular Angiography and Interventions, Society for Cardiovascular Computed Tomography, in collaboration with Mended Hearts, was published on May 2, 2018. It is a 69 page document and can be found on the ACC website.

The document addresses the conundrum of selecting the optimal imaging technique for a given clinical circumstance while balancing the risk versus the benefits while still delivering a high quality diagnostic exam with minimal radiation exposure.

The included elements of the document are:

• How radiation can harm patients and occupationally-exposed medical personnel?

• The relationship between radiation dose, subject characteristics and the risk of harm from radiation.
• How x-ray fluoroscopy machines, x-ray CT machines and nuclear cardiology scanners work?
• Measures and determinants of radiation dose delivered to patients and medical personnel by medical radiation producing machines.
• How medical providers can minimize radiation exposure to patients and to themselves while obtaining optimal radiological images?
• Training requirements for the operation of radiation producing machines.
• Standards for quality assurance for cardiovascular procedures that involve radiation.

There are no specific regulatory rules that specify how much training a physician should have to participate in utilizing radiation exposure for diagnostic imaging. The new proposed standards from The Joint Commission, if adopted, will require proof of radiation safety training to operate fluoroscopy or CT in any Joint commission accredited facility.  In general, it is expected that any physician who operates or supervises the operation of radiological equipment should be able to operate it in a manner that achieves optimal image quality while minimizing radiation exposure to patients and to attendant medical personnel including themselves.

This additional CME will require documentation on initial training and any subsequent annual refresher or update. There is no specification of how the CME is obtained which leaves an online version as an acceptable alternative to the standard classroom lectures.