CPI Literature Review

LITERATURE REVIEW

2.1 INTRODUCTION

This review provides an overview, update and critical appraisal with regard to the literature of over-utilisation of diagnostic imaging examinations employing ionizing radiation. Clearly, there is an impact from such over-utilisation on both the health system and patients, thus in order to conduct this research it is both germane and critical to comprehensively review the available work. Not only are there risks associated with exposure to medical radiation, such as developing cancer, altering the function of organs, causing genetic mutation and many other effects, there is also an impact on workflows, resulting in the reduced efficiency of MRSs due to unnecessary examinations. Ultimately, there is an impact

CPI is a widespread and powerful tool for quality improvement in health care. Its principles and applications in health care are discussed. However, there was a major gap found with regard to the use of CPI in the context of imaging. Very few publications were found on the over-utilisation of imaging, though there was fairly substantial work in other areas, such as pathology. The literature review was vital in terms of defining and characterising the extent and nature of the problem, and the important connection between itself and the current

The biological effects of low levels of radiation have been investigated and debated for more than a century. The risk of cancer induced by radiation is the primary consideration of biological effects associated with diagnostic radiography procedures

Ionising radiation has the potential to disrupt the structure of organic molecules in cells (Tubiana et al., 1990). Little question exists that intermediate and high doses of ionising radiation produce deleterious consequences in humans, including, but not exclusively, cancer (Pollycove & Feinendegen, 1999; Dickson et al., 2005). It is universally accepted that there is no safe level of radiation and even a single low dose exposure carries an associated risk and this risk increases with the dose received (Berrington de Gonzales and Darby, 2004).

Historically, the pioneer studies were essentially incidence reports resulting from medical radiation, such as the establishment of the direct relationship between x-ray exposure and some of harmful consequences (Thomson, 1898; Rollins, 1901). There were reported deaths of several x-ray pioneers, including that of radiologist Ironside whose death was attributed to x-ray exposure (Leonard, 1907; Thomas, 1995). It is likely that both Marie Curie and her daughter died as a result of x-ray exposure from the mobile radiographic units (Coppes-Zantinga