An amazing accomplishment—CT manufacturers deserve our thanks

Abstract

In the latter half of the 1990s, CT technical advancements proceeded at an extremely rapid pace. The emphasis was on producing exquisite CT image quality and the ability to try these new techniques for, it seemed, almost any indication. The highly sophisticated technology was complex and understood by few of its users. And, as well, proponents for significant CT radiation safety with lower doses for children were few. Then, in 2001,USAToday [1] reported on three articles that had appeared in the February issue of AJR [2–4]. The gist of the newspaper article, as reported (incorrectly), was that CT scans will result in fatal cancer in children. The public outcry was remarkable and caught pediatric radiologists off-guard. In an editorial, Slovis and Berdon [5] stated that “The technology is unequivocally running the physicians” and that it is clear radiologists do not know all the answers to dose reduction. The Society for Pediatric Radiology presented the first ALARA (as low as reasonably achievable radiation dose) conference in August 2001, published in April 2002 [6]. The course was made possible by the sponsorship of GE Medical Systems and William Radaj, GE’s marketing director for CT. In addition, GE Medical Systems announced that proceeds from the meeting would be added to a special allocation of US $25,000 for the SPR Research and Education Foundation to award as grants for studies in radiation dose reduction in children [7]. What is obvious today was not so apparent then—that the radiation dose you end up with depends to a certain extent on how the equipment is designed and built [8]. As an example, the concept of auto exposure control was discussed [8]. However, the prevailing value was on the full measure of image quality and this was the primary consideration when purchasing a CT scanner. By the SPR meeting of 2002, other manufacturers had joined GE—Philips Medical Systems, Siemens Medical Solutions and Toshiba America Medical Systems—in a daylong seminar on radiation dose reduction. In an editorial accompanying the publication of the seminar, Berdon and Slovis [9] said “The manufacturers have made ‘low dose’ a priority. The next generation of CT (hopefully with ‘free’ upgrades to current CT) will make it harder to give adult doses to children.” From these quite modest beginnings, the melding of expertise of medical physicists (American Association of Physicists in Medicine), radiologic technologists (American Association of Radiologic Technologists), radiologists, regulatory and federal agencies and other organizations (such as the National Cancer Institute, the U.S. Food and Drug Administration and the NCRP) and the manufacturers have since produced substantive results. Five ALARA conferences on various aspects of dose reduction followed from 2003 to 2011 [10–14]. The formation of the Alliance for Radiation Safety in Pediatric Radiology (2008), with its 73+ member organizations and representation of more than 800,000 medical professionals worldwide, dramatically increased the visibility of this project. This group formed the Image Gently campaign and vendor summits in 2008 [15] and 2010 [16], and participated in the 2009 FDA conference, “Initiative to Reduce Unnecessary Radiation Exposure T. L. Slovis (*) Department of Diagnostic Imaging, Children’s Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd., Detroit, MI 48201, USA e-mail: tslovis@med.wayne.edu