Radiation Dose In Medicine Research Articles

ACR White Paper–Based Comprehensive Dose Reduction Initiative Is Associated With a Reversal of the Upward Trend in Radiation Dose for Chest CT

PurposeIn 2010, the authors’ department implemented a comprehensive dose reduction strategy based on the ACR white paper on radiation dose in medicine. The aim of this study was to evaluate the effectiveness of the dose reduction program. MethodsIn total, 1,234 adult chest CT scans from 2007 to 2012 were analyzed retrospectively, with institutional review board approval and a waiver of the requirement for informed consent. The primary outcome was effective dose in millisieverts during the three-year periods before (2007-2009) and after (2010-2012) dose reduction implementation. Dose trends were analyzed by fitted linear modeling. The use and effects on total exposure of dose reduction strategies (high pitch, adaptive statistical iterative reconstruction [ASIR], and low tube voltage) were analyzed. ResultsThe overall mean dose for chest CT was 7.3 ± 5.1 mSv. The mean dose decreased by 30%, from 9.2 mSv (2007-2009) to 6.5 mSv (2010-2012) (P < .001). From 2007 to 2009, the mean dose increased by 1.2 mSv per year (P < .01). From 2010 to 2012, the mean dose decreased by 1.1 mSv per year (P < 0.01). High-pitch technique, ASIR, and low tube voltage increased significantly after dose reduction implementation. High pitch and ASIR were significantly associated with a reduced dose, whereas the effect of reduced voltage was not significant. ConclusionsReductions in radiation exposure from medical imaging rely on ongoing technical developments and consistent, vigilant use of dose reduction strategies. This comprehensive dose reduction strategy significantly reduced radiation exposure from chest CT. Annual increases in radiation dose reversed after the strategy was implemented and continued to decline over the study period.

Availability of Prior Imaging Studies

AJR 2012; 199:W530 0361–803X/12/1994–W530 © American Roentgen Ray Society Availability of Prior Imaging Studies In James Brink’s ARRS presidential address [1], one thing particularly struck me. He quoted Clyde Stevenson [2], a fellow Washington radiologist and president of the ARRS. As Dr. Brink noted, Dr. Stevenson stated, “The need for solid clinical information coupled with high-quality images and access to prior imaging studies is critical to our success.” Dr. Brink addresses the importance of clinical information and high-quality images but does not pursue the last point, about which Dr. Stevenson was most passionate. Dr. Stevenson’s 1966 speech continued, “All of us could flood the literature with instances in which lack of previous roentgenograms for review and comparison led to delay, increased cost, erroneous diagnosis, harm, and even death of the patient. An intense educational program is overdue” [2]. In 2011, we are still waiting for that intense educational program. How often have we heard the hospitalist say, “We can’t find the CD, so we’ll just have to repeat the scan?” How often have we recommended follow-up CT of a pulmonary nodule without knowing that a prior outside CT of the chest or abdomen identified the same nodule? Do we really expect an internist to realize that a CT of the kidneys, ureters, and bladder performed down the street 2 years ago should be requested? Another Washington radiologist, Norm Beauchamp, did mention the cost of repeat medical imaging in the emergency department in a recent Masters of Radiology panel discussion [3], but, in general, I find the radiology community strangely silent on this topic. The American College of Radiology white paper, “Radiation Dose in Medicine” [4] barely refers to the need for access to prior studies. Does it seem logical that we require patients to request their prior mammograms, but we don’t ask about a prior chest CT? We are undertaking huge efforts to decrease the dose of an individual CT, which is admirable. Now it is time to address exposure from repeat examinations and unnecessary follow-up. How can each practice optimize the chance that outside images are available to the interpreting radiologist? How can we leverage our ability to share digital images to create a single imaging record for our highly mobile patients? Is not that what “meaningful use” in radiology should look like? I encourage radiologists to “flood the literature” and lead the charge to optimize the availability of prior images by improving institutional processes, championing meaningful use initiatives, and working with third-party vendors. It is yet another way all of us can become clinically exceptional and fully engaged. Dawna J. Kramer Virginia Mason Medical Center, Seattle, WA DOI:10.2214/AJR.12.8875 WEB—This is a Web exclusive article.

Falling prey to the sunk cost bias: a potential harm of patient radiation dose histories.

Although patient dose histories will make valuable contributions to quality improvement and research initiatives, care must be taken to avoid misuse by physicians when making imaging decisions for individual patients.

CT Radiation Dose: Trending in the Right Direction

Better definition of the cancer risk on the basis of patient age and clinical condition at exposure are just two small parts of the overall radiation risk equation.

ACR White Paper on Radiation Dose in Medicine: Three Years Later

The benefits of diagnostic imaging are immense and have revolutionized the practice of medicine. The increased sophistication and clinical efficacy of imaging have resulted in its dramatic growth over the past quarter century. However, the evolution of imaging has also resulted in a significant increase in the population's cumulative exposure to ionizing radiation and a potential increase in cancer risk. The ACR, an advocate for radiation safety since its inception in 1924, convened the ACR Blue Ribbon Panel on Radiation Dose in Medicine in 2006 and issued 37 recommendations for the College to address these issues. This report updates the status of these recommendations.

Incorporating Radiation Dose Assessments Into the ACR Appropriateness Criteria®

In 2006, the ACR convened a group of radiologists, medical physicists, industry and regulatory agency representatives, and a patient advocate to address issues related to the risks of radiation exposure in medical imaging. This group, the Blue Ribbon Panel on Radiation Dose in Medicine, developed a series of recommendations aimed at optimizing radiologic image quality and radiation dose and preventing the inappropriate use of procedures involving ionizing radiation [ 1 Amis Jr, E.S. Butler P.F. Applegate K.E. et al. American College of Radiology white paper on radiation dose in medicine. J Am Coll Radiol. 2007; 4: 272-284 Abstract Full Text Full Text PDF PubMed Scopus (699) Google Scholar ]. Several of their recommendations relate to educating referring physicians about radiation exposure risk. One recommendation in particular calls for the incorporation of radiation dose information into the ACR Appropriateness Criteria, a guide for the selection of proper imaging procedures for particular medical conditions. In response to this recommendation, relative radiation level (RRL) designations were added to the Appropriateness Criteria in September 2007. These designations indicate which imaging procedures expose patients to radiation and the relative magnitude of that exposure. By adding RRL designations, referring physicians using the Appropriateness Criteria will not only be advised of the appropriate imaging procedure for medical conditions but will also be steered toward procedures that minimize radiation dose to their patients.

American College of Radiology White Paper on Radiation Dose in Medicine

American College of Radiology White Paper on Radiation Dose in Medicine

The American College of Radiology white paper on radiation dose in medicine:deep impact on the practice of cardiovascular imaging.

In April 2007, the American College of Radiology released the "White Paper on Radiation Dose in Medicine". The Blue Ribbon panel members included private practice and academic diagnostic radiologists, medical physicists, representatives of industry and regulatory groups, and a patient advocate. The panel concluded that the expanding use of imaging modalities using ionizing radiations such as CT and nuclear medicine may result in an increased incidence of radiation-related cancer in the exposed population in the not-too-distant future, and this problem can likely be minimized by preventing the inappropriate use of such imaging and by optimizing studies that are performed to obtain the best image quality with the lowest radiation dose. The White Paper set forth practical suggestions to minimize radiation risk, including education for all stakeholders in the principles of radiation safety and preferential use of alternative (non-ionizing) imaging techniques, such as MRI and ultrasound. These recommendations are especially relevant for cardiologists, who prescribe and/or practice medical imaging examinations accounting for at least 50% of the total effective dose by radiation medicine, which amounts to an equivalent of about 160 chest x-rays per head per year in US. Were they be enacted, these simple recommendations would determine a revolution in the contemporary way of teaching, learning and practising cardiology.

The American College of Radiology white paper on radiation dose in medicine: deep impact on the practice of cardiovascular imaging

The American College of Radiology white paper on radiation dose in medicine: deep impact on the practice of cardiovascular imaging

American College of Radiology White Paper on Radiation Dose in Medicine

The benefits of diagnostic imaging are immense and have revolutionized the practice of medicine. The increased sophistication and clinical efficacy of imaging have resulted in its dramatic growth over the past quarter century. Although data derived from the atomic bomb survivors in Japan and other events suggest that the expanding use of imaging modalities using ionizing radiation may eventually result in an increased incidence of cancer in the exposed population, this problem can likely be minimized by preventing the inappropriate use of such imaging and by optimizing studies that are performed to obtain the best image quality with the lowest radiation dose. The ACR, which has been an advocate for radiation safety since its inception in 1924, convened the ACR Blue Ribbon Panel on Radiation Dose in Medicine to address these issues. This white paper details a proposed action plan for the college derived from the deliberations of that panel.