This comprehensive article demonstrates the importance of CT dose monitoring and utilizing strategies to achieve ALARA (as low as reasonably achievable) doses while maintaining image quality for optimal clinical diagnosis. The authors also describe how the use of technology can improve the radiation dose efficiency of CT scanners.
Standardizing dose description parameters and metrics is an ongoing and very active area in ACR and nationwide. This will be a big help to comparing metrics between institutions and over time. The SSDE (Size Specific Dose Estimate) is a good step in that direction.
But this article also points out the large impact of exam appropriateness on dose. It is an impressive fact that a profound way to lower population dose is to avoid doing inappropriate exams. Tools such as the ACR Appropriateness Criteria or Computerized Decision Support at the point of order entry can empower appropriateness review. And every radiologist needs to increase their awareness of exam appropriateness in daily work.
It is often said that radiation from diagnostic imaging is not an important issue in cancer patients.
But this report suggests otherwise – as expressed by oncologists.
Many patients with cancer are young and/or are being treated for cure. Many have long life expectancies despite having cancer.
And the basic principal of “Do no harm” plus that of ALARA still apply – as much to cancer patients as to any other patient with a serious disease.
So we should be striving for maximal diagnostic information from minimal radiation dose with CT and other modalities in cancer patients, too.
This direction of combining a higher noise index (NI) to get lower dose images and then correcting for the resultant noise by using an increased percent of iterative reconstruction (ASIR) is exactly the way to go when striving towards “as low as reasonably achievable” (ALARA) – in my opinion.
At UWMC, we have for a couple of years now gone even further – we use NI in the 30-36 range and routine 70 percent ASIR as a standard for all our CT imaging except high resolution lung (which is NI 25 and ASIR 30%). According to the ACR CT Dose Registry, we are in the bottom 10% of their data base for CT dose….. but the images are very good.
Check out this article to learn more.
A few weeks ago, the New York Times featured an article, “Medical Radiation Soars, With Risks Often Overlooked.” The article brought up some valid points about radiation, but also requires readers to take a step back when processing some of the information given.
Yes, as the article ascertains, radiation has its indisputable medical advantages, in addition to its potential medical downsides. The amount of medical imaging, including CT scans, has significantly increased over the last few decades, as more life-saving procedures are discovered and as technology develops. As a result, some patients are subjected to higher levels of radiation, which, according to this article, is “believed to account or 1.5 percent of cancers” in the United States.
The piece goes on to say that “the cancer-causing effects of radiation are cumulative” and that doctors and hospitals fail to track the amount of radiation patients have already been exposed to when ordering a new exam. While it is critical to practice “As Low As Reasonably Achievable” (ALARA) for every protocol and to closely scrutinize every exam request for appropriateness, there is absolutely no evidence that risk from well spaced CT exams is cumulative. Therefore, canceling an otherwise appropriate exam because of cumulative dose may not be in the patient’s best interests. For all CT exams a risk/benefit evaluation should be made by a well informed radiologist. For the existence of multiple prior exams alone to change the risk/ benefit ratio would be extremely rare.
Additionally, the claim that “no one” keeps track of how much radiation patients have been exposed to is inaccurate. A number of institutions, including UW, are a part of the American College of Radiology’s Dose Index Registry, a program striving to accurately track CT radiation dose in order to establish benchmarks, monitor patient radiation dose exposure, and compare patterns. More recently, a pediatric dose registry was introduced to perform similar functions, but for a younger demographic.
Both doctors and patients should be as informed as possible when it comes to radiation. Understanding the risk/ benefit ratio is an important part of this—and no appropriate medical imaging exam should be cancelled if it will benefit the patient, especially if its radiation level is ALARA.