Guest blog by Kalpana M. Kanal, PhD, Director of Diagnostic Physics Section and Associate Professor in the Department of Radiology at University of Washington
In a recent article, radiation dose was dramatically reduced when technical changes combined with radiation safety initiatives were implemented for adult and pediatric patients undergoing procedures in a cardiac catheterization lab. The air kerma was compared between the first year and the final year of the study. Radiation safety initiatives such as formation of a safety committee, dose reporting and fellow training were implemented into the practice along with technical changes such as reduced dose rates and removal of grid for smaller patients. Considering all procedures, the air kerma decreased by 61% which was significant. For pediatric patients in age range 10-17, the air kerma decreased by 74% which is important as these patients are at higher risk than adults.
This study is important as the patients undergoing cardiac catheterization procedures typically receive high doses and are also potentially repeat patients. This study demonstrated that increased provider awareness combined with radiation safety initiatives, education and technical changes does have an impact on reducing radiation dose.
Findings presented by researchers at the Radiological Society of North America’s RSNA 2009 event are shining new light on the importance of understanding cost effectiveness in CT scan use. In particular, I had the opportunity to design and perform a study that showed how the high negative predictive value of ECG-gated cardiac CT in low- to moderate-risk chest painpatients may allow an earlier yet safe discharge from an emergency department (ED) at a considerable cost savings.
For example, the standard of care for chest pain is an ECG, a blood test and a nuclear stress test – which keep a patient in the ED an estimated 30 hours and can cost as much as $8,000. A gated cardiac coronary CT angiogram (CCTA) done instead early during the ER visit could rule out coronary artery stenosis plus other causes of chest pain, resulting in the safe discharge of a patient in just five hours at a cost of about $4,000.
But it’s not just about finding ways to lower costs. By avoiding the nuclear test and doing a low dose CT, patients also reduce the total radiation dose – resulting in a safer overall procedure.
And this is just one example of the benefits that can be found in reexaminating some of the traditional approaches to diagnosis and medical imaging.