Health Imaging & IT - April 2008 - (Page 13)

adiation dose awareness in imaging studies started a long time before the New England Journal of Medicine (NEJM) published an article last November warning that the overuse of diagnostic CT scans may cause as many as 3 million additional cancers in the United States during the next two to three decades. That’s a risk the radiology community has been well aware of for a long time. But the NEJM article revived the quest to control dose for patients and clinicians. The challenge now is expanding that awareness to the rest of the medical community. “The traditional approach to diagnostic testing can be characterized as ‘leave no stone unturned’ to achieve the most certain diagnosis possible,” says David A. Schauer, ScD, CHP, executive director of the National Council on Radiation Protection and Measurements. “Under this philosophy, as long as an imaging examination has any chance at all of demonstrating a diagnosis suggested by the clinical clues, then its use is considered reasonable.” That approach doesn’t take into consideration the impact that any radiation involved in treatment would have on the patient, he points out. “It is clear that breaking this habit and beginning to link selection of patient for imaging examination to likelihood of effect on treatment choice or on patient outcome can help to reduce the economic problems resulting from imaging uses which now adversely affect healthcare costs and to reduce unnecessary radiation exposure of the patient.” The Alliance for Radiation Safety in Pediatric Imaging launched its new Image Gently campaign in January, with the goal of raising awareness of the opportunities to lower radiation dose when imaging children. At least 600 practices have already signed on and pledge to practice in accordance with the campaign’s recommendation. The medical community has been extremely receptive, says Donald Frush, MD, chair of the American College of Radiology (ACR) Pediatric Imaging Commission. “This was not taken on as a scare campaign or adversarial campaign,” he says. “It was always based fundamentally on getting information out to practices, organizations and individuals.” Essentially, the campaign is trying to do everything that the NEJM article did not, he says. That includes spreading the word that “CT is really helpful, it saves lives and there are ways to do it appropriately.” Frush says there has been a growing interest over the past six or seven years to look at radiology’s effects specifically in children and young adults. Some of the cancers that the NEJM article predicted are related to radiation. Since they can take 30 years to develop, excessive exposure to radiation is especially important when imaging children. A two-year-old, for example, has a much higher chance of a 75-year-old of developing one of these cancers. Plus, children are more radiosensitive because their tissues Healthimaging.com R and organs are still dividing and growing. “That kind of tissue has more of a chance of having effects from radiation than tissue simply repairing itself like an adult’s,” he explains. Radiologists who specialize in pediatric radiology understand the need to image children differently, says Priscilla F. Butler, MS, senior director, Breast Imaging Accreditation Programs for the ACR, who also was involved in the Image Gently campaign. Most pediatric imaging in the United States, however, is done at community hospitals that probably don’t have a pediatric radiology specialty. “The whole purpose of the initiative was to raise awareness among the radiologists who don’t do as many pediatric patients.” “The traditional approach to diagnostic testing can be characterized as ‘leave no stone unturned’ to achieve the most certain diagnosis possible.” david a. schauer, scd, CHP, Executive director, national Council on radiation Protection and Measurements The campaign has enjoyed “extremely positive feedback,” she says. “Techs feel empowered to bring issues to radiologists. This has been a joint effort among the different players in the radiology department—technologists, radiologists and medical physicists.” Based on the positive response, the ACR is working on an educational campaign for referring physicians and patients and families. “We have to be careful,” she says. “We don’t want to scare people off from having important, lifesaving exams. But, we’re dealing with medicine. With everything we do, there is some risk.” Many opportunities It’s hard to determine how much effort is enough, Frush says, but “there is a lot of work that can be done on all fronts,” including academia, equipment manufacturers, private practice, physicists and the media. “There are a great many opportunities to get information to people about how to [image] better. Many manufacturers are very sensitive to this issue and want to behave and practice as advocates for patients.” Frush notes that over the past several years, “there has been a tremendous reception on many [CT system] manufacturers’ part to make both image quality and dose part of their marketing. I applaud them for that.” Vendors have been working with individual institutions on new software, procedures and equipment design to minimize radiation dose, says Butler. The development in CT has been amazing, she says. “Not all that long ago, there wasn’t a way to april 2008 | Health Imaging & IT 13 http://Healthimaging.com

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Health Imaging & IT - April 2008 Contents On the Web The Enterprise News Update Cracking Down: CT Radiation Dose 3D Rendering: Options Galore Thinking Thin-Client Modality Review Ergonomics & Design Special Section: Storage Strategies Imaging Tools Technology Outlook People & Technology Technology Review IT Trends Reader's Resource Stat Sheet

Health Imaging & IT - April 2008

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