Over the last 10 to 15 years, awareness of the risks of radiation exposure in medical imaging and efforts to reduce dose have escalated exponentially. Imaging equipment vendors have answered the call with dose-reducing strategies that include more sensitive image receptors, better image reconstruction techniques, dose alerts and post-processing software. Radiologists, technologists and physicists have been hard at work as well, edging down dose without compromising image quality. So where do we stand? Are we as low as we can go or is there more that can be done?
Leading by Example
The department of radiology at VCU Health in Richmond, Va., takes great pride in its efforts to improve patient radiation safety. The health system launched its Clinical Radiation Safety Initiative in 2012 and now has a Clinical Radiation Safety Office dedicated to creating “best practices for the use of ionizing radiation in an academic medical center.” As part of this commitment, VCU Health empowered two technologists with more than 60 years of combined clinical experience—Shelia Regan, BS, and Jan G. Clark, MEd—naming them the office’s clinical radiation safety educators. Regan and Clark monitor dose information within their department closely, spread the word at various industry conferences and provide special hands-on training for radiologists and technologists. They also developed an app that helps them look for “coaching opportunities” and praise employees who stand out for following safety guidelines and protocols.
“The fact that we have this clinical radiation safety office puts us ahead of the game nationally,” Regan says. “We’re excited to be at the forefront of what’s coming up for clinical radiation safety. Our entire enterprise goal for VCU Health is to be the safest hospital in the nation, so radiation safety fits right into that overall philosophy.”
VCU Health’s department-wide buy-in is evident with employees always on the look for a new way to reduce radiation dose. For example, one recent policy change reduced the number of pulses per second on the facility’s fluoroscopy systems from 15 to 10. It began with one radiologist, who made the shift and then closely examined the diagnostic quality of each image. When it was confirmed there was no drop in image quality, the department’s interventional radiologists all embraced the new parameter, reducing radiation dose by 33 percent for each patient. Regan and Clark monitored this shift in protocol, comparing data before and after the change was made in December 2016. The number of system alerts for breached radiation thresholds was 15 in September 2016 and 14 in October 2016, dropping to just six in January 2017 and eight in February 2017. Clark says her team “could clearly see that there was a reduction in patient exposure due to this physician-driven change.”
Though the Clinical Radiation Safety Office is still relatively new, its reputation has spread quickly. A neighboring health system recently sent an entire team—including administrators, a physicist and an IT specialist—to VCU Health for guidance on improving and maintaining radiation safety practices. Regan and Clark enjoy these opportunities to help other providers and see the efforts as a big victory for patients.
A Change in the Culture
Specialists throughout the country are committed to the same goals as well, using a number of different techniques and strategies to lower dose at their own facilities.
“The culture change in the United States regarding the amount of radiation use in a CT scan has been very significant and very noticeable,” says Richard L. Morin, PhD, Brooks-Hollern Professor in the department of diagnostic radiology at the Mayo Clinic in Jacksonville, Fla. “There are now practices where the radiologists know exactly what their dose index is for a variety of exams.”
Statistics show the culture change is making a difference. In a recent JAMA Internal Medicine study, for example, the authors found that after reviewing best practices at five University of California medical centers, “the number of CT scans that had an effective dose measurement that exceeded benchmarks was reduced considerably by 48 percent and 54 percent for chest and abdomen, respectively.” Also, the mean effective dose for abdominal CT decreased from 20 to 15 mSv, a reduction of 25 percent (JAMA Intern Med. 2017 Apr 10).
A 2010 article from the Journal of Cardiovascular Computed Tomography provides additional evidence