Awareness can be a powerful tool. When 50 centers performing coronary CTA compared protocols, they found that some were exposing patients to 10 times the radiation dose others were. Dramatically reducing dose to bring centers to the lowest level of exposure required no extraordinary efforts, not the purchase of new equipment or hiring of experts. It required simply getting facilities to use the dose-reduction tools already at their disposal.
Siemens Healthcare wants to see if the same can be done for the general CT community. At the International Society of Computed Tomography symposium in May, Siemens held a meeting of community leaders to discuss how education—and peer pressure—might be leveraged to broaden the adoption of dose-saving technologies, many of which are readily available yet not being used.
The meeting of experts was the first step in a long-term initiative hatched by Siemens, called SIERRA (Siemens Radiation Reduction Alliance). Its end goal is to reduce dose for all typical examinations performed on Siemens CT scanners to less than 3 mSv.
“We want to get below the threshold of natural radiation exposure,” said André Hartung, vice president of CT marketing and sales at Siemens Healthcare.
The company hopes to achieve this goal through educating its customers in the use of existing equipment while coming up with new technologies and carrying out further R&D to cut dose even more in the future.
Siemens recruited panel members from among its collaborators. The panel was charged to come up with a strategy for how the company might convince practicing radiologists, and particularly its customer base, to use dose-saving techniques.
“We have made great advances in optimizing pediatric radiation doses, but dose reduction optimization (for the rest of the patient population) remains a work-in-progress,” said Dr. Marilyn Siegel, panel member and a professor of radiology at the Mallinckrodt Institute of Radiology.
Each of the 14 panel members is already working with Siemens on the refinement, development, or implementation of technologies to reduce dose at their institutions. Bringing them together held the promise that these multiple approaches might be joined into a unified and complementary strategy for practicing radiologists, one that would then be supported by this network of dose-reduction experts. This initial meeting generated a list of action items to pursue:
• Develop an international, multi-institutional dose registry that establishes a baseline of dose levels for the 10 most commonly performed CT exams; the values can help to establish reference doses and hold the potential to dramatically lower radiation exposure in clinical practice.
• Share CT scan protocols for the 10 most commonly performed examinations on a central website as a first step in promoting best practices in the field.
• Develop a dedicated low-dose education program through Siemens and in close collaboration with leading institutions, providing trainers specialized in dose-reduction technology to work with customers to educate providers, optimize scan protocols, and implement dose-reduction
procedures.
As well as the ethical imperative of reducing dose is the economic advantage that might be derived from efforts to bring down patient exposure to the minimum needed to produce a diagnostic result.
“Due to the extensive media coverage, there is a great opportunity to really make this topic (lowering patient radiation dose) a clear differentiator for our customers,” said Stefan Ulzheimer, Ph.D., Siemens’ director of scientific marketing.
The means for achieving substantial decreases are already at hand and more technologies are in the offing. Siemens' X-Care, for example, allows organ-sensitive dose modulation while the company’s iterative reconstruction in image space (IRIS) algorithm steps in for the conventional filtered back projection algorithms to eliminate noise from images and thereby reduce the dose needed to acquire data. Iterative reconstruction techniques will play a major role in the future, Hartung said, but radiologists don't have to wait.
“Iterative reconstruction we believe is an element—an important element—but there are so many other tools that already bring the dose down by a good amount,” he said. “We should make sure that these are being used in the right way, and we believe that as a vendor it is our responsibility to educate and make sure that everybody is aware that this can be done now.”
