Imaging-caused radiation exposure begins to get attention it deserves

I recently heard a radiologist describe learning that a patient at his hospital, a woman in her early thirties, had received 30 abdominal CT scans, nearly one for every year of her life. She would go to the ER complaining of flank pain and receive a scan. Finding nothing, the doctors would send her home with pain medication. She was apparently seeking the pain meds.

Situations like this are not as unusual as we would like to think. Our system has failed to account for repeat scans that expose patients to ionizing radiation despite a consensus belief that cumulative radiation exposure increases the risk of cancer. That's changing quickly. An article in this issue ("Initiatives flag patients with excess imaging dose," page 9) describes national and local efforts to monitor cumulative medical imaging radiation exposure.

In addition, the National Conference on Radiation Protection and Measurements meeting held in April focused a harsh light on imaging-caused radiation exposure and featured presentations from some highly respected radiologists. We covered the conference extensively and posted articles from it on our website, DiagnosticImaging.com.

Two headlines from our coverage were at once striking and frightening: "CT-based radiation exposure in U.S. population soars" headed an article describing a 650% gain in collective annual dose over a 26-year period ending in 2006. The article "U.S. physicians remain oblivious to radiation exposure risks" noted, among other things, a survey finding that only 9% of referring physicians believed that there was an increased risk of cancer from CT.

Other articles addressed dose concerns in pediatrics, pregnancy, and intervention and safety in fusion imaging.

Going into the conference, the betting line was that at least some of the news would be bad and get a lot of attention in the general news media.

Thus, it was not surprising that before the meeting the ACR released a white paper outlining potential changes in the way radiology approaches radiation exposure. The most dramatic among them was one calling for steps to track the cumulative radiation exposure patients receive from medical imaging scans.

Another preconference white paper, this one from the Medical Imaging and Technology Alliance, a vendor association, emphasized the positive benefits of medical imaging and highlighted innovations that have reduced dose exposures during the last two decades.

As it turns out, the conference proceedings were largely ignored by the national media, probably because the most significant findings were released on April 16, the day of the tragic shootings at the Virginia Tech campus. The news of that event eclipsed nearly everything else for the duration of the week.

But a lack of media coverage does not minimize the importance of what has happened here: Radiology's major political organization, the ACR, is looking at major shifts in the way it views radiation exposure; a vendor group has focused on technological efforts to limit medical imaging radiation exposure; and a national forum with a series of prominent radiologists has focused attention on medical imaging radiation exposure questions.

Our special e-mail news blast highlighting developments at the conference drew an exceptional response from readers, with the articles generating some of the highest draws to the DiagnosticImaging.com web page that month.

Medical imaging radiation exposure, long a major concern in Europe, has been a simmering issue in the U.S. for some time now. The NCRP's April meeting, the ACR and vendor initiatives, and efforts like the ones described in this issue show that radiation dose control in medical imaging is hitting its stride. It's a welcome development that will be good for radiology and the patients it serves.