New Hampshire radiologist champions radiation exposure flagging system

When radiologist Dr. Steven Birnbaum rushed to the hospital after learning his daughter had been hit by a car, he probably expected her to get a CT scan. What he did not anticipate was seeing her undergo one too many. The experience spurred his efforts to identify and monitor patients who may have been overexposed to radiation from CT scans.

Birnbaum became, in his own words, a zealot. Ever since, he has been keen on educating clinicians and radiologists about radiation dose and the potential effects of overexposure. His efforts led the New Hampshire Radiologic Society to implement a system that alerts physicians when an individual patient has been frequently exposed. Local insurers now include CT radiation safety as part of their payment policies.

Birnbaum, who is the radiology safety officer for two community hospitals in New Hampshire, tells the story that sparked the initiative in an editorial published in the May 12 issue of the British Medical Journal.

The radiologist had already taken action to curb radiation overexposure at the institutions he oversees. But he admits that seeing his own daughter on the receiving end brought home the potentially damaging consequences from unnecessary tests.

The 23-year-old woman had sustained serious but not life-threatening injuries, including a skull fracture, concussion, pubic rami fractures, and left-knee injury. She had undergone CT scans of the head and cervical spine, chest and abdomen, and a brain arteriogram, which Birnbaum deemed appropriate.

The next day, another abdominal CT scan was ordered after a failed intravenous blood test. Then the radiology resident decided on a set of delayed-enhancement pelvic scans after the previous test showed a small amount of blood in the cul-de-sac. And it didn't stop there. The patient's attending physician wanted a third set of pelvic images.

"I was horrified. I asked the surgical chief resident if any thought had been given to radiation exposure in patients when doctors ordered CT studies. When she said that there was at the adjacent children's hospital but not here, I replied, 'If Molly gives birth to a salamander, I know who I am coming after,'" Birnbaum wrote in the BMJ.

Birnbaum credits CT as key in providing the right management for his daughter. But he insists that physicians weigh more carefully the risks and benefits attached to the procedure.

"Many doctors, including radiologists, have limited knowledge of the doses and of the potential consequences of the massive increases in diagnostic medical radiation exposure," he said.

Editor's note: Look for more on efforts to control cumulative imaging-based radiation dose in the Overread section of the June Diagnostic Imaging.

For more information from the Diagnostic Imaging archives:

New CT technologies can reduce radiation dose, untenable fears

Panel recommends major changes in ACR policy governing patient radiation exposure

CT-based radiation exposure in U.S. population soars