A blue ribbon panel has recommended sweeping changes for the American College of Radiology’s policies governing the tracking and physician management of radiation exposure.
A blue ribbon panel has recommended sweeping changes for the American College of Radiology's policies governing the tracking and physician management of radiation exposure.
Publication of the panel's 33 recommendations was timed to coincide with the announcement of revelations concerning the U.S. public's growing exposure to radiation from medical imaging. The panel, headed by Dr. Steven Amis, chair of radiology at Albert Einstein College of Medicine, proposed strategies to halt unnecessary growth in exposure.
The ACR proposal supports a standardized method for archiving individual patient radiation data documenting exposure during medical imaging. The information would be used to benchmark good medical practices and to identify patients who have accumulated high levels of radiation from frequent imaging sessions involving exposure to ionizing radiation. The information may be used to determine when alternative imaging should be recommended, the ACR said in a release.
Recommendations in the ACR White Paper on Radiation Dose in Medicine reflect findings announced this week at the annual meeting of the National Council on Radiation Protection and Measurement in Washington, DC. Speaking at the conference Monday morning, Dr. Fred A. Mettler Jr. estimated that U.S. residents will be exposed in 2007 to five times more radiation from medical imaging than from all natural sources. Mettler is professor emeritus of nuclear medicine at the University of New Mexico in Albuquerque.
The rapidly growing popularity of multislice CT is a primary source of the growth in medical radiation exposure, he said. He noted that CT utilization in the U.S. has grown from three million scans in 1980 to 60 million procedures in 2005, when one scan was performed for every five U.S. residents.
If adopted, the ACR panel's recommendations would represent a major change in the college's policy concerning the need to track the accumulation of medical imaging radiation exposure for individual patients. The report directs advice to radiologists, referring physicians, physicists, manufacturers, insurers, and government regulators. It encourages administrative practices that track radiation doses and emphasizes the need for action when the exposure to an individual patient exceeds certain radiation thresholds, Amis said.
"One of the recommendations is that there be standardization of information available for all imaging modalities that use ionizing radiation, particularly CT, where the exposure factors would be embedded in the patient information, so you would at least have an idea about what dose the patient has received externally," Amis said in an interview.
Another recommendation asks the ACR to encourage third-party payers to identify patients who have had frequent imaging exams involving ionizing radiation and to alert their physicians about the situation.
"If an insurer has authorized 10 CT exams for Mrs. Jones in the past year, you've got a clear idea that she is getting heavily radiated," Amis said. "If payers had the right mechanism in place, they could call the doctor who is ordering all these tests to ask if they are all needed."
A standardized report system could document the actual range of exposure patients receive for specific procedures. Benchmarks could then be set to establish recommended practices for radiologist performance, Amis said.
Measuring the radiation exposure will be difficult because of variations in the standards for calibrating dosage and differences in equipment performance for measuring exposure.
"We can fairly easily generate the parameters for what generates the beam, but what the effect will be to the patient's liver, pancreas, or spleen is very difficult to estimate," he said.
The Medical Imaging & Technology Alliance, the medical imaging division of the National Electrical Manufacturers Association, issued a report Friday documenting its members' efforts to curb radiation exposure. It credits equipment design innovations in the past 20 years for reducing radiation dose 20% to 75% for many imaging procedures.
With limited exceptions, the ACR has been reserved in its public positions concerning radiation exposure. It has always favored physician adherence to the ALARA principle (as low as responsibly achievable), Amis said. The policy relies on physician discretion regarding the appropriateness of medical procedures involving exposure to ionizing radiation on a procedure-to-procedure basis. Previous advisories from the college have emphasized the importance of monitoring radiation exposure for patients subjected to long fluoro-guided interventions.
Selected recommendations of ACR Blue Ribbon Panel on Radiation Dose in Medicine:
For more information from the Diagnostic Imaging archives: