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Dominic Siewko,

Radiation Health and Safety Officer, Philips

Radiation dose from diagnostic procedures has become a topic of debate inthe popular press. And with the Medicare payments for some higher-doseCT scans on the chopping block starting in 2016, the red flag has beeneffectively raised.

Rightfully so – health care providers and manufacturers need to take everystep to ensure the safety of both patients and clinicians. But there’s stillconfusion in the market about the definition of safety when it comes todiagnostic scans, and as a health physicist, I’m compelled to set the recordstraight on the real risk and reward of radiation dose.

The benefit is clear

In the U.S., the use of CT scans nearly tripled, from 52scans per 1,000 patients to 149 scans per 1,000 patientsbetween 1996 and 2010. According to the AmericanCollege of Radiology (ACR), nearly 68 million CT scansare performed annually in the U.S. today. Put anotherway, nearly 1 in every 5 Americans will receive a CT scanthis year. The reason is simple – CT scans can yield abetter, more precise image than a standard x-ray, andcan even eliminate the need for exploratory surgery insome cases. That’s the benefit part of the equation.

But what’s the risk?

Radiation dose is the other half of the equation. With CT scans, technicians can protect themselves or limit theirdoses by stepping out of the room or behind a barrier during the procedure. Patients, as the subjects of theprocedure, receive the exposure. But while a CT scan adds to our dose burden, let’s put it in perspective. Theamount of “background” radiation we’re all exposed to in a year is actually higher on average than some diagnosticCT scans. Take a look at this graph:

With that said, how are patients supposed to be informed about the right dose for them? And perhaps even moreimportantly, what’s the best way for health care providers to protect and inform people?

Striking the balance

The overall goal is to provide clinicians with the best possible diagnostic information at the lowest possible dose.

There are a number of ways of striking a balance between dose and benefit:

Justification of the procedure: Traditional protocols – driven by reimbursement models – typically call for thesimpler, lowest form of dose – X-ray first, then a CT scan, then an MRI, or some variation on that theme. But the truthis, it may make more sense to start with a CT scan, sparing the radiation exposure (not to mention time and expense)of the x-ray or other preliminary scan, and reaching a definitive diagnosis sooner.

Optimization of the procedure: Clinicians need to demand technology and the training that allows them to enhanceand adjust images obtained at lower doses. This produces the diagnostic benefit while limiting the dose – a “win” inboth directions.

Normalizing protocols: Patient exam data with regard to radiation exposure is currently under-utilized.Understanding the variability among scanners in one department is a good first step to ensuring standard radiationdoses are delivered.

Like most things in life, diagnostic radiology is enhanced when the balance is found between the diagnostic benefitsand the dose required to get there. Striking that balance is becoming easier through a combination of evidence,technology and intelligence, and I have faith that advancements will continue. And as they do, patients andclinicians should continue to keep the real story – the real risk and rewards – in mind.

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Dominic Siewko,

The benefit is clear

But what’s the risk?

Striking the balance

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