Feature | May 01, 2014 | Greg Freiherr

Radiation: Out of Sight, Not Out of Danger

The radiation to me was negligible. Most of the high-energy photons emitted by the technetium my mother had swallowed were being absorbed. Enough registered on the detector for a diagnostic image, but a Geiger counter held next to Mom registered the equivalent of about one hundredth milliSievert (mSv). At seven feet away, I was plenty safe.

Radiation didn’t use to bother me. A decade ago I volunteered to test drive a newly developed computed tomography (CT). The docs at Erlangen University Hospital refused, showing better sense than me — and most of my fellow Americans.

As a nation, our annual exposure to medical radiation nearly doubled from 1980 to 2008, according to a report issued in March 2009 by the National Council on Radiation Protection & Measurements. CT alone accounted for 24 percent of all medical radiation exposure in the United States. 

Europe probably fared better, but they too have had an appetite for CT. This modality contributes 57 percent of Europeans’ exposure to medical ionizing radiation, according to “DDM2 Project Report on European Population Dose Estimation,” a recent study of radiodiagnostic procedures in 36 European countries. 

Earlier this year at its European Congress of
Radiology (ECR), the European Society of Radiology (ESR) launched an initiative designed to heighten awareness of radiation safety and promote the use of the as low as reasonably achievable (ALARA) principle. The global agendum of this initiative, EuroSafe Imaging, is to promote the safe and appropriate use of medical imaging around the world. There is reason to believe this effort will take hold.

New equipment, even entry-level CTs, deliver low single digit or sub-mSv doses for virtually any exam. Meanwhile, low kVp protocols and dose-cutting algorithms have been developed to slash patient radiation exposure by half or more on many of the installed CTs.  

The sources of all ionizing radiation must be cautiously applied, not just CT. That includes nuclear medicine and radiography, and certainly fluoroscopy and cardiac cath. But CT stands out. Among the dire statistics and predictions raised at the ECR about this modality was a peer reviewed paper predicting that, in a few generations, one to two percent of all cancers in the United States will have been caused by CT exposure.

Heightened awareness is key. But more than just users must be made aware. Third-party payers must stop reimbursing the same for high- and low-dose CT exams. Ideally the use of high-dose CTs should be discontinued.

A precedent can be found in the maturation of magnetic resonance imaging (MRI), when exams done on ultra low-field MR scanners were reimbursed the same as those on high-field systems. These low performance, low image quality machines were eventually removed from radiology by accreditation standards that disallowed third-party reimbursement. Adapting this solution to CT will encourage the use of low-dose technologies and techniques by the installed base, as well as the replacement of CT dinosaurs with new low-dose scanners.  

In short, while the efforts of the ESR and other groups seeking to heighten dose awareness are laudable, they will have limited effect until the owners of CT systems have an economic reason to embrace low-dose studies. It’s time for that reason to surface.

Related Content

Example of an intentionally truncated CT image

Figure 1: Example of an intentionally truncated CT image. The truncation percentage was calculated as the ratio of the patient border touching the field of view to the total patient border (red/(read+blue)). Image courtesy of Qaelum.

Feature | Radiation Dose Management | July 15, 2019 | Niki Fitousi, Ph.D., and An Dedulle
One of the main benefits of a radiation dose management system is the possibility to automatically generate alerts when...
Routine scan of abdomen pelvis taken with the UW-Madison’s Revolution 256 CT scanner using the FDA-cleared reconstruction algorithm, called TrueFidelity.

Routine scan of abdomen pelvis taken with the UW-Madison’s Revolution 256 CT scanner using the FDA-cleared reconstruction algorithm, called TrueFidelity. UW-Madison was the first site in the U.S. to get this technology. Its use is now being integrated into UW CT protocols. Image courtesy of Timothy P. Szczykutowicz

Feature | Computed Tomography (CT) | July 12, 2019 | By Greg Freiherr
When providers develop their own imaging protocols, they are wasting time and money, according to...
Mednax National Cardiac Centers of Excellence Program Highlighted at SCCT 2019
News | CT Angiography (CTA) | July 11, 2019
Mednax Inc. and Mednax Radiology Solutions announced that Chief Medical Officer Ricardo C. Cury, M.D., FSCCT, will...
Achenbach to Receive Inaugural 2019 Stephan Achenbach Pioneer Award in Cardiovascular CT
News | Cardiac Imaging | July 10, 2019
The Society of Cardiovascular Computed Tomography (SCCT) will present Stephan Achenbach, M.D., FSCCT with the inaugural...
Researchers Use Artificial Intelligence to Deliver Personalized Radiation Therapy
News | Radiation Therapy | July 09, 2019
New Cleveland Clinic-led research shows that artificial intelligence (AI) can use medical scans and health records to...
Jonathon Leipsic Awarded 2019 DeHaan Award for Innovation in Cardiology
News | Cardiac Imaging | July 08, 2019
Jonathon A. Leipsic, M.D., FSCCT, is the recipient of the 2019 DeHaan Award for Innovation in Cardiology, announced by...
vRad Presents AI Model to Assess Probability of Aortic Dissection
News | Artificial Intelligence | July 01, 2019
vRad (Virtual Radiologic), a Mednax company recently made a scientific presentation, “Screening for Aortic Dissection...
ClariPi Gets FDA Clearance for AI-powered CT Image Denoising Solution
Technology | Computed Tomography (CT) | June 24, 2019
Artificial intelligence (AI) imaging solution form ClariPi Inc. has received U.S. Food and Drug Administration (FDA)...
Third FDA Clearance Announced for Zebra-Med's AI Solution for Brain Bleed Alerts
Technology | Artificial Intelligence | June 19, 2019
Zebra Medical Vision announced it has received its third U.S. Food and Drug Administration (FDA) 510(k) clearance for...
Canon Medical Receives FDA Clearance for AiCE Reconstruction Technology for CT
Technology | Computed Tomography (CT) | June 18, 2019
Canon Medical Systems USA Inc. has received 510(k) clearance on its new deep convolutional neural network (DCNN) image...