Quality Management & Patient Safety
Partners Radiology CT Radiation Dose Optimization & Standarization
Partners Radiology is committed to continually finding new ways to reduce unnecessary computed tomography (CT) radiation exposure while providing necessary diagnostic image quality. Our radiation dose reduction efforts focus on preventing unnecessary exposure, developing strategies to minimize the dose necessary to make clinical diagnoses and reducing cumulative radiation dose.
Recent evidence suggests that radiation from CT scans may result in a small but real increased risk of cancer later in life, particularly for children, women and young adults, who have been shown to be more sensitive to radiation. In addition, cumulative radiation exposure could, over time, have adverse effects. Reported incidents in California, in which patients received excessive radiation during CT scanning, have added to the sense of unease over what is an effective and often life-saving exam. This does not mean that CT should be avoided, as it is the best test in many situations and can provide valuable and even life-saving information. For example, medical imaging exams have been linked to increased life expectancy and reduced cancer mortality, and many imaging studies are less expensive than the invasive procures that they replace. Properly performed, the radiation dose and risks of CT can be minimized while maintaining the medical value.
Radiation dose reduction has been a priority at Partners Radiology for many years. Partners Radiology is taking a three-pronged approach to minimize radiation exposure with CT scanning: 1) promoting that only the patients who will be best served clinically receive CT exams, thus reducing unnecessary radiation exposure, 2) for those patients who need CT exams, developing CT protocols to minimize radiation dose without sacrificing the diagnostic value of the examination and 3) for those who have undergone multiple CT studies over time, working to create a system to track the cumulative radiation exposure that a patient has received at any Partners facility.
1) What is Partners Radiology doing to make sure that only the patients who will be best served clinically receive CT studies? Although CT studies are very useful and may be the most appropriate test for a patient given their clinical indications, there are times when other studies can be substituted to achieve the desired clinical or diagnostic objective. To promote appropriate ordering of CT studies and to prevent unnecessary CT radiation exposure when alternate studies are clinically appropriate, Partners Radiology is working with the radiology and IT departments to leverage electronic decision support to assist ordering clinicians in determining appropriate studies based on the patients’ clinical indication(s) and evidence-based guidelines. The electronic scheduling systems also warn when patients have recently had a similar exam or when a similar exam has already been ordered. This informs physicians at the point of ordering to prevent potential duplicate exams and to suggest patients that may be at increased risk due to cumulative radiation exposure.
2) What is Partners Radiology doing to ensure that only the lowest necessary radiation dose is being used to achieve the needed diagnostic imaging quality? In 2008 Partners Radiology launched an initiative to develop and implement a Partners-wide approach to optimizing radiation dose with CT scanning. A team of radiology experts from across the system was convened, including some of the most highly recognized leaders in CT radiation dose optimization. The team has been conducting ongoing reviews of protocols performed across the system including pediatric, abdominal, chest and neurology protocols and where appropriate has leveraged a number of strategies to reduce CT radiation dose while ensuring diagnostic acceptability of the image quality. The team agreed upon standard radiation dose ranges that are consistent with American College of Radiology (ACR) recommendations to make sure that the protocols maintain a consistent dose range across the network. Continued diligence in this area assures that examinations are performed using radiation doses that are as low as reasonably achievable while still maintaining acceptable image quality.
3) What is Partners Radiology doing to track and minimize the cumulative radiation exposure that a patient receives from any Partners facility over time? It is important to keep track of and to mitigate the amount of radiation a patient is exposed to not only during a given study but also over the course of their lifetime. To prevent excessive cumulative radiation exposure, Partners Radiology is working to develop an automated system for tracking a patient’s past scans and issuing alerts for patients who have received multiple studies of a given body region. The team also plans to collaborate with the hospital sites, equipment vendors, and IT departments to develop a comprehensive and accurate system-wide radiation dose registry through direct capture of radiation dose information from imaging devices at the time of the study, which would allow tracking of cumulative radiation dose per patient. In this way we will be able to track the cumulative radiation exposure that a patient has received from any Partners facility over time.
As attention and concerns continue to grow around the potential risks of CT radiation, it is important to assure our patients and families that Partners Radiology leads the field with our work to optimize our use of CT radiation in order to minimize the dose necessary to achieve the image quality needed make clinical diagnoses. This is just one of many examples of Partners Radiology’s commitment to providing safe, consistent, high-quality care to the people we serve. To learn more about this topic, please refer to the links below:
Partners Radiology proudly endorses the ACR Image Gently Campaign.
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