Reduction of Medical Radiation Exposure
Joe Adams
Spring 2009 MED INF 407
Legal, Ethical, and Social Issues
Karin Lindgren
Medical imaging has become an invaluable tool in the clinical diagnostic process.
Advancements in imaging technology have allowed for increased visualization,
intervention, interpretation, and reduced report turn around times. Unfortunately, these
advances do come with a price. Procedures, such as x-ray, fluoroscopy, nuclear medicine
and computed tomography (CT) produce ionizing radiation. As the reliance upon these
procedures and the amount of acquired images increase, so too does the amount of
exposure a patient receives. There are currently no standards for monitoring and
preventing excess doses. The healthcare community must confront the surge of radiation
exposure through education, safe practices, and medical informatics for the benefit of
patient care.
BACKGROUND
In 1980, the average American had a medical radiation dose of 0.54 mSv. By 2006, that amount
increased 600 percent, to 3.2 mSv per capita. The worldwide average background radiation dose is
estimated at 2.4 mSv per year (RSNA, 2008).
In 2006, nearly half of the total radiation exposure in the U.S. came from medical
imaging procedures. Dr. Kenneth R. Kase, senior vice president of National Council on
Radiation Protection and Measurements (NCRP) explains, “The increase was due mostly
to the higher utilization of computed tomography (CT) and nuclear medicine. These two
imaging modalities alone contributed 36 percent of the total radiation exposure and 75
percent of the medical radiation exposure of the U.S. population” (NCRP, 2009).
(source: NCRP, 2009)
The amount of imaging orders, in particular CT, has grown exponentially. In
2008, Shah & Platt noted an increase in CT use by 700% over the previous ten years (p.
243). James A. Brink, M.D., explains that physicians in the U.S. order many CTs
because they are easily performed and provide quick diagnostic interpretations. CT has
become a standard evaluation modality for illness and injuries. This is attributed to
technological advancements in visualization and acquisition speed in addition to the
increased availability of scanners. (Shah & Platt, 2008, pp.243-244) “CT scans comprise
approximately 17 percent of all medical procedures, but their popularity has been
growing in recent years, with 72 million performed in 2006” (Gutierrez, 2009).
(source: Shah & Platt, 2008)
According to the State of New York Department of Health, initially CT
examinations were almost always requested in the form of consultation with a radiologist.
The trend has changed with referring clinicians now having the ability to order various
imaging procedures. “This lack of a consultation eliminated the step whereby the
radiologist acted as gatekeeper, thus preventing an honest discussion of the benefits
versus the risks that are imposed by a specific imaging procedure or the availability of
alternative imaging options” (Daines & Saunders, 2008).
Advanced imaging exams often provide physicians with the reassurance that they
have not overlooked anything. “A survey of doctors in the Journal of the American
Medical Association reported that over 50% asked for imaging tests just to protect
themselves from potential lawsuits” (Chow, 2008). The tactic of ordering radiologic
procedures to minimize exposure to “error of omission” litigation has followed the
increased malpractice allegations.
A recent example of one such lawsuit involves the circumstances surrounding the
death of actor John Ritter. Multiple physicians and a hospital faced a wrongful death
lawsuit filed by Ritter’s family. Among the allegations included one that a radiologist
failed to perform a radiographic procedure that might have revealed Ritter’s aortic
dissection. This omission was alleged as a “a missed opportunity for Ritter to receive
potentially life-saving surgery. The jury, however, disagreed with his family’s arguments
and found in favor of the defendant doctors” (Levin & Perconti, 2008).
Surveys performed in the greater Chicago area (Cook County) over a 20-year
period highlight the increase in malpractice allegations of patient injuries resulting from
the referring clinician’s failure to order medical imaging studies. According to Berlin
(2005), “the allegation of failure to order a radiologic study accounted for 2% of all
medical malpractice cases filed against physicians in Cook County in 1982. The
proportion increased to 3.9% in 1992 and to 5.4% in 2002. In the same 20-year period,
the actual number of failure-to-order-radiologic-studies lawsuits increased by 2.5 times,
from 23 to 56” (p. 1418).
(source: Berlin, 2005)
Unfortunately, this trend has given rise to defensive medicine – “ordering
expensive tests and procedures that are not indicated medically but the absence of which
may render physicians vulnerable in a malpractice lawsuit, or the practice of encouraging
the ordering of tests and procedures that are of marginal or of no medical benefit,
primarily for reducing medicolegal risk” (Berlin, 2005, p. 1418).
This phenomenon is of course not limited to radiology; physicians routinely order
various diagnostic procedures to protect themselves, regardless of the cost and necessity.
Interestingly, Berlin (2005) noted, “The annual cost to the nation of defensive medicine
has been estimated to range from $25 billion to $126 billion” and “researchers estimated
that defensive medicine accounts for 5–9% of the annual cost of the national health care
budget” (p. 1418).
Too often, advanced imaging exams are ordered even when they are not
appropriate based upon patient symptoms. "Ten to 20 percent of diagnostic imaging
exams did not contribute to patient management," said Dr. Reed, a professor of radiology
and pediatrics at the University of Manitoba and chair of the Department of Radiology at
Children’s Hospital in Winnipeg. "There was an increase in radiation dose, cost, waiting
time and anxiety" (RSNA, 2008). In addition to incurring unnecessary exams, increased
healthcare costs, and resource burdening, patients are exposed to increasing amounts of
ionizing radiation.
Unfortunately, CT generally produces higher exposure to radiation than other
medical imaging modalities. An average exam produces about 10 mSv. "Radiation
exposure from these scans is not inconsequential and can lead to later cancers," said Len
Lichtenfeld of the American Cancer Society (Gutierrez, 2009). Potential risks from
radiation vary by dose and by patient anatomy and condition. The effective dose is that
of radiation absorbed with consideration to tissue radiosensitivity and body mass. Shah
& Platt note, “In considering the effective dose of radiation it is helpful to compare the
effective dose for different radiologic studies. For example, the radiation from a single
abdominal CT is nearly 250 times that of a plain chest radiograph” (p.244).
Shah & Platt (2008) observe doses of radiation exposure in the range of 10 to 50
mSv cause an increased lifetime risk for fatal malignancy. An effective dose from a
single CT procedure may range from 5 to 60. They note reports indicating 30% of
patients who have a CT will have more than one study; “Since the dose from each CT
scan is cumulative over the life of an individual, multiple scans result in an even greater
lifetime risk of fatal cancer for the individual” (p.244).
Radiation-induced effects may be divided into deterministic and stochastic effects.
Deterministic effect: A radiation effect characterized by a threshold dose. The effect is
not observed unless the threshold dose is exceeded. (The threshold dose is subject to
biologic variation.) Once the threshold dose is exceeded in an individual, the severity of
injury increases with increasing dose. Examples of deterministic effects include skin
injury, hair loss, and cataracts (Miller
et al., 2004)
A recent, well-publicized example of deterministic effects involved Jacoby Roth,
a two-year-old who required a head CT at Mad River Community Hospital in Arcata,
California on January 23, 2008. The infant was allegedly subjected to 65 minutes of CT
exposure. The exam should have lasted less than one minute. This overexposure left
Jacoby with radiation burns to his head and face similar to sunburn. Upon analyzation of
his blood, a cytogeneticist found substantial chromosomal damage (Domino, 2008).
The parent’s attorney filed a lawsuit against the hospital, “claiming negligence
and medical battery. Hospital records show that 151 scans were done on the boy during
the session” (Domino, 2008). This suit prompted an investigation by the California Public
Health Department. They determined that overexposure was due to “operator error” by
the state-licensed radiologic technologist (Domino, 2009). The technologist’s license
was suspended.
The Public Health Department fined Mad River Community Hospital $25,000 due
to licensing requirement violations (Tam, 2009). The hospital “failed to ensure that the
imaging department staff followed written policies and procedures for radiation safety,
and failed to report an unusual occurrence to the state” (Trading Markets, 2009).
Stochastic effect: A radiation effect whose probability of occurrence increases with
increasing dose, but whose severity is independent of total dose. Radiation-induced
cancer is an example (Miller et al., 2004)
While CT and other radiographic examinations provide tremendous benefits as
diagnostic tools, careful consideration of exam appropriateness is crucial. Notes
Lictenfeld, “This doesn't mean people shouldn't get CT scans, but it does mean we need
to be very careful in how we use these technologies in the future" (Gutierrez, 2009). For
patients who have not undergone several examinations, the benefits of these procedures
usually outweigh the risks. However, as patients undergo numerous exams, the balance
shifts and cumulative risks manifest.
An American College of Radiology White Paper on Radiation dose in medicine
notes,
Ionizing radiation, especially at high doses, has long been known to increase the risk for
developing cancer. In fact, x-rays have recently been officially classified as a “carcinogen” by the
World Health Organization’s International Agency for Research on Cancer, the Agency for Toxic
Substances and Disease Registry of the Centers for Disease Control and Prevention, and the
National Institute of Environmental Health Sciences. The most comprehensive epidemiologic
study supporting the carcinogenic effect of radiation is that of the atomic bomb survivors in Japan.
The data from this study show a statistically significant increase in cancer at dose estimates in
excess of 50 mSv. (Amis et al., 2007).
It is readily apparent that increased utilization of imaging services like CT and
Nuclear Medicine which employ 10 to 50 mSv doses subject patients to higher
accumulated doses. This is especially feasible as the same patient undergoes multiple or
recurrent studies. “Up to 7 percent of patients who underwent CT at a major medical
center in 2007 had accumulated enough radiation exposure from previous CT scans to
increase their risk of cancer by at least 1 percent” (RSNA, 2009).
Currently, no standard exists for acquiring, evaluating, and archiving radiation
dose information. Likewise, no federal requirements exist in the US for monitoring or
reporting lifetime cumulative radiation dose for patients (Colang, Killion, &Vano, 2007).
The likelihood of [radiation induced] effects in any individual patient cannot be predicted unless
that patient’s radiation dose is known. This is the principal reason for recording patient radiation
dose. Monitoring and recording patient dose data can also be valuable for quality-assurance
purposes as well as for patient safety (Miller et al., 2004)
Furthermore, there are no standardized guidelines for the use of advanced medical
imaging procedures. These issues are gaining increased attention throughout professional
medical and engineering organizations worldwide and efforts are underway to address
these concerns, in part, utilizing medical informatics.
SOLUTIONS
To facilitate physicians in selecting the most appropriate imaging exam based
upon a patients signs and symptoms, the American College of Radiology (ACR) has
developed ACR Appropriateness Criteria®. These evidence-based guidelines provide
clinicians with a tool to “enhance quality of care and contribute to the most efficacious
use of radiology” (ACR, n.d.a). The guidelines are readily accessible on the internet and
PDA applications.
The guidelines are developed by expert panels in diagnostic imaging, interventional
radiology, and radiation oncology. Each panel includes leaders in radiology and other specialties.
There are currently 159 topics with over 800 variants (ACR, n.d.a).
(Source: http://acsearch.acr.org/VariantList.aspx?topicid=68780)
The guidelines also include relative radiation levels (RRLs). RRL’s allow
ordering practitioners to approximate relative exposure differences between radiologic
procedures. “The RRLs are based on effective dose, which is a radiation dose quantity
used to estimate population total radiation risk associated with an imaging procedure.
This quantity takes into account the sensitivity to radiation of different body organs and
tissues” (ACR, n.d.b)
(source: http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/RRLInformation.aspx)
In 2001, recognizing the trend in CT utilization and concerned about the affects of
radiation in children and small adults, the FDA released the following recommendations
to Radiologists, Radiation Health Professionals, Risk Managers, and Hospital
Administrators:
1.
2.
3.
4.
Optimize CT Settings. Based on patient weight or diameter and anatomic region of interest,
evaluate whether your CT operating conditions are optimally balanced between image quality and
radiation exposure. To reduce dose while maintaining diagnostic image quality:
Reduce tube current. With all other factors held constant, patient radiation dose is directly
proportional to x-ray tube current. For example, a 50 percent reduction in tube current results in a
50 percent decrease in radiation dose.
Develop and use a chart or table of tube-current settings based on patient weight or
diameter and anatomical region of interest. See reference 9 for an example of tube current
settings based on patient weight and anatomical region of interest (i.e., chest, pelvis or abdomen)
for a single-detector helical-scanning CT unit. The diameter of the patient may be a better
predictor of the tube-current required than body weight because patient diameter better correlates
with the x-ray beam attenuation in the patient. Your facility’s medical physicist and the scanner
manufacturer can help in developing this chart or table.
Increase table increment (axial scanning) or pitch (helical scanning). If the pitch is increased,
the amount of radiation needed to cover the anatomical area of interest is decreased.One study
showed that increasing the pitch from 1:1 to 1.5:1 decreased the radiation dose by 33 percent
without loss of diagnostic information. Consult your facility’s medical physicist, who can advise
you on optimal tube-current and pitch settings for diagnostic requirements. You can also contact
the manufacturer of the CT scanner for recommendations specific to your model.
Note that some newer CT scanners may automatically suggest or implement an increase in mA if
pitch is increased. For these models, increasing the pitch may not result in a lower radiation
dose. Contact the CT scanner’s manufacturer for recommendations on your model’s automatic
current adjustment features.
2.
3.
Reduce the number of multiple scans with contrast material. Often, CT scans are done before,
during, and after injection of IV contrast material. When medically appropriate, multiple
exposures may be reduced by eliminating pre-contrast images (i.e., unenhanced images).
Eliminate inappropriate referrals for CT. In some cases, conventional radiography,
sonography, or magnetic resonance imaging (MRI) can be just as effective as CT, and with lower
radiation exposure. Most conventional x-ray units deliver less ionizing radiation than CT systems,
and sonography and MRI systems deliver no x-ray radiation at all. It is important to triage these
examinations to eliminate inappropriate referrals or to utilize procedures with less or no ionizing
radiation. (FDA, 2001).
Students of radiology and radiation therapy are taught early on to follow
principles of ALARA (As Low As Reasonably Achievable). Much of the curriculum
focuses on the physics, effects, and safety measures involved with ionizing radiation.
The concept of ALARA is not new to radiology. It began when the Nuclear Regulatory
Commission in December 1977 began pushing for radiation standards that lowered the dose to
patients and occupational workers. As a result, The Office of Standards of the Nuclear Regulatory
Commission published NUREG-0267, a follow up document to their attempts to reduce radiation
exposure. This document was called, Principles and Practices for keeping Occupational Radiation
Exposures at Medical Institutions As Low As Reasonably Achievable. The acronym ALARA
remained as the documents impact on the radiology community to include patient and
occupational exposure mandate for minimum necessary exposure. In 1994 the ALARA document
became a part of title 10f the Code of Federal Regulations (10CFR35.20) which is binding on all
institutions as a NRC regulation. Therefore, it must be practiced as a matter of mandate of federal
code. So when the radiographer stresses the practice of ALARA it should be understood by all that
it is because it is required and respectful to the patient (Joseph & Phalen, n.d.)
The Standards of Ethics of the American Registry of Radiologic Technologists
includes the following:
The radiologic technologist uses equipment and accessories, employs techniques and procedures,
performs services in accordance with an accepted standard of practice, and demonstrates expertise
in minimizing radiation exposure to the patient, self, and other members of the healthcare team
(ARRT, 2008).
In the previous mentioned case of the 2-year-old boy who was overexposed, in
addition to administering the fine, the CDPH required that a plan of correction
including the following items be implemented by January 9, 2009:

Development of an ALARA educational in-service and competency validation tool,
administered to each radiology technologist on staff and to newly hired technologists

Specific ALARA recommendations for pediatric patients

Reminders to technologists that expert resources are available to assist with CT exams

Yearly review of ALARA philosophy with staff, and documented revalidation of competency as
part of annual evaluation

Maintenance of records about ALARA competency validation for all clinical staff (Keen, 2009)
While radiation safety education and ALARA principles remain paramount,
medical informatics provides solutions to monitoring and reducing exposures.
Researchers, manufacturers, and physicians are coordinating to employ various solutions
to this recently well-publicized radiation safety concern.
These solutions include:

Computer Order Entry (CPOE) coupled with clinical decision support (CDS) to
facilitate ordering only appropriate exams for the patients

Integrating the Healthcare Enterprise (IHE)’s Radiation Exposure Monitoring
(REM) Integration Profile for dose tracking

Online quality system control system in digital radiology to manage patient
dosimetry and procedure data in real time at the imaging modality

Smart cards to track patient radiation histories

RHIOs and NHIN
While there may exist many guidelines for ordering advanced imaging procedures
at a healthcare facility, these guidelines are often not easily accessible or simply not
followed. Utilizing CPOE, ordering physicians are required to enter the patient’s
condition and demographics for imaging studies. These indications can be compared
against evidence-based criteria, such as the ACR Appropriateness Criteria. Orders
meeting the criteria are passed to a radiology information system (RIS) or scheduling
system as appropriate. Otherwise, physicians would be alerted of the
contraindication, presented with suitable alternatives, or allowed to bypass the
warning.
Advantages for this type of system include providing a gatekeeper effect,
preventing unwarranted exams from the outset, educating physicians on
appropriateness criteria, and suggesting more applicable examinations. Not only does
CPOE prevent unnecessary radiation exposure, but also it can be used to
contraindicate exams based on medication conflicts (e.g. intravenous contrast), or
patient information (e.g. pacemaker contraindicated for MRI). This type of system
can also be audited to determine trends, quality improvement realizations, and
highlight areas where educational efforts may be required. Incorporating a patient’s
cumulative dose and exam history can further educate physicians in taking the
appropriate course.
Disadvantages to CPOE include the build and maintenance of appropriateness
criteria, site-specific considerations, and buy-in from ordering physicians. Depending
on the equipment specifications, one site may provide services more appropriate for
given orders (e.g. 64 slice CT for cardiac imaging vs 16 slice). This may alter either a
patient’s preferred imaging site, or the exam order based on that preference. Without
buy-in, physicians may bypass recommendations altogether (RSNA 2008). A good
balance of alerts and recommendations must exist with physician judgment.
Appropriateness criteria must be readily accessible and displayed in a desired fashion
so as not to interfere with an efficient physician workflow.
IHE’s Radiation Exposure Monitoring (REM) Integration Profile is based on the
work done by Digital Imaging and Communications in Medicine (DICOM) and the
International Electrotechnical Commission (IEC) to develop DICOM Dose objects
appropriate for radiation dose monitoring.
The Radiation Exposure Monitoring Integration Profile specifies communications between
systems generating reports of irradiation events (generally acquisition modalities and
workstations) and systems which receive, store, or process those reports (generally local dose
information management systems and/or national/regional dose registers). It defines how DICOM
SR objects for CT and projection X-ray dose objects are created, stored, queried, retrieved, deidentified, and may be processed and displayed (IHE International, 2008).
Advantages are realized by utilizing existing standards (DICOM). The REM Profile
achieves the fundamental means of acquiring dosimetry records for individual
radiographic examinations. It is intended to facilitate the ability to do things like:
• view the estimated dose a patient (or particular organs) received for a certain exam
• determine if the estimated dose for a given procedure, system or physician regularly exceeds
some reference level, policy trigger or is otherwise an "outlier" requiring further investigation
• compute the population "dose summary" for a specific exam in a certain hospital or region
• compute the population "dose summary" for a certain pathology or indication
• compare exam-specific "dose summaries" against other sites/regions, against local policy targets
or against standards of practice
• For patients’ physicians, overall data provided from monitoring such exposures can help them
determine (in consultation with the imaging physician) if the benefit from the diagnostic
information provided by an individual examination (or additional examinations) outweigh any
small risk that may be associated with the imaging exam.
• For medical physicists, having such post-procedure information available for individual patients
may help them make essential patient-specific dose estimates for pregnant patients or patients
exhibiting skin erythema as a result of long fluoroscopy examinations.
• For professional societies and regulatory agencies, a collection of exposure data can be useful
when setting or reviewing radiation dose related guidelines. Many such groups have expressed a
desire to establish standards of practice or dose reference levels based on a quantitative
understanding of current practice, however they have found it prohibitively difficult to collect such
data.
• For physicists and physicians, this kind of data can be vital to answering some of the
fundamental scientific questions that remain and developing a more detailed understanding (IHE
International, 2008).
IHE points out the following disadvantages:
• The values provided by this tool are not “measurements” but only calculated estimates.
• For computed tomography, “CTDI” is a dose estimate to a standard plastic phantom. Plastic is
not human tissue. Therefore, CTDI should not be represented as the dose received by the patient.
• For planar or projection imaging, the recorded values may be exposure, skin dose or some other
value that may not be patient’s body or organ dose.
• It is inappropriate and inaccurate to add up dose estimates received by different parts of the body
into a single cumulative value.
Vano et al. present a quality control solution at the point of care, the imaging
modality. Online patient dosimetry and an image quality system in digital radiology
are used to alarm radiographers when national reference values are exceeded,
evaluate technical parameters, operational practice and image quality in addition to
providing an image audit, linking the dose imparted, the image quality and the alarm
condition.
For this project, “current mean values of entrance surface dose (ESD) were
compared with local and national reference values (RVs) for the specific examination
type evaluated” (Vano et al, 2006). For these dose calculations, the system utilizes
both DICOM header information and modality-provided parameters (e.g. distance of
x-ray tube, selected exposure - mAs, kVP, time etc.). When diagnostic reference
levels (DRL) are exceeded, a radiographer or biomedical engineer may be alerted,
allowing them to adjust technical, or equipment factors appropriately with the advice
of a radiation physicist.
One advantage to this approach at the radiation producing modality includes the
use of standard DICOM header information to collect dosage data. This system
allows for real-time dose monitoring. Utilizing actual instrument imaging parameters
permits education for technologists and immediate corrective action by an engineer to
encourage radiation safety dependent upon best practice DRLs.
A disadvantage to the proposed implementation is the use of a PACS as an
intermediary between the workstation and the modality. There is no mention of
transmitting the analysis to an electronic medical record or calculating cumulative
patient dose over time.
This is feasible using Modality Performed Procedure Steps (MPPS). MPPS, a
part of the DICOM standard, is a network transaction that is initiated by an imaging
modality (acquisition device). This allows the transmission of the actual performance
information at the beginning and end of an acquisition. This information may include
patient demographic, order, specific acquisition times, equipment information,
imaging parameters, operator name, billing information and radiation dose. Noumeir
(2005) explains,
Modality Performed Procedure Step may include radiation information intended to enable the RIS
to store information on patient exposure to ionizing radiation. Such information includes the
anatomic region and the exposure time. With MPPS, the RIS is able to track and record radiation
information for legal or quality-control purposes (p.266).
A final radiation safety method involves the use of a dosimetry device worn by a
patient during radiographic procedures. This method is intended for the purpose of
monitoring lifetime cumulative dose. “The International Atomic Energy Agency (IAEA)
has launched an effort to create a running total of how much medical radiation patients
are exposed to over time by issuing smart cards and modifying electronic medical
records” (Gould, 2009).
It has long been a common practice for radiation workers (technologists,
radiologists, etc.) to wear dosimeters during their workday. Standard protocols allow
for measure of cumulative radiation dose. This has not been the case for patients. A
smart card is viewed as a method to allow patients and their physicians to monitor the
clinical exposure over the patient’s lifetime.
The most notable advantage of this solution is the transportability involved with
smart cards. If used consistently, this solution also provides a method to keep track
of lifetime radiation exposure. The key word “consistently” leads to several
disadvantages of this method. These include reliance on every imaging modality and
EMR encountered to be interoperable with the smart card.
All modalities that use ionizing radiation would have to display the dose delivered to patients in a
standardized format to implement the IAEA's ambitious tracking proposal. Hospitals and clinics
would also need an EMR system that can store the dose data for each patient and produce a
running total of lifetime x-ray exposure (Gould, 2009).
Strangely, there was no mention in IAEA’s solution of storing this information
regionally or on the national level. This places the onus squarely on the shoulders of a
patient. In one sense, this is desirable, as healthcare moves towards patients as proactive
partners in their own care. On the other hand, dependence on the patient alone (assuming
they are at a disparate health system) is akin to depending on someone having his or her
bankcard ever present. This is especially concerning with older or incompetent patients.
Ideally, there will exist collaboration amongst clinics, hospitals and other medical
facilities and practitioners with a Regional Health Information Organizations (RHIOs)
and a National Health Information Network (NHIN). This will provide appropriate
clinicians with a patient’s complete medical record in a patient-centric manner; one based
upon a patient’s control and choice.
Using this interoperable exchange, a referring physician would have access to every
radiographic procedure performed over tha patient’s lifetime. Coupled with CPOE, this
would allow the physician to avoid unnecessary duplicate orders, and monitor the
patient’s subjection to multiple studies, perhaps seeking an alternate, non-radiation
procedure. Furthermore, accumulated doses could be readily stored and accessible to
ordering practitioners, patients, and perhaps radiation physicists monitoring in a manner
similar to pharmacists overseeing medication summaries. This also provides
contraindication to specifics exams and imaging dye based on medication, allergies, or
other patient specific concerns.
No one solution previously mentioned addresses an ideal radiation safety measure.
Instead, each solution must be harnessed cooperatively to reduce unnecessary exposure to
ionizing radiation. This complete effort must be based not only at the patient entrance or
imaging modality, but also by radiology professionals, along the EMR, RHIO and
beyond. If the entire radiology procedural history, standard-based dose calculations and
guidelines are accessible to providers, physicians can determine whether the benefit of
imaging procedures outweighs the risk.
Medical Informatics provides valuable solutions for monitoring and reducing patient
exposure to diagnostically employed radiation. These solutions must be used in concert
to realize the greatest benefit of this effort. Coordination of various calculations,
recording, tracking and investigative solutions becomes increasingly important as the use
of advanced medical imaging explodes. Ultimately it falls on professionals to utilize
radiation safety knowledge and harness the best tool available to provide the most
efficacious use of radiology examinations in optimizing quality patient care.
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