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. 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:

2. 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.

3. 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.

4. 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. 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).

3. 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, de-

identified, 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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