Health Care Providers Pledging Less Radiation

Heath care providers are pledging to stop the overuse of radiation on patients during medical exams in a new, nationwide safety effort launched this week in Chicago.

The first step in the Image Wisely campaign is a pledge — signed so far by nearly 700 health care providers — to use the least radiation necessary on patients for a procedure. An expert panel at a radiology meeting Thursday said the campaign may lead to more review of protocols, more accreditation of imaging facilities and more widely shared standards on proper radiation doses.

Too much radiation can cause cancer. The average American's total radiation exposure has increased in recent decades because of the increased use of new imaging tests, particularly CT scans, raising questions about possible increased cancer risk.

"There are lots of reasons that medical images are over-utilized," said William Hendee of the Medical College of Wisconsin in Milwaukee, speaking on an imaging safety panel at the Radiological Society of North America's annual meeting in Chicago.

The way most insurers pay doctors, with a fee for each procedure, rewards doctors for doing more procedures, Hendee said. Some doctors order exams on equipment they own, increasing the financial incentive to do more tests. Procedures are performed at times to protect a doctor against malpractice claims. And some doctors don't know the best exam for a patient and may, for example, do a CT scan to evaluate a patient's gallbladder when an ultrasound without radiation is preferred.

Patients can be part of the problem if they request a test they don't need because a friend had similar symptoms and got that test. And duplicate tests can be done when a doctor doesn't know the patient's full medical record, Hendee said.

Then there's "dose creep," when technologists increase the radiation dose to get amazing-looking pictures of the body.

"With digital imaging it's easy to use increased dose per procedure to yield prettier images. But you don't need pretty images to provide information necessary to yield a diagnosis," Hendee said.
The Image Wisely campaign launched this week at the RSNA meeting with ribbons, buttons, stickers, a website and a wise owl logo.

Next year, hospitals and imaging facilities will be able to join a nationwide registry that will keep track of CT scan doses and warn institutions that are giving too much radiation.

"You don't know that you need to improve unless you have that information from everybody else," said Priscilla Butler of the American College of Radiology, a professional society that is developing the registry. The Image Wisely campaign will encourage institutions to take part in it and to become accredited.

Dr. Christoph Wald of Tufts University Medical School in Boston encouraged patients to keep track of how many X-rays, CT scans and other radiation tests they've had.

"It should be stated very clearly that the dose levels that are typically used in medical imaging have a low level of risk for causing cancer," Wald said. "And the benefit of safe and appropriate imaging to sick people who have terrible potential diseases really outweighs the low risk of cancer."