Original articleACR White Paper on Radiation Dose in Medicine: Three Years Later
Introduction
Ionizing radiation has been used for diagnostic purposes in medicine for more than a century. The benefits of noninvasive or minimally invasive procedures are integral to modern patient care and greatly exceed the associated risks. The development of remarkable equipment such as multidetector row CT and the increased utilization of x-ray and nuclear medicine imaging studies have transformed the practice of medicine as imaging studies increasingly replace more invasive, and often more costly, techniques for any number of indications. However, this dramatic evolution of imaging into the widespread diagnostic and therapeutic role it now occupies in medicine has also resulted in a significant increase in the population's cumulative exposure to ionizing radiation and a potential increase in cancer risk.
Factors such as (1) more advanced, more accurate technology; (2) fear of litigation; (3) increased need for immediate diagnosis and patient throughput in busy clinical settings; (4) increased patient demand; and (5) a lack of radiation safety training for nonradiologist providers have contributed to the significant growth in imaging utilization.
Expanding international and federal interest in, and scrutiny of, radiation dose from imaging procedures prompted the ACR to appoint the Blue Ribbon Panel on Radiation Dose in Medicine in 2006 to assess the issue and to recommend an action plan for the College that would reinforce its long-standing commitment to radiation safety. The diverse panel, chaired by one of us (E.S.A.), included academic and private practice radiologists, medical physicists, representatives of industry and regulatory groups, and a patient advocate. The panel's “American College of Radiology White Paper on Radiation Dose in Medicine” was published in the May 2007 issue of JACR [1].
That report offers an extensive set of recommendations designed to counteract medical and societal trends that might contribute to unnecessary radiation exposure that Americans may experience because of overuse or misuse as these beneficial technologies advance. Its 37 specific recommendations addressed key issues such as
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educating stakeholders in radiation safety principles;
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appropriately utilizing imaging to minimize any associated radiation risk;
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standardizing radiation dose data to be archived during imaging for ultimate use in defining good practice;
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developing and implementing maximum radiation dose estimate pass-fail criteria for the ACR CT Accreditation Program;
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supporting the current multiorganizational effort to improve radiology resident training in medical physics;
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including in the ACR Practice Guidelines and Technical Standards additional considerations for special radiosensitive populations, such as children and potentially pregnant women;
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encouraging radiology practices to define a surveillance mechanism to identify patients with high cumulative radiation doses due to repeated imaging so that alternative imaging techniques may be considered; and
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working with patient advocacy organizations to more effectively communicate the potential radiation risks and health benefits of imaging procedures.
Although most of the recommendations call for specific actions on the part of the ACR, several encourage radiology practices and departments to take a more proactive approach to radiation safety.
Section snippets
Progress
Since the publication of the white paper, 30 of the 37 recommendations have been completed or are in progress. Each recommendation's status is outlined in Table 1 [2, 3, 4, 5, 6, 7].
Recent Attention to Medical Radiation
A number of important developments have occurred since the publication of the 2007 white paper, validating the panel's recommendations and making them even more critical. These include scientific reports, articles in the public media, and increased scrutiny by the US government. It is worthwhile to itemize just a few of these developments:
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Scientific reports
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A 2009 National Council on Radiation Protection and Measurements [8] publication, Ionizing Radiation Exposure of the Population of the
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Image Gently
The Alliance for Radiation Safety in Pediatric Imaging was formed in 2007 as a coalition of health care organizations dedicated to promoting safe, high-quality pediatric imaging nationwide [5]. The alliance was organized under the leadership of the Society for Pediatric Radiology, with the American Society of Radiologic Technologists, the ACR, and the American Association of Physicists in Medicine included as founding organizations. The primary objective of the alliance is to raise awareness in
Image Wisely
The ACR and the Radiological Society of North America established the Joint Task Force on Adult Radiation Protection to build on the success of the Image Gently campaign. The primary mission of the joint task force is to raise awareness among providers of the need and the opportunities to eliminate unnecessary imaging examinations and to lower the amount of radiation used in necessary imaging examinations to only that needed to capture optimal medical images. The task force has expanded into
Conclusions
Although the radiology community and the public media have helped raise the radiation awareness of radiology professionals, referring physicians, and patients, more still needs to be done. The Alliance for Radiation Safety in Pediatric Imaging's highly successful Image Gently initiatives and the new Alliance of Imaging Professionals' Image Wisely movement will further these efforts.
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