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Nobody wants to expose patients to any more radiation than necessary. But, as the Wall Street Journal reported Monday, getting the dosage right during a CT scan is trickier than it might seem.

The basic goal is simple. Richard Morin, PhD, of the radiology department at Mayo Clinic in Jacksonville, Florida, told the Journal:

We want to be using the optimal amount—not too much and not too little.

Dr. Morin is also chair of the Dose Index Registry for the American College of Radiology, which collects data from scanners around the country to help set radiation-exposure standards.

That Goldilocks standard—not too much, not too little, but just right—can be elusive. New software can reduce radiation dosage as much as 65 percent while preserving (mostly) image quality. But it generally runs on only the newest machines. Given that CT scanners aren’t exactly cheap, older, higher-dose machines are likely to stick around for years, particularly at smaller or more rural facilities.

“Patients should be more demanding that they are getting the lowest dose possible,” said Gene Saragnese, chief executive officer for imaging systems at Philips Healthcare. “There are still machines out there that are 10 years old.”

Of course Saragnese would love to see those 10-year-old machines replaced by shiny new Philips scanners. But just how are patients supposed to demand the lowest dose? It’s not as if there’s a public online list of all scanners at all clinics and their average radiation doses for typical procedures. And referring physicians probably don’t have the faintest idea what the dosages might be at the imaging facilities to which they send patients.

Speaking of referring physicians, Alec J. Megibow, MD, professor of radiology at NYU Langone Medical Center in New York, told the Journal he often receives orders from physicians to do two CT scans of the same body part, one with and one without contrast. Two scans, obviously, mean double the radiation exposure.

Dr. Megibow said two scans are rarely justifiable medically, so he runs only one, even though he thereby reduces his and his employer’s income. He said:

If I have to bring one out of one thousand back, I’ll live with that. The perverse incentive is, I get paid for doing both. I am being paid to practice bad medicine.

* * *

“You’ll get my dosimetry badge when you pry it from my cold, dead fingers”—and other controversies swirling around the seemingly innocuous little monitoring device for radiation exposure: see the surprisingly contentious details on our Facebook page.

Related seminar: ALARA – CT (As Low As Reasonably Achievable)


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