In an editorial in the September 2012 issue of Chest, David Brenner, PhD, DSc, director of Columbia’s Center for Radiological Research, discusses three aspects of radiation and CT scans—quality control, training, and overuse—that urgently need addressing.
Quality control, writes Dr. Brenner, is uneven in US medical imaging facilities. Radiation doses from identical procedures can vary by as much as a factor of 10 from facility to facility, increasing the risk of unnecessary radiation exposure. He suggests that the mandatory quality control standards already legislated for mammography be extended to all advanced imaging techniques.
In the US, an MD degree is considered sufficient training for a physician to prescribe any diagnostic radiographic exam. Dr. Brenner recommends that everyone associated with CT imaging—including prescribing physicians, interpreting physicians, physicists, and technologists—receive mandatory continuous education on modern imaging techniques.
Finally, evidence suggests that 20–30 percent of the more than 80 million CT scans done in the US each year are not clinically justified. Dr. Brenner recommends wider use of clinical CT decision guidelines to provide guidance as to when a particular CT scan is appropriate. He notes that one successful approach to increasing use of these guidelines is to incorporate them into the computerized systems used to order CT scans.
Although introducing more legislation into clinical medicine should not be taken lightly, Dr. Brenner writes, well-crafted legislation on advanced radiologic imaging deserves serious consideration, to ensure that every patient receives the best possible imaging with the lowest possible radiation dose.