ACR, SCBTMR Statement on Recent NEJM Article on CT Scan Safety

Reston, VA – June 29, 2010 - Direct FDA jurisdiction over how CT scanners are used — including radiation dose requirements — as suggested recently by an article published online in the New England Journal of Medicine (NEJM), is likely a logistical impossibility given number of scanner types, scanner generations, and the variety of indications for which medical imaging serves an appropriate role. Such narrowly defined regulations may not allow for the flexibility that physicians need to provide the best possible care to their patients.

The American College of Radiology and the Society of Computed Body Tomography and Magnetic Resonance (SCBTMR) affirm that a more immediate, and ultimately more effective way to address the issues of radiation dose and appropriate utilization of imaging exams, is for the government to require that all imaging providers adhere to existing, previously voluntary, programs that the American College of Radiology and other imaging stakeholders already have in place and have been proven effective: 

§         Computerized exam ordering systems based on American College of Radiology Appropriateness Criteria help doctors prescribe the best exam for a patient’s given condition, inform them when an exam that does not use radiation may be more appropriate or when no scan may be warranted at all. This reduces unnecessary exams and radiation exposure to patients.

§         ACR facility accreditation requires facilities to maintain image quality, checks radiation dose used, and minimizes the likelihood of adverse events such as those highlighted in recent news reports, by requiring physicians to meet certain education/training standards, scanners to be surveyed regularly by a medical physicist to ensure proper function, and technologists operating scanners to be certified.

§         The ACR CT dose index registry will allow providers to submit radiation dose data so that facilities may compare their CT dose indices against realistic national benchmarks and may re-examine their imaging protocols if necessary. It will also alert facilities if a dose threshold has been exceeded.

Since 2002, the ACR’s Diagnostic Reference Levels (DRL) have outlined dose levels that CT scans should not normally exceed while recognizing that there may be certain instances where dose would have to be increased, such as in the case of morbidly obese patients. The ACR and SCBTMR support the National Council of Radiation Protection and Measurements’ effort to develop more detailed reference levels to include more exam types and body areas. The ACR CT dose index registry will aid in the development of DRLs and provide scientific feedback regarding the effectiveness of radiation dose reduction efforts over time.

These efforts can cut down on radiation dose received from duplicative scans, help to ensure that patients receive appropriate dose per scan, and set in place a nationwide standard of care so that Americans can expect quality imaging regardless of where they live.

Medical imaging exams have been directly linked to greater life expectancy, declines in cancer mortality rates, and are generally less expensive than the invasive procedures that they replace. No imaging exam should be performed unless there is a clear medical benefit that outweighs any theoretical risk. The ACR and SCBTMR support the ‘as low as reasonably achievable’ (ALARA) concept which urges providers to use the minimum level of radiation needed in imaging exams to achieve the necessary results.

Lawmakers and government agencies need to work with the provider community to help ensure that that the next steps to address the very important issues of medical radiation reduction and necessary utilization are the correct steps. Federally mandating participation in these existing programs can help ensure that medical imaging is safe, effective, and available without removing treatment decisions from doctor’s hands, and without further stressing the American healthcare system.

FOR PATIENTS:

The ACR urges patients and providers to visit the “Radiology Safety” section of the ACR website as well as the “Radiation Safety” section of www.radiologyinfo.org, the patient information site co-managed by the ACR and the Radiological Society of North America (RSNA), and the Image Gently™ site (www.imagegently.org) for more information regarding radiation exposure from medical imaging exams. 

Patients should also keep a record of their X-ray history and before undergoing a scan, should ask their physician:

• Why do I need this exam?
• How will having this exam improve my health care?
• Are there alternatives that do not use radiation which are equally as good?
• Is this facility ACR accredited? 
• Is my child receiving a “kid-size” radiation dose (for pediatric exams)?