Imaging exams have led to improvements in the diagnosis and treatment of many types of medical conditions, however, the radiation from these exams may elevate a patient’s lifetime risk for developing cancer.  The U.S. Department of Health & Human Services recently released a white paper to address the need for a balanced public health approach to medical imaging.  They are specifically targeting imaging procedures with the highest radiation doses: CT, fluoroscopy, and nuclear medicine.

Managing the risks of imaging procedures depends on two principles of radiation protection: appropriate justification for ordering and performing each procedure, and optimization of the radiation dose used during each procedure.  A balanced approach gives each patient the right imaging exam at the right time with the right radiation dose.

Unnecessary radiation comes from issues related to device use as well as clinical decision making.  For example, wide ranges have been observed for radiation doses associated with a specific types of imaging.  While organizations like the American College of Radiology (ACR) have taken steps to establish nationally recognized diagnostic reference levels,   variations still occur.  Clinicians may also lack important information that could better prepare them to make decisions while ordering medical imaging exams and the associated radiation exposure.

The FDA’s new initiative seeks to reduce unnecessary radiation exposure by:

A.   Promoting safe use of medical imaging devices:

  1. Establishing requirements for manufacturers of CT and fluoroscopic devices to incorporate additional safeguards into equipment design, labeling, and user training.
  2. Partner with the Centers for Medicare and Medicaid Services to incorporate key quality assurance practices into accreditation and participation criteria for imaging facilities and hospitals.
  3. Recommend that the healthcare professional community, in collaboration with the FDA, continue efforts to develop diagnostic reference levels for CT, fluoroscopy, and nuclear medicine procedures locally and also through a national radiation dose registry.

B.   Support informed clinical decision making:

  1. Establish requirements for manufacturers of CT and fluoroscopic devices to record radiation dose  information for use in patients’ medical records or a radiation dose registry.
  2. Recommend that the healthcare professional community continue to develop and adopt criteria for appropriate use of CT, fluoroscopy, and nuclear medicine procedures, or other procedures that use these techniques.

C.   Increasing Patient awareness:

  1. Provide patients with tools to track their personal medical imaging history.

While there are undeniable benefits to all radiation based imaging, it is critical to be mindful of the effects of overexposure to radiation.  We can all look forward to more appropriate care based on the initiatives of the FDA and others to reduce unnecessary exposure.


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