por Carol Ko
, Staff Writer | September 05, 2013
From the September 2013 issue of HealthCare Business News magazine
The benefits of CT scanning far outweigh its risks, but dose reduction continues to be a relevant and much-discussed topic partly because stories around the risks of CT radiation exposure continue to pop up in the media, causing consternation among the public.
Dose concerns have popped up again this year with a recent study that showed CT scans resulted in an increased cancer risk among pediatric patients. Children, who undergo two or three CT scans before they turn 15, face a three times greater risk for brain cancer, for example.
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The study suggested alternative methods of screening whenever possible along with widespread adoption of dose reduction techniques such as diagnostic reference standards, which set guidelines around how much radiation to use for certain patients. Such practices are already standard in Europe where physicians must stay within the limits of these standards or justify the extra dose they’re using.
Dose by any other name
Though there’s a concerted push within the United States to standardize, regulate and reduce dose, some daunting obstacles stand in the way of widespread dose reduction.
The first one is pretty basic: not everyone agrees on what dose is or how to measure it. “It’s like alphabet soup,” explains Siegel. “There are multiple terms thrown around.”
For example, one metric, the CT dose index, is a measurement of scanner output. But there’s also another metric called the dose length product. And recently, the American Association of Physicists in Medicine came out with yet another metric called size-specific dose estimates (SSDE) based on patient size.
These different metrics create confusion among practicing physicians, who typically don’t have time to fiddle with measurements or figure out the best metric to use. Different terminologies among different vendors further exacerbate the problem.
There’s also a big challenge on the training front. Though radiologists typically receive scattershot training in CT dose and physics, dose reduction is far from standard in all training programs. “There’s no push for them to look at dose, there’s no teeth behind it,” says Siegel.
Lack of education and training isn’t just limited to technologists or radiologists, either. A new study published in the August issue of Pediatrics indicated that most parents did not know that CT scans could increase their child’s risk of developing cancer. Siegel observes this in her own practice: “I rarely get questions from parents. They should understand that we’re also exposed to naturally occurring background radiation every day. They should clearly understand that if CT is the best test to evaluate their child’s illness, the radiation dose will be kept as low as possible. They should be empowered to ask if their imaging facility is using low dose techniques.”