New Efforts Look to Cut Radiation From CT Scans

Wall Street Journal
April 9, 2013
New Efforts Look to Cut Radiation From CT Scans

Featuring:Dr. Jason Naidich, Sr. VP, Imaging, and Chair, Radiology, North Shore-LIJ, and Dr. John Pellerito, Associate Chair, Radiology

The health-care industry is trying to dial back the amount of radiation used for high-quality diagnostic images.

After several studies linked the growing use of CT scans to greater risk for cancer, physicians, radiologists, researchers and manufacturers are working to try to lower radiation exposure through improved software programs, new diagnostic machines, and a push for doctors to order fewer tests.
Use of CT scans nearly quadrupled from 1996 to 2011, although the growth has started to slow, according to figures from IMV Medical Information Division, a marketing research and consulting firm.

CT scans are used to detect problems in the body's soft tissues and muscles and can provide definitive diagnoses for conditions like appendicitis and pulmonary embolisms without invasive surgeries. The more radiation that is used, the clearer the picture.

Many radiologists acknowledge they have reviewed images with higher quality than necessary. But, they say, a patient potentially would be exposed to even more radiation if an initial scan isn't clear enough.

Informing Patients
Some argue that patients need to know more about the radiation dangers and should have a bigger say in how their tests are administered.

Getty Images
The more radiation that is used for CT scans, the clearer the picture.

At Mayo Clinic in Jacksonville, Fla., medical physicist Richard Morin says that he explains to patients how Mayo doctors meet regularly to look at the amounts of radiation they use, and that patients are reassured when they understand that Mayo is working to make sure the exposure is as little as possible.

"We want to be using the optimal amount—not too much and not too little," says Mr. Morin, who also is the chairman of the Dose Index Registry for the American College of Radiology, based in Reston, Va., which collects data from scanners at hospitals around the country to help set national standards for radiation exposure.

Medical-equipment manufacturers such as General Electric Co., Siemens AG and Philips Electronics NV have developed new software packages that allow radiologists to use as much as 60% less radiation to get images. Siemens says it has installed 100 machines with this new software in the U.S.

"Patients should be more demanding that they are getting the lowest dose possible," says Gene Saragnese, who runs imaging systems for Philips Healthcare. "There are still machines out there that are 10 years old."

North Shore-LIJ Health System recently began using a software package from GE with the aim of reducing radiation doses as much as 65%. The software works only on the company's top-of-the-line CT machines.

Slower Results
But change is slow. John S. Pellerito, imaging technology chief for North Shore, which has hospitals throughout greater New York, says, "The processing techniques used with this new equipment require adjustments." The software takes longer to generate images, so it can't be used in emergencies, says Jason Naidich, chairman of North Shore's radiology department.
Some doctors say their fellow physicians should learn not to order unnecessary or duplicative tests, and to be willing to sacrifice some image quality.

Alec J. Megibow, professor of radiology at NYU Langone Medical Center in New York City, says he often receives orders from physicians for a CT scan with and without contrast, which would require two scans and twice the exposure.

Dr. Megibow says two scans rarely are medically justifiable, so he only runs one test. "If I have to bring one out of 1,000 back, I'll live with that," he says. "The perverse incentive is I get paid for doing both. I am being paid to practice bad medicine."

Ms. Linebaugh is a staff reporter for The Wall Street Journal in New York. She can be reached at [email protected].

A version of this article appeared April 9, 2013, on page R4 in the U.S. edition of The Wall Street Journal, with the headline: New Efforts Look to Cut Radiation From CT Scans.

Focus onHealth TV

Watch Focus onHealth, Northwell Health's TV show. It's the healthy way to stay informed!