Salt Lake City — In recent years, new medical knowledge has raised concerns about the safety of radiation used in some medical diagnostic imaging tests. But until now, a program to accurately measure how much cumulative radiation patients receive over their lifetime while getting medical treatment has not been available.
Intermountain Healthcare hospitals and clinics are leading the nation by compiling the cumulative radiation patients receive from about 220,000 higher-dose procedures and imaging exams each year, starting with exams performed in the last quarter of 2012. That information is now readily available to both physicians and patients.
Physicians and other medical personnel can review the cumulative radiation a patient has received through Intermountain's electronic medical record system. Patients can view their own radiation history by signing up for Intermountain's free "My Health" program, which provides information through a secure password-protected portal on the Internet. In addition to providing the cumulative radiation history, patients and physicians are also given access to educational materials on the risks and benefits of medical radiation.
"We are very excited to begin see the benefits of monitoring cumulative radiation," says Donald Lappé, MD, medical director of Intermountain's Cardiovascular Clinical Program. "With this information, clinicians and staff have reduced radiation, avoided unnecessary treatments, and found alternatives which do not involve x-rays."
While a patient's individual situation typically dictates the imaging procedure needed, knowing a patient's cumulative radiation exposure can help physicians and medical caregivers determine which type of imaging test is best. The benefits from a procedure usually outweigh the slightly increased cancer risk from exposure to radiation, but the potential risk of radiation should be considered before these imaging tests are performed. In some cases, equivalent information can be obtained with a medical test that does not use radiation, such as ultrasound or MRI scans.
"Having such information available is especially helpful for children with certain chronic health problems, as they may need to have many tests involving radiation during their lifetime," says Keith White, MD, medical director of Intermountain's Imaging Services. "The cancer risk from an imaging test is lower the older a person gets, and the highest risk is for children."
Intermountain has continually looked for ways to adjust imaging processes to maintain the benefits of medical imaging while minimizing the risks to patients. Nationally, much of the clinical movement to decrease radiation exposure has emerged from the pediatric radiology community, and radiologists from Primary Children's Medical Center, which is owned by Intermountain Healthcare, have actively contributed to this effort. For example, Primary Children's is one of six pediatric hospitals nationally participating in a study to establish benchmarks for appropriate radiation exposure in pediatric CT exams. The commitment to reducing dose is an ongoing commitment of Intermountain Healthcare to patients at all its facilities.
Images created using radiation provide important information about a patient's health. They are often needed to help doctors and other health professionals diagnose a problem or treat it in the best way. Imaging tests using radiation include CT scans, angiograms, nuclear medicine heart tests, mammograms, x-rays, and bone density scans. MRI and ultrasound exams do not use radiation to produce an image.
It's well understood that exposure to high doses of radiation — much higher than the amounts used in imaging exams — involves an increased risk of cancer, as well as other potential damage to the body. Most experts agree that there is some risk connected to low-dose radiation exposure at the level used in medical imaging, although the exact risk is not definitively known.
Most medical imaging tests add only a small fraction of radiation exposure when compared to natural sources of radiation. For example, a chest x-ray uses about the same radiation as living in your natural surroundings for about 10 days. There isn't consensus among experts about the magnitude of cancer risk, but doctors agree that patients shouldn't be exposed to any more radiation than necessary. Intermountain has specifically targeted imaging tests that use higher level of radiation, such as CT.
Still, when a CT scan or another imaging test is deemed necessary, patients should get it, says Dr. White. "The radiation doses are not significant enough compared to the benefit of extending lives, saving lives, and improving the quality of lives. At Intermountain Healthcare, we feel that it is our duty to patients to do all that we can to reduce exposure to radiation while continuing to provide excellent medical care," he said.
Sharing the cumulative radiation number with patients and their healthcare providers is just one of many steps Intermountain takes to increase safety with medical radiation. Intermountain routinely reviews its processes and works hard to use the least amount of radiation necessary to produce high-quality diagnostic images. Intermountain has also partnered with GE Healthcare to develop techniques that help further reduce radiation doses from CT scans by up to 50 percent, while still maintaining a high-quality image.