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Ionizing Radiation Utilized For Medical Imaging: The Benefits Don't Come Without Risks
Advances in medical imaging over the past several decades have had undeniably positive effects on patient care. Current cross-sectional imaging examinations can provide exquisite anatomic detail, and the rapid speeds of image acquisition and display allow important diagnoses to be made accurately within minutes. Much of the credit goes to CT, with state-of-the-art multidetector scanners allowing images of the entire body to literally be obtained within a matter of seconds.
Because of these technical developments, the use of CT in the United States has skyrocketed, from 3 million total examinations performed in 1980 to 60 million in 2005. As a CT study may expose a patient to as much as 100 times the radiation dose needed to image the same body part radiographically, there are appropriate concerns about the known carcinogenic effects of ionizing radiation. Mostly because of CT, medical imaging is about to surpass natural background sources as the largest per capita cause of radiation exposure to the US population.
Radiation-induced cancer mortality statistics are derived from studies of Japanese atomic bomb survivors and, therefore, must be considered estimates. The following, however, are generally accepted as facts:
• Radiation-induced cancers appear at the same ages as similar spontaneous cancers
• Cancers of the bone marrow, thyroid, breast and lung present the greatest mortality risks
• Regardless of the time of exposure, the risk of developing such cancers persists throughout life
• Children are approximately ten times more sensitive to these carcinogenic effects than are adults, with girls at greater risk than boys
The risk of cancer mortality resulting from a single whole body CT scan on a 45-year-old patient is estimated at 1 in 1,250 (0.080%). At age 65, this risk decreases to 1 in 1,700 (0.059%). While these numbers appear small, they are greater than the 1 in 5,900 (0.017%) risk of dying in an automobile accident in the US during any given year. Therefore, exposure to the ionizing radiation utilized for diagnostic imaging should never be considered trivial.
When ordering a diagnostic imaging study that utilizes ionizing radiation, in particular CT, the following should be considered:
• Limit the imaged anatomy to the area of clinical concern
• Avoid repetitive studies
• Sonography or MR imaging should alternatively be used if available and likely to be of comparable diagnostic utility
 
The image on the left is of a multidetector CT scanner. The image on the right is the new radiation warning symbol introduced in February 2007 in an attempt to better illustrate that ionizing radiation may be lethal to humans. Unfortunately, the benefits offered by the equipment on the left come with the risks alluded to on the right.
The American College of Radiology (ACR) published a "white paper" on radiation dose in medicine in the May 2007 issue of its journal, JACR, which can be accessed via this link: ACR Radiation White Paper.
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Northwest Radiologists Participating In Medicare PQRI Program
As most physicians and allied healthcare providers are likely now aware, CMS instituted a pay-for-performance (P4P) project called the Physician Quality Reporting Initiative (PQRI) last month. This is a voluntary program that gives incentives for successfully reporting quality data provided under the Medicare Physician Fee Schedule between July 1 and December 31, 2007. PQRI is part of Medicare’s attempt to transform itself from a passive payer to an active purchaser of high-value healthcare, and it is an early step toward the inevitable linking of health professionals’ payments to quality.
There are 74 total PQRI items, with two specifically affecting radiology. Both pertain to stroke and TIA patients, one (Measure 10) involving brain imaging and the other (Measure 11) carotid imaging. In order to be PQRI compliant, our examination reports must contain specific language with regard to the description of certain findings, and ordering healthcare professionals are presented with new examination terminology. If you have inpatients admitted with stroke or TIA (or whose discharge ICD-9 codes may ultimately indicate the presence of such), we encourage you to order the relevant imaging studies using this new terminology. They have already been made part of the CareLink charge master, and we hope that they are somewhat self-explanatory.
Screen capture from CareLink, listing some of the new PQRI-compliant radiology orders that we encourage you to use when appropriate.
While a confidential physician-based initiative at this time, it is widely anticipated that CMS and other providers will soon be making this type of P4P data readily available to our healthcare consumers. As hospital-based physicians, our success with PQRI will reflect positively on Northwest Community Healthcare as a whole. We apologize for any inconvenience or confusion that this may cause, but we do hope for your support. Please feel free to contact us with any questions, comments or concerns. We assume that many of you are setting up your own PQRI programs at this time, and we are more than willing to do what we can to assist you in your efforts.
For more information about Northwest Radiology Associates, the services we provide, and how to contact individual radiologists, please visit our web site: northwestradiologyassociates.com.
If you wish to be added to our distribution list, or if you have any questions or comments, please email: ckalbhen@northwestradiologyassociates.com.
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