Radiology, arguably, has been one of the fastest growing but least visible areas of medicine over the past two decades. The role of the stethoscope and the skill of a hands-on physical examination are less important and less utilized today because we are now able to effectively see inside the human body and make diagnoses that may have required extensive surgery in the past. The success of imaging can be measured by the sheer volume of imaging procedures that are performed in this country on a yearly basis.
Despite its success and importance, radiology is often an invisible component of the health care success story from the perspective of the general public. Physicians utilize the services of radiologists but patient’s rarely see or understand the importance of the radiologist or the radiology process in its entirety. In a recent article in the Wall Street Journal, “Dialing Back on Radiation in CT Scans to Lower Risk” (June 12,2012), the lay public was given a rare glimpse of an area of active concern for radiologists, Primary care physicians and Specialty physicians.
The Wall Street Journal article outlined a study from Duke University that explored the possibility that effective CT examinations for appendicitis can be performed with significantly lower (50% lower) radiation doses to the patient. In the past the goal of radiologists and radiology equipment vendors was to design the radiology exam to acquire the most pristine picture possible—clearer and more detailed radiology pictures meant better diagnosis was the mantra. The realization is “crystal clear” CT pictures come at a price– excessive and potentially damaging radiation exposure.
It has been known for over a century that radiation carries a risk. It has been over the last decade though that the risk of even low dose radiation, especially to children, has been more clearly defined and understood. Radiology offers excellent diagnostic capabilities but new evidence suggests this often life-saving capability must be weighed against the small but measurable risk of long-term harm or delayed cancer risk. Since 2002 the pediatric radiologist population has been extensively researching and advocating that radiology must be practiced with the concept of ALARA (radiology exams performed with radiation doses As Low As Reasonably Achievable) firmly in mind. The web site, www.ImageGently.org was created and has become an extensive source of knowledge for physicians and patients centered on the concept of performing radiology with concern about the radiation exposure that accompanies many radiology exams.
The adult radiology community followed this success with a campaign and web site known as www.ImageWisely.org. These initiatives are a stark reminder that the days of just pursuing a stellar picture are over. Imaging departments must always attempt to utilize the dramatic and potentially life-saving resources of radiology with ALARA firmly in mind and must pursue the lowest radiation dose that allows the appropriate diagnosis to be made. Even if that means not getting the prettiest picture these expensive machines can produce. The Duke study showcases one of many approaches being explored to be certain that the proper balance of what is possible, what is necessary and what is safe be maintained in the delivery of care to patients who need radiology resources for their health care concerns.
In the end, concern over ALARA points to the importance of having very highly trained radiology clinical specialists available as the knowledge base of radiology has exploded at the same rate as the number of scans. More importantly ALARA standards mandate that the radiologist- to hospital- to physician communication channel be well designed, extensively utilized and serve as a conduit of patient relevant information. This helps to ensure that the correct exam is ordered, the correct exam is performed, and the appropriate interpretation provided –this commitment to sub-specialty based radiology decision making and communication will help guarantee that the radiologist’s diagnosis is made with the least radiation exposure to the patient.
ALARA education and implementation has been at the forefront of my current practice, Foundation Radiology Group, for several years. An extensive dialogue has been developed with equipment vendors who service hospitals to allow for robust proactive involvement in all equipment decisions that promote ALARA principles. Additionally, the utilization of an extensive sub-specialization model ensures that training levels and communication expertise is appropriately matched with the community clinicians to ensure that exams are completed correctly and interpreted with a level of accuracy exceeding industry standards. This allows for the exam to be performed, interpreted and acted upon with as little radiation exposure as possible. Foundation’s industry leading SAFR Quality Review (Strategically Aligned Foundation Radiology Quality Review) ensures that Peer to Peer reviews are performed at all facilities to provide a check and balance system to include reviewing imaging techniques —thus providing additional steps to the ALARA monitoring process. Foundation’s Elegant Radiology’s model and corporate culture carries a singular focus of ensuring that fertile channels of communication exist between all levels of the increasingly complex health care team. Foundation is committed to defining all pertinent radiology issues for hospitals and patients and will continue to strive to be ahead of emerging radiology trends in order to fulfill its mission statement: Revolutionizing the practice of radiology in community healthcare settings.
James W. Backstrom, MD, is the current Chief Medical Officer (CMO) for Foundation Radiology Group. A nationally renowned, fellowship trained neuroradiologist and pediatric neuroradiologist, Dr. Backstrom was recently named one of the top radiologists in his field by Pittsburgh Magazine in its annual “Best Doctors” issue. For more information about Foundation Radiology Group visit www.foundationradiologygroup.com or call us at (412) 223-2272.