Every couple of years the public is reminded that radiation is potentially harmful.  Most of us yawn as this is not exactly a eureka moment, while some of us panic, but what is being done about it?  In the past week the media brought this issue to our attention through an article published in the Archives of Internal Medicine which projected that radiation used in computed tomography (CT) scans performed in 2007 would ultimately induce 29,000 cancers and kill 15,000 people.  The American College of Radiology responded that there were some legitimate concerns about the accuracy of these projections, but there is little argument about the crux of the issue: x-ray exposure carries the risk of induced malignancies.

 

For many decades improving technology had allowed steady reductions in the amount of radiation needed to produce diagnostic x-ray examinations, thus lessening our attention to radiation dosage.  This changed radically when CT became available.  A CT procedure requires much more radiation than plain film x-ray.  Nonetheless it has been the belief of most physicians that the benefit of improved diagnostic accuracy more than compensated for the risk.  This is only true, however, if the CT examination is appropriate to the clinical question for which it is ordered.  If, on the other hand, the CT procedure is not appropriate, or can only provide information already at hand, or worst of all was ordered for “defensive” or commercial reasons, the risk far exceeds the benefit.  (See www.fanc.fgov.be/GED/00000000/2100/2109.pdf for an excellent brief discussion of the roots of overutilization.)  The problem, then, is what to do about this?

 

Radiology Benefits Management (RBM), including prior authorization of medical imaging requests, is perhaps the single most effective tool in addressing this problem.  RBM has proven to significantly reduce inappropriate

 

Continued