ECRI Institute's recommendations for controlling CT radiation dose

The benefits of computed tomography (CT) have increased greatly over the past decade. Now twice as powerful, it offers dynamic images of anatomy, including the beating heart. Future advancements promise to deliver even more clinical benefits. However, CT has always had a downside: it can deliver high radiation doses to patients, putting them at increased risk of developing cancer.

Keeping CT radiation dose in check is a top safety concern for hospitals, and one of the most complex problems to solve.  While high levels of radiation may put patients at risk, too little will diminish image quality—possibly resulting in misdiagnosis or the need for patients to be rescanned and exposed to even more radiation.

Practical recommendations for striking the delicate balance between too much and not enough radiation are presented in a new guidance article, "CT Radiation Dose: Understanding and Controlling the Risks©," released by ECRI Institute (www.ecri.org), an independent, nonprofit organization that researches the best approaches to patient care. This comprehensive Health Devices© article expands on the recommendations about controlling CT radiation dose published in ECRI Institute's 2010 Top 10 Technology Hazards list.

"Healthcare facilities are obviously interested—and in principle—committed to managing dose during CT," says James Keller, Jr., vice president, health technology evaluation and safety, ECRI Institute. "But a recent ECRI Institute survey suggests that most hospitals don't actively track and audit radiation doses in CT."

According to Keller, the newest CT models are being built with dose-saving technologies, but they can be cost-prohibitive for many organizations. ECRI Institute's aim is to provide unbiased, objective guidance to help facilities ensure that even older models are delivering the lowest reasonable radiation exposure to patients.

"In time, these technologies will become more widely installed," says Keller. "Until then, there are a number of effective strategies every facility can implement to reduce dosage."

While the radiologist is ultimately responsible for radiation dose control, ECRI Institute emphasizes that the responsibility also lies with the facility itself, referring physicians, medical physicists, radiation technologists, and CT device manufacturers. The article identifies sixteen practical recommendations that every facility should consider to help control radiation dose in CT. The recommendations are organized into 5 main categories: prioritizing dose reduction, protocol optimization, patient selection, the technician's responsibilities, and quality assurance.

"While most CT users are aware of dose-saving adjustments that can be made on the scanner, we are presenting details on aspects that may not be universally understood—and that may actually be counterintuitive," says Jason Launders, MSc, lead author of the article and senior medical physicist at ECRI Institute.

The article includes a section on dose-reduction technologies—and how much dose savings they each achieve. For example, it includes the advantages and limitations of axial cardiac scanning, iterative reconstruction, specific-organ dose reduction, adaptive postprocessing software, and other technologies. Also included is a CT Dose Primer section, which explains factors that can be re-programmed in any CT system to reduce dose.

"CT Radiation Dose: Understanding and Controlling the Risks" is featured in the April 2010 issue of Health Devices, ECRI Institute's monthly journal featuring independent, comparative evaluations of medical devices and systems, as well as in-depth technology guidance.