Tracking and reducing exposure is a top priority
for regulators, providers and vendors.
By Elizabeth Gardner
E XPOSING
DAN GER
It’s rare to hear excitement over another government reporting requirement, but that’s how Rebecca Smith- Bindman, M.D., feels about a new California law that requires providers to track their patients’ long-term ra- diation exposure from CT scans. “There’s been lots of struggling to respond to the requirements of this law, but I think it’s an extraordinary thing,” says
Smith-Bindman, director of the Radiology Outcomes Research Laboratory at the UCSF Medical Center, San Francisco, who contributed to
a December 2011 Institute of Medicine report on decreasing potential
environmental risks associated with breast cancer. She’s also principal
investigator on a project at the five University of California medical
centers to standardize and optimize CT doses system-wide and report
those doses as part of patients’ electronic health records (more information on the project is on page 24).
Her research shows that CT radiation doses are often 30 to 50
percent higher than they need to be for adequate imaging. The increased exposure is of acute concern because her research also notes
a five-fold increase in the number of CT scans in the past 20 years, to
about 75 million in 2010. In addition, a study published in The New
England Journal of Medicine estimates that 30 percent or more of advanced imaging studies may be unnecessary.
But Smith-Bindman also identified an enormous opportunity for
information technology to play a central role in tracking and reduc-
ing long-term radiation exposure. Her studies found that the mere act
of tracking doses can encourage a facility to reduce them, without
hurting overall image quality. “Radiology has this incredible elec-
tronic data and we have not done a good job of using it for qual-
ity improvement and patient-centered care,” Smith-Bindman says.
“We need to put this information in a special place in the electronic
record where it can be accessed.” She says that too often, the dose
information is locked in an image and never makes it to electronic
health record systems, where physicians besides the radiologist can
use it to evaluate whether the value of a CT scan is worth the addi-
tional radiation exposure.
