Radiologists Across the World Need to Lead the Way in Radiation Safety

As the gatekeepers of imaging, radiologists worldwide need to take a leading role in educating patients, referring physicians and the public about the issues surrounding radiation safety, according to a panel of experts from across the globe gathered for RSNA's International Trends meeting.

By Elizabeth Gardner

Held Monday, this year's meeting focusing on "Radiation Safety Regulations and Impact on Patient Care," drew more than 30 attendees representing major radiology organizations across the globe. They gathered to assess the current state of radiation safety regulations and discuss how radiologists can impact the issue. Each year the International Trends meeting is held on a topic of global concern to the profession to help radiology organizations work together toward solutions.

"We can all remember coming to this meeting when ultrasound was the hot topic, and then CT and then MRI, but right now there are no new technologies and quality and safety are the hottest topic," said James Borgstede, M.D., president of the International Society of Radiology and RSNA Board Liaison for International Affairs who co-moderated the meeting with International Advisory Committee Chair Byung Ihn Choi, M.D. "If we don't take the lead here, someone else will."

Radiation Education, Awareness Lacking

A survey conducted among the attendees before the meeting showed that while most thought their countries do a reasonably good job of regulating radiation exposure, a majority think that neither their country's referring physicians nor their patients are well-educated on the issue. Respondents also said their governments were the most influential factor in determining how radiation exposure is regulated while educational institutions are perceived to have the least influence.

Radiation exposure from all sources has increased 65 percent in the past decade—partly due to greatly expanded use of CT scans—said presenter Marilyn Goske, M.D., Corning Benton Endowed Chair for Radiology Education, Professor of Radiology and Pediatrics at the University of Cincinnati College of Medicine and staff radiologist at Cincinnati Children's Hospital Medical Center who founded and chairs the international Image Gently® campaign focusing on using kid-sized imaging for children in the U.S.

"There has been an alphabet soup of international agencies working toward radiation protection for years, but now the conversation has really moved into the medical field, where there's greater awareness of the need for optimizing dose," Dr. Goske said.

While awareness of radiation exposure has grown, it's by no means universal even among medical personnel said Omolola Atalabi, M.B.B.S., of Nigeria, where there are fewer than 500 radiologists serving a country of 170 million people. Dr. Atalabi said that most radiological exams in Nigeria are carried out by thousands of radiology assistants with no formal training. In the U.S., Dr. Goske said the Image Gently campaign recently expanded its outreach to include the nation's 143,000 dental hygienists who collectively take no formal position on radiation exposure, despite being responsible for millions of dental X-rays annually.

Without a clear understanding of the risks of radiation exposure weighed against the advantages of imaging studies, non-radiologists can make a host of unreasoned decisions, said Ulrich Bick, M.D., professor of radiology and vice-chair in the Department of Radiology at the CHARITE Berlin, Germany, who discussed the issue of appropriate use. In Germany, the law gives radiologists the ultimate say in whether a study is appropriate by giving them the authority to overrule a referring physician. All the same, "appropriate use looks easier than it is," Dr. Bick said. Practice guidelines disagree and sometimes payers may refuse to cover an exam if they think it's too expensive. For new modalities or types of exams, payers demand the highest level of evidence, a randomized controlled trial, before they'll cover the cost, Dr. Bick said. "It's ridiculous, because those trials are usually not available and it delays access to new tests."

Residents May Face Knowledge Gap

Perhaps the most concerning knowledge gap (though the one that might be easiest to fill) is among radiology residents. While they are required to record dose information as part of their reports, many don't understand its significance, said Teresita Angtuaco, M.D., a professor of radiology and director of the Division of Imaging at the University of Arkansas for Medical Sciences and chair of RSNA's Committee on International Radiology Education.

"Residents have to learn it for the board exams, but that's the only interest they have in radiation dose issues," Dr. Angtuaco said.

"We have to engage the residents in thinking that this is part of their job and to educate the public about radiation safety, because they're the gatekeepers of imaging," Dr. Angtuaco added. "Who else is going to tell people if radiologists don't?"

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