RSNA, ACR defend medical imaging in response to NEJM study/perspective

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The Radiological Society of North America (RSNA) and the American College of Radiology (ACR) have released statements defending the radiology profession in wake of a recent study and perspective published in the New England Journal of Medicine on imaging and radiation exposure that has garnered national media attention.

The RSNA “reaffirmed its commitment to patient safety” in response to the NEJM study, and accompaning perspective. In “Exposure to Low-Dose Ionizing Radiation from Medical Imaging Procedures,” Reza Fazel, MD, and colleagues reported that the repeated use of imaging procedures in the United States “can result in high cumulative doses of radiation.” And in a perspective accompanying the NEJM article, Michael Lauer, MD, asserted that most imaging tests haven’t proved beneficial compared with the risks and costs.

In its response to Fazel’s study and Lauer’s accompanying piece in NEJM, the ACR urged patients “not to delay or avoid seeking needed imaging care because of radiation concerns raised in a study and an ill-advised and misinformed perspective.”

The ACR said that the patients who experienced higher doses of radiation outlined in Fazel’s study “were almost certainly cancer patients and others with chronic illnesses whose conditions necessitated repeat exams” in order to determine treatment effectiveness and ensure short-term survival.

“For most other patients, repeated exams and the high levels of radiation discussed in the study are not reality,” said the ACR statement. “It is important to understand this to provide context and avoid unnecessary hysteria that may lead to patients foregoing necessary imaging care and placing their health in jeopardy.”

“There is overwhelming agreement in the radiology community that certain imaging procedures carry risk,” RSNA said, “but with appropriate utilization, low-dose protocols and implementation of programs that track cumulative dose in the patient's medical record, the potential benefits far outweigh that risk."

According to the RSNA, radiologists and other radiology professionals have followed strict imaging utilization standards and have worked to “improve the safety of imaging exams by minimizing dose without sacrificing diagnostic ability.”

The RSNA also pointed out that programs are being implemented to guard against the problem of cumulative radiation exposure. The society referred to a recent announcement by the Radiology and Imaging Sciences at the National Institutes of Health Clinical Center that CT and PET/CT equipment purchased by the center will be required to routinely record radiation dose exposure in a patient's hospital-based EMR.

While the study by Fazel and colleagues highlights a topic that should be “at the forefront,” the RSNA said, “it is important that one of the salient points from the authors not be overlooked: ‘An important reason for the growing use of such procedures stems from their ability to radically improve patient care.’”

As far as Lauer’s perspective is concerned, the ACR said “there is no evidence” supporting his claim that most imaging tests offer net negative results.

The ACR statement went on to say that the radiology community has embraced efforts to reduce radiation dosage and that radiologists “are working to lower dose and to educate elected officials, government agency staff and referring physicians of the need for further steps toward this goal.”

The ACR and the RSNA both mentioned the jointly created ACR/RSNA Task force for Adult Radiation Protection as well as the launching of the “Image Gently” campaign to raise awareness of pediatric radiation safety and to lower radiation dose in the imaging of children.