Hospitals analyzing the radiation risk

Dr. Paul Gabriel saw a young man in the Grant Medical Center emergency department last week who had kidney pain and blood in his urine.

The default step for the ER director would be to order a CT scan. But the patient had undergone six scans — including one the month before — that all confirmed kidney stones.

To send him for another was probably a waste of time and resources, but more important, it was going to increase the man’s lifetime exposure to radiation.

So they agreed to skip the test.

“He was extremely appreciative,” Gabriel said. “He said, ‘I don’t want to have cancer in 20 years,’ and I said, ‘I don’t want you to.’ ”

Americans are increasingly asking whether medical professionals are doing all they can to limit patients’ exposure to CT scans and X-rays.

Doctors and hospital leaders say they’re investing time and money making sure that decisions are medically wise and err on the side of protecting patients.

“There’s everywhere in America a growing awareness,” said Dr. Richard White, chairman of radiology at the Ohio State University Medical Center. “The awareness is justified, but some of the fear isn’t.”

Patients with cancer, gastrointestinal disorders or repeated kidney stones, for example, have repeated scans and should be most concerned, White and others said.

And if the scans begin early in life, there’s more reason to be cautious, as radiation exposure over many years poses more risk.

Two years ago, news that Cedars-Sinai Medical Center in Los Angeles gave hundreds of patients about eight times the normal amount of radiation during diagnostic scans drew the attention of patients, doctors and regulators, and it has served as a catalyst for improvements nationwide.

Last month, the Joint Commission, which accredits hospitals and often prompts quality-improvement efforts, sent a notice urging health-care providers to find new ways to avoid repeated doses of harmful radiation.

In the past 20 years, Americans’ radiation exposure has nearly doubled because of increased use of imaging.

“CT scanning has become the single-most-important source for radiation exposure in humans,” said Dr. Pablo Ros, chairman of radiology at University Hospitals in Cleveland.

“It’s very successful, very powerful and provides a lot of information, but particularly our nonradiology colleagues may not realize the significance of the radiation exposure,” he said.

At times, those tests aren’t necessary, or the patient might be better served by other diagnostic tools, such as ultrasound or MRI.

If a patient does need a CT scan, the dose can be limited. Other times, no scan is really needed, but doctors feel obligated to order one to guard against legal problems.

“We order way too many CT scans. There’s tremendous pressure,” Gabriel said.

To reduce exposure, hospitals are buying better equipment and educating referring physicians about how best to determine whether CT scans or X-rays are really needed, White said.

At Ohio State and other centers, technicians have been trained to better tailor the scans to patients.

“A little tiny lady won’t get the same strength of the power of the beam as a larger person,” White said.

This practice “takes some more time and effort, but once it’s put into the daily grind, the techs respond well and the patients like it,” Ros said.

Michelle Hamilton, director of radiology at Mount Carmel West, said conversations with patients about the risks and benefits of scans are routine.

And the hospital continues to evaluate changes it can make to reduce exposures, including recently lessening the dosing for cardiac CT scans.

One important advance within the OhioHealth system has been a viewing program that allows radiologists to look at all the scans a patient has had within the system, said Dr. Harlan Meyer, radiology medical director at Grant.

They can see all exams since 2003, and if a patient has had 25 since then, it qualifies as a “ radiation alert,” prompting more evaluation. In some cases, those patients go on to undergo a different diagnostic approach, such as MRI, Meyer said.