Priscilla F. Butler

Image Gently: Ten Steps You Can Take to Optimize Image Quality and Lower CT Dose for Pediatric Patients

AJR:194, April 2010 This article suggests 10 steps that radiologists and radiologic technologists, with the assistance of their medical physicist, can take to obtain good quality CT images while properly managing radiation dose for children undergoing CT. The first six steps ideally should be completed before performing any CT on a pediatric patient. The final four steps address the unique consideration that should be given for each scanned patient.

The ACR BI-RADS® Experience: Learning From History

The Breast Imaging Reporting and Data System (BI-RADS) initiative, instituted by the ACR, was begun in the late 1980s to address a lack of standardization and uniformity in mammography practice reporting. An important component of the BI-RADS initiative is the lexicon, a dictionary of descriptors of specific imaging features. The BI-RADS lexicon has always been data driven, using descriptors that previously had been shown in the literature to be predictive of benign and malignant disease. Once established, the BI-RADS lexicon provided new opportunities for quality assurance, communication, research, and improved patient care. The history of this lexicon illustrates a series of challenges and instructive successes that provide a valuable guide for other groups that aspire to develop similar lexicons in the future.

ACR White Paper on Radiation Dose in Medicine: Three Years Later

The benefits of diagnostic imaging are immense and have revolutionized the practice of medicine. The increased sophistication and clinical efficacy of imaging have resulted in its dramatic growth over the past quarter century. However, the evolution of imaging has also resulted in a significant increase in the populations cumulative exposure to ionizing radiation and a potential increase in cancer risk. The ACR, an advocate for radiation safety since its inception in 1924, convened the ACR Blue Ribbon Panel on Radiation Dose in Medicine in 2006 and issued 37 recommendations for the College to address these issues. This report updates the status of these recommendations.

Image GentlySM: A National Education and Communication Campaign in Radiology Using the Science of Social Marketing

Communication campaigns are an accepted method for altering societal attitudes, increasing knowledge, and achieving social and behavioral change particularly within public health and the social sciences. The Image Gently(SM) campaign is a national education and awareness campaign in radiology designed to promote the need for and opportunities to decrease radiation to children when CT scans are indicated. In this article, the relatively new science of social marketing is reviewed and the theoretical basis for an effective communication campaign in radiology is discussed. Communication strategies are considered and the type of outcomes that should be measured are reviewed. This methodology has demonstrated that simple, straightforward safety messages on radiation protection targeted to medical professionals throughout the radiology community, utilizing multiple media, can affect awareness potentially leading to change in practice.

U.S. Diagnostic Reference Levels and Achievable Doses for 10 Adult CT Examinations

Purpose To develop diagnostic reference levels (DRLs) and achievable doses (ADs) for the 10 most common adult computed tomographic (CT) examinations in the United States as a function of patient size by using the CT Dose Index Registry. Materials and Methods Data from the 10 most commonly performed adult CT head, neck, and body examinations from 583 facilities were analyzed. For head examinations, the lateral thickness was used as an indicator of patient size; for neck and body examinations, water-equivalent diameter was used. Data from 1 310 727 examinations (analyzed by using SAS 9.3) provided median values, as well as means and 25th and 75th (DRL) percentiles for volume CT dose index (CTDIvol), dose-length product (DLP), and size-specific dose estimate (SSDE). Applicable results were compared with DRLs from eight countries. Results More than 46% of the facilities were community hospitals; 13% were academic facilities. More than 48% were in metropolitan areas, 39% were suburban, and 13% were rural. More than 50% of the facilities performed fewer than 500 examinations per month. The abdomen and pelvis was the most frequently performed examination in the study (45%). For body examinations, DRLs (75th percentile) and ADs (median) for CTDIvol, SSDE, and DLP increased consistently with the patients size (water-equivalent diameter). The relationships between patient size and DRLs and ADs were not as strong for head and neck examinations. These results agree well with the data from other countries. Conclusion DRLs and ADs as a function of patient size were developed for the 10 most common adult CT examinations performed in the United States.

Image gently 5 years later: What goals remain to be accomplished in radiation protection for children?

477 to house these materials for download by parents, medical professionals, government agencies, and health care organizations worldwide. The brochures empower parents with basic information about their child’s examination and afford them the opportunity to ask questions before the imaging test. This process of informed decision making provides the underpinning for a partnership between caregivers and family, which is encouraged by the Institute of Medicine [3] as a fundamental aspect of medical professionalism.

The ACR/Society of Breast Imaging Resident and Fellowship Training Curriculum for Breast Imaging, Updated

The education committees of the ACR Commission on Breast Imaging and the Society of Breast Imaging have revised the resident and fellowship training curriculum to reflect the current state of breast imaging in the United States. The original curriculum, created by the Society of Breast Imaging in 2000, had been updated only once before, in 2006. Since that time, a number of significant changes have occurred in the way mammography is acquired, how adjunctive breast imaging methods are used, and how pathology is assessed. This curricular update is meant to reflect these and other changes and to offer guidance to educators and trainees in preparing those interested in providing breast imaging services.

Radiation protection and dose monitoring in medical imaging: a journey from awareness, through accountability, ability and action…but where will we arrive?

Abstract Radiation awareness and protection of patients have been the fundamental responsibilities in diagnostic imaging since the discovery of x-rays late in 1895 and the first reports of radiation injury in 1896. In the ensuing years, there have been significant advancements in equipment that uses either x-rays to form images, such as fluoroscopy or computed tomography (CT), or the types of radiation emitted during nuclear imaging procedures (e.g., positron emission tomography [PET]). These advancements have allowed detailed and indispensable evaluation of a vast array of disorders. In fact, in 2001, CT and MRI were cited by physicians as the most significant medical innovations in the previous 3 decades. Rapid technological advancements in the last decade with CT, especially, have required imaging professionals to keep pace with increasingly complex technology to derive the maximum benefits of improved image acquisition and display techniques, in essence, the improved quality of the examination. It has also been challenging to fulfill the fundamental responsibilities of safety during this period of rapid growth (e.g., radiation protection, management of the risk of additional interventions driven by incidental findings, performing studies that were not indicated). The purpose of this paper is to define critical issues pertinent to ensuring patient safety through the appropriate assessment, recording, monitoring, and reporting of the radiation dose from CT.

Approaches to promotion and implementation of action on radiation protection for children

The Radiation Protection in Medicine conference, reviewed in this journal supplement, outlined nine strategies to promote radiation protection for patients. The Alliance for Radiation Safety in Pediatric Imaging has focused its work on three of those areas: creating awareness of the need and opportunities for radiation protection for children; developing open-source educational materials for medical professionals and parents on this critical topic for improved patient safety and communication; and lastly, advocating on behalf of children with industry, government and regulatory bodies to improve equipment design and safety features, standardisation of nomenclature and displays of dose reports across vendor platforms that reflect the special considerations of children.

Clinical Implementation of the National Electrical Manufacturers Association CT Dose Check Standard at ACR Dose Index Registry Sites

PURPOSE The goal of the study was to determine if and how the National Electrical Manufacturers Association CT Dose Check standard has been implemented in clinical practice. METHODS A survey was conducted of all sites participating in the ACR Dose Index Registry, using a web-based survey instrument, to determine whether respondents were aware of the CT Dose Check standard and the American Association of Physicists in Medicine (AAPM) recommendations for Dose Alert values, and if clinical sites had implemented it. RESULTS A total of 170 responses were received, representing 37% (170/460) of surveys sent and 23% (170/734) of facilities participating in the ACR Dose Index Registry. Of responding facilities, 57.1% (96/168) were aware of the CT Dose Check standard, and 51.2% (86/168) were aware of the AAPM recommendations. At 44% (73/165) of responding facilities, at least 1 CT scanner with Dose Check capability was present. Of sites responding that they had at least 1 CT scanner with this capability, 57% (42/74) had implemented Dose Alerts, and 71% (30/42) had implemented Dose Notifications on CT scanners with the capability. Most responding sites were located in community hospitals (55.8%; 86/154). CONCLUSIONS Although the National Electrical Manufacturers Association CT Dose Check standard and the AAPM recommendations for its use had been available for at least 2 years at the time of the survey, nearly half of the participating sites were not familiar with them. Education and outreach are needed if this tool is to be used effectively.