Outside pressure has helped raise the priority of this patient
safety issue to the point that it now has the attention of physi-
cians, hospital management, and equipment manufacturers.
reduce patient exposure. These solutions
include redesigning scan protocols, post
processing software, and dose modulation. It concluded the main strategies for
reducing dose are changes in acquisition
parameters (kVp, gantry rotation time,
milliampere, pitch), post processing
to eliminate rescanning for additional
planes and filtering out noise, and manufacturers installing dose modulation capabilities on the scanners. 6
A 2002 article in the British Journal
of Radiology describes several steps in
helping to reduce patient dose. These
become established, a particularly intense
approach to protecting both patient and
operator was indicated. 13
Research should be conducted in the
next few years to evaluate the effectiveness
of the dose reduction efforts currently being implemented. This research should
include discussions of proper referring
physician utilization of CT, proper radiologist oversight of CT utilization and CT
protocol construction, original equipment
manufacturer (OEM) equipment radiation reduction technology advancement,
and radiation safety education level for all
Clear justification for CT exams
Target examination technique to the
clinical application and exposure neces-
sary resulting in the minimal dose to the
A single spiral exposure or sequence of
serial scans that will satisfy the clinical
Performing additional contrasted scans
only when clear clinical evidence of need
The tube current should be reduced to
minimum, especially in high resolution
Current literature should be routinely
reviewed to assure current practice is
aligned with the best, most recent evi-
Imaging centers should actively partici-
pate in further national studies to help
refine reference levels for CT
A study in 2009 echoed the need for
dose reduction, and concluded that
“doses for commonly performed CT
exams are higher and more variable
than generally quoted.” 14 In addition,
concerns were expressed in the areas of
interventional CT and CT fluoroscopy.
When procedures under CT fluoroscopy
The general consensus is that the cur-
rent level of CT utilization is much too
high and is climbing at an alarming rate.
The advancement of CT technology has
brought about the ability to scan larger
anatomical areas with greater speed and
detail. This ability comes at a cost. As
more options became available, the de-
mand for these studies grew at a rapid
pace. With over half of the radiologists
and 90% of the referring physicians un-
derestimating the danger, the problem
will continue to grow. Our failure to po-
lice ourselves has encouraged interven-
tion from outside influences such as The
Joint Commission, Centers for Medi-
care and Medicaid Services, commercial
insurance payers, and the general pub-
lic. 7 Outside pressure has helped raise
the priority of this patient safety issue to
the point that it now has the attention
of physicians, hospital management, and
1Goldman LW. Principles of CT and CT technology. J Nucl Med Technol. September
2007; 35( 3):115–128.
2Guzick DS. The department of imaging services. The Univ of Rochester Dept of Med
newsletter. 2005; June 02. Available at:
April 5, 2011.
3Ehealthmd.com. Advances in CT. 2011. Available at: http://ehealthmd.com/library/
ctscan/ CTS_advances.html. Accessed April
4Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol.
2001 Feb;176( 2):289–96.
5Brenner D, Hall E. Computed tomography—
An increasing source of radiation exposure.
N Engl J of Med. 2007;35:2277–2284.
6Smith A, Dillon W, Gould R, Wintermark M.
Radiation dose-reduction strategies for
neuroradiology CT protocols. Am J of
7U.S. Food and Drug Administration, Center
for Devices and Radiologic Health.
Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging. 2010. Available
Reduction/ ucm199994.htm. Accessed
April 5, 2011.
8Brix G, Nagel HD, Stamm G, et al. Radiation
exposure in multi-slice versus single-slice
spiral CT: Results of a nationwide survey.
Euro Radiol. 2003;13:1979–1991.
9Hidajat N, Wolf M, Nunnemann A, et al.
Survey of conventional and spiral CT
doses. Radiol. 2001;218:395–401.
10Aziz ZA, Padley SP, Hansel DM. CT techniques for imaging the lung: Recommendations for multislice and single slice