Medical imaging saves lives every day, but several years ago, studies showed that even small doses of radiation can lead to patients eventually developing cancer. At Intermountain Healthcare, we've taken strategic steps to minimize exposure, and have seen excellent results.
Our multi-pronged initiative involved developing new software, purchasing and implementing radiation-reducing technologies, replacing tests that use radiation with other diagnostic assessments, standardizing imaging techniques across our 23 hospitals and clinics, and making special adjustments for both children and body size.
We're excited that the combined impact of this plan will likely lead to a healthier population generations from now, as they are expected to reduce lifetime cancer cases by 64 and decrease the lifetime cancer deaths by 32 per year.
Our team began the process of reducing radiation exposure by developing a comprehensive radiation management and measurement program. This involved developing software that estimated the amount of radiation used in a variety of procedures including computerized topography (CT) and nuclear medicine. As these data were added to a patient's electronic health record, a portal was also created that allowed them and their physicians to see cumulative totals of radiation administered since 2011.
Intermountain teams also created educational materials about radiation exposure. As a result, physicians and patients better comprehended the benefits and risks of radiation.
Once the management system was in place, Intermountain identified exams that had highest levels of radiation. The amount of radiation emitted in a particular test varies, but in general, the higher the dose, the sharper the image. Intermountain physicians did careful analysis and developed standard imaging techniques which achieved an appropriate balance between emissions and clarity of the image.
Children posed a special challenge because they are particularly susceptible to the negative effects of radiation. Radiologists at Intermountain's Primary Children's Hospital collaborated with colleagues in Pediatric Surgery and Emergency Medicine to create a process where ultrasound, which does not use any radiation, was used for patients with questionable appendicitis rather than the traditional approach by ordering a CT scan. Ultrasound proved just as accurate, and the number of CT examinations performed on children with suspected appendicitis dropped 65 percent.
Further, new technologies that reduce the required radiation exposure in CT were installed on all CT scanners that could accept the upgrade. Radiology teams focused on brain examinations, the most common CT procedure. The goal was to have 90 percent of CT brain exams performed using doses of less than or equal to 2 millisieverts, which was 30 percent lower than our previous standard, and roughly one-third the average amount of radiation that a person would be exposed to through natural sources like sun and soil in a year. Intermountain achieved that goal and has continued to maintain this reduced level of radiation since.
Finally, we looked at body size. Intermountain conducted an extensive review of imaging studies to develop size-based protocols for abdominal and pelvic CT. In essence, larger amounts of radiation were given to larger patients and smaller amounts to smaller patients. Since then, more than 90 percent of abdomen and pelvic CT examinations were performed using the protocols, resulting in a decreased of the average abdomen and pelvis CT dose by 4 percent, a decrease in the variation in radiation used (based on patient size) by 6 percent, and a more consistent image quality.
Reducing radiation is an ongoing endeavor. Intermountain Healthcare is committed to exploring further technical advances, protocol standards and the complete elimination of tests that use radiation when they can be replaced with other assessments. These initiatives are practical examples of how Intermountain is saving lives, reducing harm and fulfilling its mission of helping people live the healthiest lives possible.
Keith White, MD, Medical Director of Imaging Services for Intermountain Healthcare
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