DOTmed News spoke with Dr. David Bluemke, director of radiology and imaging sciences at the National Institutes of Health's Clinical Center, about the new program to require radiation dose monitoring on all radiation-producing imaging equipment purchased by the institute.

In a policy first elaborated last September, all X-ray and CT equipment sold to the NIH must now record radiation dose exposure to electronic health records to allow doctors to track exposure, and its risks, over time.

Over the next two to three months, Dr. Bluemke says he expects the first devices, likely from Siemens, to arrive at the clinic.
"They demonstrated to us their initial progress," he says of Siemens.

A HALF-CENTURY LATE

Dr. Bluemke thinks the program is, in many ways, "50 years overdue."

"We think it's extremely reasonable to keep track of what we're doing in radiology," he says. "Nearly all other medications are documented very well. But radiation doses are not documented at all in the medical record."

This is a problem mainly for two reasons, he thinks. First, it would be better medicine if ordering physicians knew immediately what imaging exams a patient had recently. It might stay their hand when requesting additional CT scans, for instance.

"If you give an indication to a physician who's ordering the CT scan about how much accumulated radiation the patient has got, it tends to change behavior," he says. "There are alternatives to CT scanning. MRI is usually an alternative. Ultrasound is an alternative. If the patient has had frequent examinations, they might want to hold off for another six months [before getting the new scan]."

"Just by having the information, the doctors will look at it and start to modify their own prescribing information," he adds.

Equally important, attaching radiological history to the EMR is an early, if small, step in answering a question that's becoming pressing in light of the increasing use of CT scans: exactly how dangerous is medical imaging-related radiation, if at all?

"Four or 5 major studies in the most prominent medical journals in the U.S. are saying there are going to be tens of thousands of deaths caused by [medical imaging] radiation," Dr. Bluemke notes. Yet, he thinks they're "talking without any information or data at hand," and the actual risks from diagnostic imaging are not well known.

"I think it'll be very difficult to [understand the risks] unless we get a national medical record or some way for testing patients for a period of time," he says.

Still, even without a complete understanding of the risks, Dr. Bluemke believes the new program fosters a valid precautionary approach when it comes to diagnostic imaging. "If you don't need it, don't do it," he says.

NIH's Radiology and Imaging Sciences clinical center will now routinely record radiation dose exposure in a patient's hospital-based electronic medical record, for those clinical research patients at the NIH Clinical Center exposed to radiation during some imaging tests.

Read more on DOTmed:

NIH to Begin Incorporating Radiation Doses in EMRs
www.dotmed.com/news/story/11545

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