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Image Gently and
Image Wisely Update
Priscilla F. Butler, MS, FAAPM, FACR
Senior Director and Medical Physicist
American College of Radiology
Radiation
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And last month…
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NCRP Report No. 160 (2009) - Ionizing
Radiation Exposure of the Population of the US
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NCRP Report No. 160 (2009) –
Sources of Radiation Exposure
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We live with
1-3 mSv Bkgd 4000 mSv
can kill
Radiation
“Is there a safe point?”
In medicine, there are risks in everything we
do; the job of your doctors and imaging
professionals is to make sure the benefit from
having the procedure outweighs any small risk.
Questions We Get
“What is my risk?” It is Low;
Overall Lifetime Cancer* Risk (BEIR VII )
• In a lifetime, approx 42 out
of 100 people will be
diagnosed with cancer
from causes unrelated to
radiation
• Approx 1 cancer out of
100 people could result
from radiation exposure to
100 mSv above
background * Incidence; not mortality
“Doctor, what’s my radiation dose
from that exam?”…not that easy
• What kind of dose?
• Can’t measure dose; can
only estimate dose:
– Measure something
– Calculate something
• Variables affect this
estimate
– mA, time, kVp, filtration,
pitch, slice thickness,
distance, etc, etc
– Exposed area
– Patient habitus
Organ
dose
“I had an x-ray of my head, 1 of my hip and
1 of my big toe…what’s my total dose?”
• Impossible to
add up individual
organ/body area
dose estimates
to determine a
total dose
• Different organs;
different risks
• Worker dose is regulated by states and feds
• Patient dose is NOT regulated
– Why?
– Risk is relative
– Patient derives a benefit to
his/her health
– Physicians must weigh individual
benefit to their patient from
having the exam against the risk
to the patient from the radiation (as well as any other risks –
contrast reactions, procedure issues, etc.)
• For both workers and patients, dose should be kept “as
low as reasonably achievable” (ALARA)
“What is the upper regulatory
limit for patient dose?”
It’s Important to Remember,
Medical Imaging Saves Lives
Detect disease
Diagnose disease
Treat disease
BUT, we need to use it WISELY and GENTLY
Basic Principals of Radiation
Safety in Imaging
• Justification
• Optimization
• Justification
– Is the exam needed?
– Is it the right exam?
– Are systems in place to
minimize inappropriate use?
– Are ordering and interpreting
physicians trained and
qualified?
Radiation Dose Management in
Medicine
• Optimization
– Is the right equipment
used ?
– Are the right techniques
used?
– Are repeats minimized?
– Is shielding used (if
appropriate)?
– Are operators trained and
qualified?
– What is the estimated
patent dose?
Radiation Dose Management in
Medicine
New Approaches Taking Wing to
Raise Awareness…Social Marketing
• Use public media
• Use commercial marketing techniques
“……to promote behavior changes that will improve the
health of the population”
• The shared mission of these two initiatives is to improve
radiation protection in medical imaging through
education and other resources
•
The Alliance for
Radiation Safety in
Pediatric Imaging
The image gently campaign
Founding Organizations
The Society for Pediatric Radiology
American Society of Radiologic Technologists
American Association of Physicists in Medicine
American College of Radiology
RSNA 2014: 8th IG Alliance meeting!
Steering Committee
Susan John, MD
Neil D. Johnson, MD
Sue C. Kaste, DO
Sarah Kaupp (advacate)
Alan Lurie, DDS
William Mayo-Smith, MD
Ceela McElveny
Gregory Morrison, CAE, MA RT(R), CNMT
Luke Person, MD
Manrita Sidhu, MD
Theodore Treves, MD
Marilyn J. Goske MD, Donald P. Frush MD
Co-chairs; Keith J. Strauss, MS (Vice-Chair)
Kimberly E. Applegate, MD, MS
Jennifer Boylan, MA
Dorothy Bulas, MD
Priscilla F. Butler, MS
Michael J. Callahan, MD
Brian D. Coley, MD
Steven Don, MD
Shawn Farley
Marta Hernanz-Schulman, MD
What is Image Gently?
A communication campaign by….
Alliance for Radiation Safety in Pediatric Imaging
for education and awareness: imaging experts, patients,
families, caregivers, referring healthcare providers
ADVOCACY
Several modalities addressed…CT was first
To improve medical radiation protection for children
90+ health care organizations/agencies (>25 international)
>1,000,000 participants worldwide: radiologists
technologists
medical physicists
other providers
Raising awareness:
communication through social
marketing strategy
Website
6 campaigns
Speakers group
Scientific publications
Image Gently summits
Speakers at national
meetings
Parent/provider
brochures (translations)
Newsletter
Power of ALLIANCE
Back to Basics CR/DR
2012
SEPTEMBER 2014
Dental Campaign
Digital Radiography (“Back to Basics”)
• Tools
• Educational resources
• Downloadable
PowerPoint
presentations
• Papers
Campaign Rollout
Editorials in
Pediatric Radiology - Improving Health Literacy
for Parents about CT Scans for Children - Why We
Need to Talk to Parents about CT Imaging
AJR
AAP News
Presentations – SPR
Advertisements
www.imagegently.org
Image Gently ALARA CT
Meeting
February 21, 22, 2014
Orlando, Florida
Hyatt Airport
141 participants
21 speakers
For Parents
Downloadable Pamphlets on
www.imagegently.org
8 page Long Version on
Medical Radiation
Safety for parents
Detailed information
web sites
references
www.imagegently.org
2 page Short Version on
CT radiation safety for
parents
Useful as a handout for
Radiology departments
Emergency departments
Pediatric offices
Image Wisely
Provides resources for radiologists, imaging technologists, medical physicists, other imaging practitioners, and patients to help them
lower the amount of radiation used in medically necessary imaging studies of adults and eliminate unnecessary procedures.
• Joint Task Force between ACR & RSNA
• Focus on dose reduction for adults
• Introduced at RSNA 2010
• Original co-chairs:
Steve Amis, MD
James Brink, MD
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Image Wisely
Current Leadership: Image Wisely® Co-chairs
Richard Morin, PhD ACR
Mayo Clinic
Jacksonville, FL
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William Mayo-Smith, MD
RSNA
Brigham and Women’s Hospital
Boston, MA
Image Wisely Executive Committee - ALL volunteers
Richard Morin, PhD, FACR, Mayo Clinic (Jacksonville)
William Mayo-Smith, MD, FACR, Brigham and Women's
Hospital
Donald Peck, PhD, FACR, Henry Ford Medical Group
Greg Morrison, MA, RT (R), ASRT
Donald Frush, MD, FACR, Duke University Medical
Center
Amy Hara, MD, Mayo Clinic (Scottsdale)
Jay Pahade, MD, Yale University
Pari Pandharipande, MD, Massachusetts General
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Information Resource - www.imagewisely.org
In 2014
Total visits:
83,187
Page views:
211,684
Total users:
63,639
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Percentage of Image Wisely Users by Country - 2014
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Image Wisely Web Page Views - 2014
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Top 3
1. Content
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CT and Nuclear Medicine Content for Imaging Professionals
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Content for Imaging Professionals
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http://www.imagewisely.org/
2015 RSNA: Fluoroscopy Safety Webpage Launched
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Top 3
1. Content
2. Pledge
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Individual Pledge
Yes, I want to image wisely.
I wish to optimize the use of radiation in imaging patients and thereby pledge:
1. To put my patient’s safety, health and welfare first by optimizing imaging examinations to use only the radiation necessary to produce diagnostic quality images;
2. To convey the principles of the Image Wisely Program to the imaging team in order to ensure that my facility optimizes its use of radiation when imaging patients;
3. To communicate optimal patient imaging strategies to referring physicians, and to be available for consultation;
4. To routinely review imaging protocols to ensure that the least radiation necessary to acquire a diagnostic quality image is used for each examination.
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Schools can Pledge, too
Facility Pledge – Levels of Commitment
LEVEL 1 – Take the Image Wisely pledge
LEVEL 2 – Earn accreditation from an organization that
directly evaluates the following :
Radiation dose indices and compliance with accreditation
pass/fail thresholds
Clinical image quality (peer-reviewed by an external,
qualified interpreting physician)
Phantom image quality (peer-reviewed by an external,
qualified medical physicist)
Personnel (qualifications set by the accrediting organization)
LEVEL 3 – Participate in a dose index registry that
includes routine evaluation of procedures and dose
indices
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ACR Dose Index Registry
• A tool for quality improvement so facilities can review
dose indices and optimize protocols
Collects and compares dose index information across
facilities
Fully automated; uses standard methods of data
collection and processing (DICOM SR, IHE REM
Profile, RadLex)
Will help to develop size-specific reference levels
CT DIR launched in May 2011
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A Registry for All Practice
Settings
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At least 2 facilities are
outside of the US
November 2014
Top 3
1. Content
2. Pledge
3. Case
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Radiation Safety Case – FREE ½ credit
• New ! Case 6: Optimizing Radiation Use during a Difficult
IVC Filter Retrieval
• Case 5: Imaging Wisely When
Evaluating for Pulmonary Embolism
• Case 4: Technical Errors and Image
Quality in Digital Radiography
• Case 3: CT Brain Perfusion Dose Optimization
• Case 2: Dose Management in Endovascular Image-Guided
Neuro-Interventions
• Case 1: CT Dose and Size-Specific Dose Estimate (SSDE)
• Soon: Cone Beam CT
Content from Manufacturers About Optimizing Dose with their CT Equipment
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Content for Referring Practitioners
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ACR Appropriateness Criteria®
Appropriate utilization
First developed in 1993
Evidence-based guidelines to assist referring
physicians in making the most appropriate imaging or
treatment decision
Developed by expert panels in diagnostic imaging,
interventional radiology, and radiation oncology that
includes referring physicians
Addresses over 180 clinical conditions
Topics reviewed annually and updated as appropriate
ACR Select – for computerized order entry
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Relative Radiation Levels - Sample Variant Table
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Content for Patients – Directs to RadiologyInfo.org and ImageGently.org
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Available in Spanish and English
Radiology Benefits and Risks
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Video presentation
or HTML
Imaging History Card (English and Spanish)
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IMAGE WISELY
Thanks you.
Questions?
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