We have to calm dose hysteria…RIGHT NOW!

Americans are scared. Some are frightened out of their wits. A radiologist recently told me about a patient with terminal pancreatic cancer who refused a CT ordered by his oncologist. Why? The patient said he was worried about radiation.

The public has been bombarded the last couple years with warnings about radiography, fluoroscopy, cardiac cath, nuclear medicine, CT, even dental x-rays. Any radiation exposure raises the lifetime risk of cancer, say public health officials. The dose from one dental x-ray equals only half a chest x-ray. But a CT abdominal scan delivers the same dose as 400 chest x-rays. Compound those worries with newspaper and Internet accounts of skin burns, cataracts, and hair loss in hundreds of patients undergoing CTs at hospitals in Los Angeles and Huntsville, AL. Is it any wonder this country is in the grips of dose hysteria?

Public trust in medical imaging must be restored. The FDA has a plan. The details still have to be worked out. A public meeting on March 30 and 31 will get the process going. But the broad sketch, made public Feb. 9, looks good.

The agency wants the makers of CT and fluoroscopic systems to build safeguards against overexposure into their machines. The equipment might include alarms that sound if the dose is set too high. Systems might also display each dose on screen, recording or sending the data to the patient’s electronic medical record or to a national dose registry.

What a great idea. Already imaging equipment cannot be sold in Europe unless it can display or record dose. It will be relatively easy for vendors to do the same in the U.S.

The FDA plans to collaborate with the Centers for Medicare and Medicaid Services to make quality assurance practices for imaging equipment a part of mandatory accreditation of imaging facilities and hospitals.

Why not? Credentialing is already done voluntarily by major medical centers and many others. Making them mandatory and inclusive of safeguards against radiation overdose for all providers of CT and fluoroscopy just makes sense.

The FDA also wants to develop and disseminate “patient medical imaging history cards” that will keep track of a patient’s accumulated radiation dose.

It’s hard to find anything wrong with this. Healthcare staff working around radiation have been required to wear radiation badges for decades. Why not have a card for patients to keep track of the radiation they receive during exams? Considering the public’s already strong interest in healthcare and the growing popularity of consumer-driven Internet sites for keeping health records, these cards could be a real hit.

These kinds of efforts are not only good ideas, they are absolutely critical to the welfare of the U.S. public. Research has documented the link between the use of medical imaging and improvements in public health. Concerns about radiation threaten to undo that by making people skip needed exams.

Radiation concerns have been simmering for too long. The means to address them are readily available and inexpensive to put in place. All that’s needed is the will to do so.

It would have been better if the imaging community had come up with the ideas proposed by the FDA. Second best is that providers and vendors now enthusiastically embrace them, working hard-and very publicly-with the FDA to figure out the details.

We have to own these ideas, take a high profile in their development, push for their adoption, and make a big deal out of putting them in place. And we must do so not only to promote the public welfare but from a sense of enlightened self-interest.

The public must not get the impression that imaging providers or vendors are anything but gung-ho about protecting their safety. If we are perceived as dragging our heels, the result will be disastrous.

If anyone has any doubts, just tune into nightly news broadcasts about Toyota.