The following article, by Jennifer Chung Klam, appeared in the November 17, 2011 Special Health Care issue of The Daily Transcript:

Show up in the emergency room with extreme abdominal pain or a severe headache, and there’s a good chance you’ll get a CT scan.

Computed tomography, or CT scans, provide highly detailed images of internal organs, bones, soft tissue and blood vessels by combining data from multiple X-ray images. Using these scans, physicians can determine whether that stomach pain means you need an appendectomy, or whether that headache is just a sinus blockage or something more serious. CT scans also allow doctors to easily diagnose problems such as cancers, cardiovascular disease, infectious disease, trauma and musculoskeletal disorders.

The scans are quick, painless, noninvasive and accurate, and offer far more detail than regular x-ray exams. As such, the procedure has seen tremendous growth – from 3 million CT scans in 1980 to more than 62 million today.

However, the price of increased clarity is increased exposure to X-ray radiation. Some studies suggest that about 1.5 percent to 2 percent of all cancers in the United States might be caused by the clinical use of CT scans. While most experts agree the benefits of screening for diagnostic purposes generally outweigh the risks, there is growing concern for the increase in radiation exposure associated with the scans.

One local company is trying to minimize exposure by pledging to use the lowest dose possible while maintaining image quality.

“We felt it was important to minimize that risk,” said John O. Johnson, M.D., and chief of CT imaging at Imaging Healthcare Specialists. “We have implemented a program of low-dose radiation for CT imaging so that we can take that small risk to the patient and make it even smaller.”

Imaging Healthcare Specialists (IHS), with 11 centers serving San Diego and Temecula, is the largest provider of outpatient imaging services in San Diego County. It was founded in 2005 through the merger of Radiology Medical Group and Open Air MRI Centers.

In 2007, the Alliance for Radiation Safety in Pediatric Imaging – a coalition founded by the Society for Pediatric Radiology, the American Society of Radiologic Technologists, the American College of Radiology and the American Association of Physicists in Medicine – developed the Image Gently campaign to raise awareness of the need to adjust radiation dose when imaging children.

“We took that as a model and kind of a mantra at Imaging Healthcare Specialists and started looking at ways of lowering the dose” in children as well as adults, Johnson said. “The idea behind the Image Gently campaign is not every CT scan is the same; not every patient is the same size; not every diagnosis is the same. So each CT scan should be customized for each patient.”

For example, if a patient is smaller in size, say a young adult or female, a lower radiation dose should be able to be used without compromising image quality, he said.

Radiologists can get more detailed scans by using more radiation, but doctors always need to weigh the risk against imaging needs. Often, IHS physicians are willing to accept a small erosion in quality to lower the dose, said Johnson.

In addition to reducing dosage based on age, height, weight and body mass index, IHS has invested in the most advanced scanners and noise reduction software, which can reduce exposure by 50 percent. IHS also routinely shields breast and thyroid tissue to further protect sensitive organs.

“The shields in and of themselves can reduce radiation by 40 percent,” Johnson said.

Using a combination of these techniques, IHS has been able to reduce radiation in some patients by as much as 90 percent.

Earlier this year, IHS took the Image Wisely pledge, the adult counterpart to the Image Gently campaign. The program encourages practitioners to avoid unnecessary procedures and to use the lowest optimal radiation dose.

“Our goal is to get the word out, increase awareness, and let more people know that patient safety is a top priority by spreading the word,” Johnson said. “We want to make this a top priority for everybody.”

In the past, doctors were more focused on having perfectly crisp, clear images. There was no perceived problem. Standard protocols for dosing levels were used, and today many institutions still adhere to these one-size-fits-all protocols, according to Johnson.

But awareness of the issue is growing, in part due to a high-profile public health concern in late 2009. It was reported that during an 18-month period, 269 patients at Cedars-Sinai Medical Center in Los Angeles were exposed to radiation at eight times the normal dose.

In the wake of the incident, California passed Senate Bill 1237, which requires hospitals and clinics to record radiation doses of CT scans, and radiation overdoses to be reported to the patient, treating physician and the California Department of Public Health. The law goes into effect July 2012.

In the meantime, IHS has enrolled in the Dose Index Registry (DIR), supported by the American College of Radiology. DIR collects, anonymizes and stores information about CT exams from participating facilities. In the coming years, IHS will be able to establish its own benchmarks and compare its performance with other institutions. Data collected from the registry will also be used to establish national benchmarks for CT dose indexes.

“We’ve aggressively lowered the dose probably more than anybody in the country,” Johnson said. “Especially for an outpatient, community-based organization, we’ve been very forward thinking and proactive.”