The overall goal is to provide clinicians with the best possible diagnostic information at the lowest possible dose.
There are a number of ways of striking a balance between dose and benefit:
Justification of the procedure: Traditional protocols – driven by reimbursement models – typically call for the simpler, lowest form of dose – X-ray first, then a CT scan, then an MRI, or some variation on that theme. But the truth is, it may make more sense to start with a CT scan, sparing the radiation exposure (not to mention time and expense) of the x-ray or other preliminary scan, and reaching a definitive diagnosis sooner.
Optimization of the procedure: Clinicians need to demand technology and the training that allows them to enhanceand adjust images obtained at lower doses. This produces the diagnostic benefit while limiting the dose – a “win” in both directions.
Normalizing protocols: Patient exam data with regard to radiation exposure is currently under-utilized. Understanding the variability among scanners in one department is a good first step to ensuring standard radiation doses are delivered.
Like most things in life, diagnostic radiology is enhanced when the balance is found between the diagnostic benefitsand the dose required to get there. Striking that balance is becoming easier through a combination of evidence, technology and intelligence, and I have faith that advancements will continue. And as they do, patients and clinicians should continue to keep the real story – the real risk and rewards – in mind.