RSNA 2016: Radiologists must find dosing’s sweet spot to optimize patient safety

Too many radiologists think only about dose reduction when they hear “radiology” and “patient safety” in the same sentence, according to Ehsan Samei, PhD, professor of radiology at Duke University.

Instead, he said, imaging providers should focus on optimizing dose to the patient and condition. It should be somewhere in the so-called “Goldilocks zone”—not too high, not too low. Samei will make the case for an imaging philosophy based on that sweet spot at RSNA 2016 in a talk entitled, “The Broad Relevance of Safety Culture in Medical Imaging,” part of a four-speaker session on radiation safety.

“We are not here to make radiation safe—we are here to make the procedure safe,” Samei said. “If the procedure itself is not providing the certainty that is required to be able to intervene for improved patient health, the procedure isn’t safe.”

Instead of viewing dose as a one-directional metric of patient safety, radiologists should take a more holistic approach considering patient well-being, according to Samei. While most radiologists recognize the “image gently” mantra, the consequences of insufficient dose receive less attention: duplicated scans and poor images.

However, some radiologists may be hesitant to re-scan patients.

“Most people do not even retake the image,” Samei said. “We want to be nice people, we don’t want to trouble our patients, trouble the process. But a mediocre image comprises the overall safety of the patient.”’

The two most important considerations when finding the dosage sweet spot are the primary indication and the patient size, according to Samei.

“If I’m looking for a kidney stone, or a liver lesion, or a fracture, or a hemorrhage, that sweet spot is different,” he said. “A generic reduction of 20 percent is unsafe. It has to be indication specific.”

Tailoring dosage to patient size is another key determination of radiation dose.

“Optimizing the radiation dose becomes a mandate in such a way that it’s not just a reduction, it’s about the right sizing of the radiation dose,” Samei said. “Both too high and too low of a dose in unsafe, I think that second part is a nuance that most people don’t understand.”

In his presentation, Samei will also cover the potential harms of radiation and the interconnected roles of individual and cumulative doses over a patient’s lifetime, sharing insights drawn from his research on clinically relevant imaging. Bridging the gap between academic work and clinical utilization is a cornerstone of his research efforts as a tenured professor of radiology, medical physics, biomedical engineering, physics, and electrical and computer engineering.

Samei is joined by renowned medical physicist Madan M. Rehani, PhD, James A. Brink, MD, of Massachusetts General Hospital, and Andrew J. Einstein, MD, PhD, of Columbia University Medical Center. Attendees can hear their presentations on goals for dose reduction by 2020, revising appropriateness criteria, and reducing risk in nuclear imaging, respectively, on Monday, Nov. 28, at RSNA 2016.