Exposure to ionizing radiation and estimate of secondary cancers in the era of high-speed CT scanning: projections from the Medicare population.

PURPOSE: The aims of this study were to analyze the distribution and amount of ionizing radiation delivered by CT scans in the modern era of high-speed CT and to estimate cancer risk in the elderly, the patient group most frequently imaged using CT scanning. METHODS: A retrospective cohort study was conducted using Medicare claims spanning 8 years (1998-2005) to assess CT use. The data were analyzed in two 4-year cohorts, 1998 to 2001 (n = 5,267,230) and 2002 to 2005 (n = 5,555,345). The number and types of CT scans each patient received over the 4-year periods were analyzed to determine the percentage of patients exposed to threshold radiation of 50 to 100 mSv (defined as low) and >100 mSv (defined as high). The National Research Council's Biological Effects of Ionizing Radiation VII models were used to estimate the number of radiation-induced cancers. RESULTS: CT scans of the head were the most common examinations in both Medicare cohorts, but abdominal imaging delivered the greatest proportion (43% in the first cohort and 40% in the second cohort) of radiation. In the 1998 to 2001 cohort, 42% of Medicare patients underwent CT scans, with 2.2% and 0.5% receiving radiation doses in the low and high ranges, respectively. In the 2002 to 2005 cohort, 50% of Medicare patients received CT scans, with 4.2% and 1.2% receiving doses in the low and high ranges. In the two populations, 1,659 (0.03%) and 2,185 (0.04%) cancers related to ionizing radiation were estimated, respectively. CONCLUSIONS: Although radiation doses have been increasing along with the increasing reliance on CT scans for diagnosis and therapy, using conservative estimates with worst-case scenario methodology, the authors found that the risk for secondary cancers is low in older adults, the group subjected to the most frequent CT scanning. Trends showing increasing use, however, underscore the importance of monitoring CT utilization and its consequences.

The radiologist's guide to health services and policy research training.

OBJECTIVE: This article will briefly describe the driving forces of radiology's changing landscape because of health care reform and outline opportunities for radiologists in training to use health services and policy research skills to help show the value of radiologists in patient care, define the future business model of radiology, and shape wide-reaching public policy. CONCLUSION: The ability of our specialty to continue to thrive will require the presentation of sound evidence showing our added value to patients' overall health and well-being.

Creating a patient-centered imaging service: determining what patients want.

OBJECTIVE: The purpose of this study is to determine patients' preferences for how, from whom, and how soon they receive imaging results. MATERIALS AND METHODS: Hard copies of our survey were randomly distributed to patients at an academic medical center outpatient imaging facility for 9 weeks, during August through October 2008, to collect data regarding patient preferences for how they received results ("Method"), from whom ("Person"), and how quickly ("Speed"). RESULTS: A total of 129 (23%) of 557 patients (47.4% male; median age, 55 years) undergoing CT (62%) and MRI (38%) completed the survey. According to survey responses, results needed to be communicated within a few hours for an "acceptable" rating from 95% of patients. Thirty-one percent preferred to receive normal results by the fastest method, whereas 35% preferred to receive abnormal results by telephone. Patients did not show an overwhelming preference regarding which physician communicates the results. More than 25% of patients were indifferent as to who was giving the results and cared only about the speed of delivery. For normal results, 12% chose from the radiologist, 41% from the referring physician, 14% from both, and 33% from whoever is faster (p < 0.0001). For abnormal results, 6% chose from the radiologist, 41% from the referring physician, 27% from both, and 26% from whoever is faster (p < 0.0002). CONCLUSION: Patients in our study wanted their results communicated much sooner than is currently practiced. Optimizing patient satisfaction may require a new communication model.