Evaluating an Image Gently and Image Wisely Campaign in a Multihospital

Healthcare System

Kevin Fernandes, BSTodd Miller, MD

Terry L. Levin, MDAlan H. Schoenfeld, MSE. Stephen Amis, Jr., MD

Background:• 2% of cancers/year in the US may be attributable to medical

radiation from CT1

• 29,000 patients in the US/year may develop malignancy due to CT2

• The potential life time risk of radiation induced malignancy is heightened in children1,3,4

• Cancer incidence increases by 24% in exposed children5

• Image Gently (2007) & Image Wisely (2009) guidelines aim to reduce exposure to unnecessary medical radiation

Objective:

Reduce CT use by educating our referring medical community and

optimizing CT protocols

1. Obtained number of imaging examinations (CT ,magnetic resonance imaging (MR) and ultrasound (US) performed between January 1, 2004 and December 31, 2014 using RIS system

a) 865,879 imaging procedures

2. Obtained patient age & unique number of patients seen yearly using Clinical Looking Glass (Montefiore EHR search engine)

a) 4,508,030 patients

3. Stratified the annual volume of modality specific imaging examinations by patient age: <20 years old, 20-39 years old, 40-59 years old.

4. Obtained dose as measured by volume CT dose index (CTDIvol) from the Dose Index Registry (National Radiology Data Bank) for each CT examination from January 1st 2011 to December 31, 2014.

Methods & Data:

Initiatives of the Image Gently/Image Wisely Campaign

Multidepartmentaleducational

initiative Review and optimize CT

protocols

Interdepartmental research to

evaluate efficacy of alternative imaging

modalities for specific clinical

scenarios

Educational Initiative:• Annual Interdepartmental lecture series

Appropriate indications for ordering a CT

Medical radiation; potential risk versus benefitProvided to departments of Emergency Medicine, Surgery, Pediatrics, Family Medicine, and Internal Medicine including subspecialty groups

• Medical student Radiology clerkship formal lecture

Radiation safety

• Mandatory annual educational modules

incoming housestaff and CT technologists

• Encourage use of modified CT protocols

low dose, pediatric specific and focused CT imaging

• A decrease in CT % usage and a compensatory rise in US % usage was demonstrated in each age category.

• MR %usage increased only in the pediatric population.

Results:

0%

10%

20%

30%

40%

50%

60%

70%

80%

CT-2004 CT-2014 US-2004 US-2014 MR-2004

MR-2014

CT-2004 CT-2014 US-2004 US-2014 MR-2004

MR-2014

CT-2004 CT-2014 US-2004 US-2014 MR-2004

MR-2014

CT-2004 CT-2014 US-2004 US-2014 MR-2004

MR-2014

Total Population <20 y/o 20-39 y/o 40-59 y/o

% o

f Tot

al I

ma

gin

g

Imaging as a % of Total Imaging by Age 2004-2014

Between 2011 and 2014* a reduction or stabilization of radiation dose was demonstrated.

* CT dose data was not available prior to 2011

Results:

0

10

20

30

40

50

60

July

-De

c 2

011

Jan-

June

201

2

July

-De

c 2

012

Jan-

June

201

3

July

-De

c 2

013

Jan-

June

201

4

July

-De

c 2

014

MED

IAN

CTD

IVO

L/SC

AN

(M

GY)

YEAR

Median CTDI per Scan

CT HEAD BRAIN W IVCON

CT HEAD BRAIN WO IVCON

CT CHEST W IVCON

CT CHEST WO IVCON

CT ABDOMEN PELVIS W IVCON

CT ABDOMEN PELVIS WO IVCON

• From 2004-2009, CT composed the majority of all imaging studies across all age groups.

• After initiation of the campaign, CT use declined across all age groups with a corresponding increase in US use (2010-2014). MR use was unchanged.

• By 2014, US became the predominant imaging modality in the pediatric age group

• By 2014, CT protocol optimization resulted in reduced dose/scan for most studies.

• Educational campaigns are effective in changing the ordering patterns of referring physicians and complement the radiologist’s efforts to decrease dose

Findings:

1. Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. The New England journal of medicine. 2007;357(22):2277-2284.

2. Berrington de Gonzalez A, Mahesh M, Kim KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Archives of internal medicine. 2009;169(22):2071-2077.

3. Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR. American journal of roentgenology. 2001;176(2):289-296.

4. Brody AS, Frush DP, Huda W, Brent RL, American Academy of Pediatrics Section on R. Radiation risk to children from computed tomography. Pediatrics. 2007;120(3):677-682.

5. Mathews JD, Forsythe AV, Brady Z, et al. Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ. 2013;346:f2360.

References: