Some CT Scans May Have Too Much Radiation, Researchers Say
University of California-San Francisco Professor Calls for Improved Safety Measures
Rebecca Smith-Bindman, a professor at the University of California-San Francisco medical school, has spent well over a decade researching the disquieting risk that one of modern medicine’s most valuable tools, computerized tomography scans, can sometimes cause cancer.
Unregulated Radiation Levels
About 93 million CT scans are performed every year in the United States, according to IMV, a medical market research company that tracks imaging. More than half of those scans are for people 60 and older. Yet there is scant regulation of radiation levels as the machines scan organs and structures inside bodies. Dosages are erratic, varying widely from one clinic to another, and are too often unnecessarily high, Smith-Bindman and other critics say.
Varying Doses
“It’s unfathomable,” Smith-Bindman said. “We keep doing more and more CTs, and the doses keep going up.”
One CT scan can expose a patient to 10 or 15 times as much radiation as another, Smith-Bindman said. “There is very large variation,” she said, “and the doses vary by an order of magnitude — tenfold, not 10% different — for patients seen for the same clinical problem.” In outlier institutions, the variation is even higher, according to research she and a team of international collaborators have published.
New Medicare Regulations
Under new Medicare regulations effective this year, hospitals and imaging centers must start collecting and sharing more information about the radiation their scanners emit. The Centers for Medicare & Medicaid Services issued the new rules in the closing months of the Biden administration, aimed at making imaging safer.
Phased Implementation
The requirements, rolled out in January, are being phased in over about three years for hospitals, outpatient settings, and physicians. Under the complicated reporting system, not every radiologist or healthcare setting is required to comply immediately. Providers could face financial penalties under Medicare if they don’t comply, though those will be phased in, too, starting in 2027.
Reaction from Healthcare Organizations
The Leapfrog Group, an organization that tracks hospital safety, welcomed the new rules. “Radiation exposure is a very serious patient safety issue, so we commend CMS for focusing on CT scans,” said Leah Binder, the group’s president and CEO. Leapfrog has set standards for pediatric exposure to imaging radiation, “and we find significant variation among hospitals,” Binder added.
Concerns from Medical Imaging Associations
The American College of Radiology and three other associations involved in medical imaging, however, objected to the draft CMS rules when they were under review, arguing in written comments in 2023 that they were excessively cumbersome, would burden providers, and could add to the cost of scans. The group was also concerned, at that time, that health providers would have to use a single, proprietary tech tool for gathering the dosing and any related scan data.
Future of CT Scans
The landscape has recently changed. ACR said in a statement from Judy Burleson, ACR vice president for quality management programs, that CMS is allowing in other vendors — and that ACR itself is “in discussion with Alara” on the data collection and submission. In addition, a company called Medisolv, which works on healthcare quality, said at least one client is working with another vendor, Imalogix, on the CT dose data.
Conclusion
The new CMS regulations aim to improve the safety of CT scans by encouraging better measurement and assessment of radiation levels. While some medical imaging associations have expressed concerns about the regulations, many patient safety advocates and healthcare organizations welcome the changes. As the field of medical imaging continues to evolve, it is essential to prioritize patient safety and minimize the risk of radiation exposure.
FAQs
* How many CT scans are performed in the United States each year?
About 93 million
* What is the aim of the new CMS regulations?
To improve the safety of CT scans by encouraging better measurement and assessment of radiation levels
* How many CT scans are performed for people 60 and older?
More than half
* What is the estimated number of excess cancer cases caused by CT scans each year?
29,000, about 2% of all cases diagnosed annually
* What is the estimated radiation exposure range for a single CT scan?
10-15 times as much as another scan
