ACR/RSNA launch national Image Wisely campaign

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CHICAGO - It's impossible not to see them. Image Wisely cartoon owls are omnipresent figures in the halls of the massive McCormick Place Convention Center complex, intermingling amidst technical exhibits, and lurking at Lakeside Learning Center.

Image Wisely, a wake-up alert and a call-to-action combined and rolled into a national campaign, launched on Sunday at RSNA 2010. The campaign, an initiative of the American College of Radiology (ACR)/RSNA Joint Task Force on Adult Radiation Protection, encourages radiology professionals to take personal responsibility to keep patients safe from inappropriate and/or excessive exposure to radiation dose.

The campaign's website,, was launched without fanfare on Monday. However, a formal presentation about the campaign held late in the day attracted standing-room-only attendance.

Radiation dose exposure from diagnostic imaging exams to U.S. residents has increased fivefold since the 1980s. Dose exposure from CT scans represents almost half of this, even though CT exams account for approximately 12% of the total, James Brink, MD, professor of diagnostic radiology and department chairman at the Yale School of Medicine in New Haven, CT, informed attendees.

CT scans have revolutionized clinical diagnosis. They are also being overused and ordered inappropriately, without enough evaluation of their diagnostic necessity or cumulative radiation risk to the patient. And a certain percentage of scans are being performed by radiology professionals who are not ensuring that radiation dose is optimized.

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The Image Wisely logo. Courtesy of the ACR.
The Image Wisely campaign intends to challenge this through education, easy access to information, and peer pressure. It will take a two-pronged approach: First, educate and inform radiology professionals; second, educate and enhance awareness of ordering physicians and the public. The first modality being targeted is CT, to be followed by nuclear medicine and radiography/fluoroscopy.

Work began on the campaign a year ago, with the first meeting of the Image Wisely committee held in November 2009. Its first order of business was to invite the American Academy of Physicists in Medicine (AAPM) and the American Society of Radiologic Technologists (ASRT) to join, according to E. Stephen Amis, MD, professor of radiology at the Albert Einstein College of Medicine and chairman of the radiology department at Montefiore Medical Center in New York City. Amis and Brink co-chair the committee.

"We've been really busy. We've accomplished a lot, but there is a lot more still to come," Amis said, referencing website content development that is still a work-in-progress. "We thought it important to put our house in order first and complete the first phase before targeting clinical providers and the public, and before we started telling ordering providers what to do. We as a profession need to be very informed about the right way to image patients."

The scope of the campaign is impressive. It includes the development of educational resources available at the website for radiologists, technologists, and medical physicists. The material has been vetted and peer reviewed: "It represents the most current, most concise, most useful, and best information in the public domain that increases awareness of opportunities to eliminate unnecessary exams, to lower the amount of radiation used to perform appropriate exams, and to dose optimize. We don't want to waste anyone's time," Amis said.

Professional print ads and public service announcements have been produced. The decade-old ACR Primer on Radiation Risk/Benefits has been dusted off, updated, and reformatted as a slide-show presentation to be added to Working with the U.S. Food and Drug Administration (FDA), the committee developed a patient medical imaging record that can be downloaded and printed. Plans, as yet unspecified, are in the works to interact with a variety of federal and state government agencies and possibly congressional committees.

Vendor microsites will be part of the radiology professional website segments. All companies that sell CT scanners in the U.S. will have a microsite offering users easy access to information about dose reduction techniques on specific equipment, dose monitoring, and dose optimization. Links to video training modules and simulation exercises for radiologic technologists have been mentioned by at least one vendor.

Taking the pledge

As with the hugely successful international Image Gently campaign for pediatric patients, the Image Wisely campaign wants radiologists who practice in the U.S. to take its pledge to optimize the use of radiation in adult imaging patients. The names of radiologists and medical physicists who take the pledge will be added to an Image Wisely pledge database.

But the Image Wisely initiative doesn't stop there. "We need to get all of our CT scanners accredited by the ACR," both Amis and Brink urged, noting that fewer than half of the scanners being used in the U.S. may be accredited.

Finally, when it is possible to transfer the radiation dose from a patient's CT exam to a local and/or national registry, radiologists should make this happen in their radiology department or freestanding imaging center.

"If all of the dose information for each exam performed on your CT scanners automatically uploads to a registry, it can be automatically compared immediately with average doses from other scanners throughout the nation," Amis said. "While there may be geographic differences accounting for different body mass index averages, high dose outliers can be identified in a matter of hours or a day. This would immediately stop repetitive use of inappropriate and dangerous radiation doses as occurred in California this year."

Click here to read and take the Image Wisely pledge.

By Cynthia E. Keen staff writer
November 30, 2010

Related Reading

U.S. radiation concerns overdue: Siemens executive, November 28, 2010

Leaders in Imaging: A conversation with William Hendee, PhD, October 13, 2010

Radiologists call for curbs on overuse of imaging, August 24, 2010

Radiology gears up for FDA radiation hearings, March 30, 2010

Image Gently achieves global reach by 2nd anniversary, February 20, 2010

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