Patient's radiation history should not guide imaging orders

A coalition of radiology groups including the RSNA and the American College of Radiology (ACR) is advising clinicians to avoid basing decisions on whether to order medical imaging exams on a patient's past history of cumulative exposure to medical radiation.

Concerns have recently arisen about cumulative patient exposure to radiation. Some researchers have advised that patients who have a high cumulative exposure be steered to imaging modalities that don't deliver radiation, such as ultrasound or MRI.

However, a group that includes the RSNA, ACR, the American Association of Physicists in Medicine (AAPM), and the Health Physics Society is discouraging this practice. In a joint position statement issued this month, the coalition advised that medical imaging is still an important part of patient care.

"The decision to perform a medical imaging exam should be based on clinical grounds, including the information available from prior imaging results, and not on the dose from prior imaging-related radiation exposures," the statement said.

The AAPM went on to discourage using dose values like effective dose from prior medical imaging exams for medical decision-making. Using metrics like cumulative effective dose to form medical decisions could negatively affect patient care, according to the group.

The statement also cautions against overreliance on dose measurement tools like software that can track radiation dose over time. None of these tools are capable of quantifying the biological effect of radiation on individual patients, the AAPM warned.

The joint statement issued by all the groups also noted that radiation dose information tracked in electronic health records is not standardized or universally accepted -- another reason this information should not be used to deny imaging exams for patients.