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Evaluating an Image Gently and Image Wisely Campaign in a Multihospital Healthcare System Kevin Fernandes, BS Todd Miller, MD Terry L. Levin, MD Alan H. Schoenfeld, MS E. 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 Methods & Data: 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. Initiatives of the Image Gently/Image Wisely Campaign Interdepartmental research to evaluate efficacy of alternative imaging modalities for specific clinical scenarios Multidepartmental educational initiative Review and optimize CT protocols Educational Initiative: • Annual Interdepartmental lecture series Appropriate indications for ordering a CT Medical radiation; potential risk versus benefit Provided 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 Results: Imaging as a % of Total Imaging by Age 2004-2014 80% 70% % of Total Imaging 60% 50% 40% 30% 20% 10% 0% CT-2004 CT-2014 US-2004 US-2014 Total Population MR2004 MR- CT-2004 CT-2014 US-2004 US-2014 2014 <20 y/o MR2004 MR- CT-2004 CT-2014 US-2004 US-2014 2014 20-39 y/o MR2004 MR- CT-2004 CT-2014 US-2004 US-2014 2014 MR2004 MR2014 40-59 y/o • 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: Me dian CTDI pe r Sc an 50 CT HEAD BRAIN W IVCON 40 CT HEAD BRAIN WO IVCON CT CHEST W IVCON 30 CT CHEST WO IVCON 20 CT ABDOMEN PELVIS W IVCON CT ABDOMEN PELVIS WO IVCON July-Dec 2014 Jan-June 2014 July-Dec 2013 Jan-June 2013 July-Dec 2012 0 Jan-June 2012 10 July-Dec 2011 MEDIAN CTDIVOL/SCAN (MGY) 60 YEAR Between 2011 and 2014* a reduction or stabilization of radiation dose was demonstrated. * CT dose data was not available prior to 2011 Findings: • 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 (20102014). 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 References: 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 radiationinduced 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.