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Is Radiation Dose Too Low? | What Now for Medicare Fix?
January 6, 2025
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Together with
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“Our results in fact emphasize how the over-exaggerated and obsessive understanding of radiation dose … can impact patient safety negatively.”
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Ria F et al, in a new paper on CT radiation risk.
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New investment opportunities are becoming available to physicians that enable them to participate in the development of the technologies and services that will shape healthcare’s future. In this Imaging Wire Show, we talk to principals with The Physicians Capital Fund, an early-stage venture capital fund that’s now accepting physician investors.
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A new study raises a provocative question: Is radiation dose from medical imaging exams too low? The authors propose in a paper in Nature’s Communications Medicine that lowering radiation dose too much negatively impacts patient care by making exams less diagnostic. But radiation dose experts are pushing back on the claim.
Efforts to minimize medical radiation dose are almost as old as radiology itself.
- The arrival of CT in the 1970s saw a sharp rise in radiation dose exposure, but a series of radiation overdose incidents in the 2000s spurred new efforts to monitor and reduce dose.
Today, CT radiation doses are remarkably low, with some ultra-low-dose protocols enabling exams at levels below 1 mSv – only slightly higher than a chest X-ray at 0.1 mSv.
What’s more, CMS this year is launching new dose reporting quality measures designed to reward radiology practices for tracking and reporting radiation dose.
- Imaging practices will be able to secure additional reimbursement by complying with an electronic clinical quality measure (eCQM), CMS1074v2, issued by CMS to reduce excessive CT dose exposure.
That brings us to the new paper. Researchers from Duke University developed a statistical model that they believe balances radiation risk from imaging exams with imaging’s clinical benefit.
- They created a “detectability index” to quantify the benefit of imaging’s precise characterization of disease – which could lead to misdiagnosis if pathology isn’t adequately visualized – and weigh it against the lifetime cancer risk from an exam.
They then tested the model in a simulated dataset of 1M liver cancer patients, finding …
- The clinical risk of lower dose outweighed the radiation risk by 400%.
- Radiation dose should be increased for over 90% of abdominal CT scans under their formula.
But pushing back against the paper are advocates for radiation dose reduction, including radiologist Rebecca Smith-Bindman, MD, of UCSF.
- She points out that the use of imaging continues to grow exponentially, with little evidence to justify its benefit for many uses, and therefore every effort should be taken to minimize harms like radiation risk.
The Takeaway
The new paper shows that even concepts thought to be self-evident – like the benefit of radiation dose reduction – can still be open to debate. Time will tell whether the new paper gains traction in the discussion over radiation dose management.
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Learn the Basics of CT Colonography
Medicare will soon be paying for CT colonography exams for colon cancer screening. Get up to speed today with Medality’s comprehensive CT colonography course, led by experts Judy Yee, MD, Kevin Chang, MD.
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- What Now for Medicare Fix? A proposal that would have fixed most of a 2.8% cut in the 2025 Medicare conversion factor fell victim to political turmoil over the federal budget last month. The Medicare payment fix was not included in the last-minute continuous resolution passed on December 20 to keep the government running, meaning doctors face reimbursement cuts as the new year begins. Chances are high that legislators will address the cuts during the new Congressional session, however, as they did in March 2024.
- What Triggers Radiation Dose Alerts? Certain factors are the most common reasons for alerts generated by CT radiation dose monitoring software. In a new study in European Journal of Radiology, authors reviewed nine papers for the causes of high-dose alerts, finding the frequency of alerts ranged from 1.5-10.2% and occurred most often with CT chest exams. Alerts were mostly triggered by overweight patients, scan repetition, patient miscentering, and other technical factors. Alerts also occurred more often with less-experienced and part-time radiographers, but dose monitoring software can reduce alert frequency.
- RT Enrollment Grows: There may be help on the way for the radiologic technologist shortage. A new survey from ASRT shows that enrollment in RT training programs in 2024 grew 12% compared to 2023 (19.8k vs. 17.7k). The survey included responses from directors of 412 programs approved by the ARRT, and found big jumps in students enrolled in programs training for careers in ultrasound (+75%) and MRI (+81%), as well as nuclear medicine (+55%). ASRT said enrollment growth appears to be driven by high vacancy rates for RTs.
- Mammo Screening Falls Short: Despite lowering the national breast screening age to 40, a new study found that mammography screening rates are lagging among women ages 40-49. Research published in JAMA Network Open found only 59% of women in their 40s got screened over two years, with 15% reporting mammography over two years before and 26% saying they had never had a mammogram. Women without a usual place of care were 7% more likely to be overdue for screening and 20% more likely to have never been screened.
- Breast Screening Changes Post-USPSTF: In related news, researchers claim in JAMA Network Open that the USPSTF’s 2009 decision to raise its recommended starting age for breast screening to 50 didn’t cause more advanced cancers. In 2M women diagnosed with breast cancer from 2004 to 2019, rates of in situ breast cancer for women ages 40-49 rose 3.9% annually before 2009 and fell -0.97% after that, which they attributed to less screening. But they saw no increase in rates of distant and regional cancers.
- Visage Signs $19M Contract: The hits just keep on coming for Visage Imaging. The company signed an $18.7M seven-year contract to install its cloud-based Visage 7 enterprise image management technology at Duly Health and Care, the largest multi-specialty physician group in the Midwest. Duly will install the Visage 7 image management platform, open archive, and workflow modules, with go-live targeted for the second quarter. Visage closed 2024 by signing several large enterprise imaging contracts.
- Radiologists Work Harder in Ultrasound: Radiologists who read diagnostic ultrasound scans seem to be working harder for less reimbursement. In a presentation from RSNA 2024, researchers analyzed Medicare claims for 2.4M ultrasound scans for multiple clinical applications in 2021. The authors found that compared to 2001 radiologists had to service 9.2 percentage points more RVUs per beneficiary for the same reimbursement. They also found that geographic differences in reimbursement persisted despite Medicare adjustments to account for regional differences. They suggested that reimbursement valuations be revised.
- Epic Stops Duplicative Imaging: Clinicians love to complain about Epic, but a new study from the company’s research group claims its EHR software prevented over 5.8M duplicate imaging orders in one year alone. For the past 10 years, the EHR has notified providers if a duplicative imaging study is being ordered, and in 2021 this functionality was expanded to check orders from external organizations. Epic researchers analyzed over 32.4M notifications in a year, finding the notification system prevented 400k-500k duplicate orders per month.
- 3D Firm Raises $19M: Advanced visualization developer Axial3D of Northern Ireland raised $18M to further commercialize its flagship Insight platform for converting medical image data into 3D visualizations that can be viewed on workstations or printed as 3D models for guiding surgical procedures. In other news, the company at RSNA 2024 announced a collaboration with GE HealthCare to use MRI data to create patient-specific 3D models.
- Fischer Debuts MammoCAT: A venerable brand from the early days of digital mammography is back. Fischer Imaging has debuted MammoCAT, a full-field digital mammography system based on slot-scanning technology. Fischer claims that MammoCAT uses half the radiation dose as conventional FFDM systems without requiring breast compression. It doesn’t require an anti-scatter grid and performs both planar and digital breast tomosynthesis. Fischer delivered a MammoCAT to Johns Hopkins University for preclinical testing and plans to raise capital to commercialize the system in 2025.
- Careverse Debuts at RSNA: Among the companies making their debuts at RSNA 2024 was Careverse, a firm that’s developing multimodal and large language AI tools for radiologists. The company’s offerings include an FFR-CT algorithm for calculating coronary artery function, tools for CAC scoring and fully automated vessel segmentation and reconstruction of CCTA scans, and finally a “digital heart” that uses AI to measure cardiac anatomy and lesions including vulnerable coronary plaque and peri-coronary fat. Careverse has also developed AI applications for brain, chest, abdominal, and breast applications.
- LG to Enter C-Arm Market: Display and digital detector manufacturer LG plans to diversify with a mobile C-arm the company displayed at RSNA 2024. The company’s FT Scan prototype is a non-rotational C-arm that will feature next-generation fixed X-ray tubes for better image quality and fewer motion artifacts, with lower radiation dose. LG also displayed a 27-inch 8MP clinical review monitor as a prototype. Other RSNA highlights included a 28-inch ergonomic monitor, digital X-ray detectors, and a 32-inch 4k surgical monitor.
- RapidAI Goes Enterprise: RapidAI set its sights on the enterprise imaging market at RSNA 2024, launching its cloud-based Rapid Enterprise Platform. The solution includes Rapid Navigator Pro, which features improved integration to enable AI results to be viewed more seamlessly on PACS workstations. RapidAI has added third-party algorithms to Enterprise Platform for detecting conditions outside the neurovascular system, like vertebral compression fractures, C-spine fractures, and incidental pulmonary embolisms.
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Streamline Your Radiology Workflow
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MRI Access and the Cost of Inpatient Stays
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- An End-to-End AV and AI Solution: Never buy separate AV and AI solutions again. Get in touch with TeraRecon to find out how your health system can benefit from all the Intuition clinical features you need, plus a growing list of exclusive subscription-only content that leverages the power of AI.
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- How to Standardize CT Images: The quality and appearance of CT scans can vary considerably. In this white paper from Riverain Technologies, find out how image normalization can standardize CT images, making them easier to analyze and interpret.
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- The Leader in Molecular Imaging: United Imaging’s uMI portfolio of solutions is designed to help you lead the way in molecular imaging. From digital PET/CT systems designed to stand the test of time to the cutting-edge uEXPLORER total-body PET scanner, discover the uMI difference today.
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- Get Your Head Around AI for Neuroradiology: Check out the latest blog from Blackford on how advances in deep learning algorithms for neurology imaging are improving outcomes and easing the burden on radiologists.
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