Patient exposure to ionizing radiation from medical imaging has always been a clinical concern, because that radiation can raise their risk for cancer. But concern is rising as use of advanced medical imaging such as computed tomography (CT) increases. In the United States, CT use is three times what it was in the 1990s.
“Consensus is growing in the medical community that we need to work to minimize radiation exposure from CT,” said GHRI Senior Investigator Diana Miglioretti, PhD “We need to make sure that patients receive the lowest possible dose while still getting the benefits of CT.” Dr. Miglioretti leads a team of GHRI researchers and Group Health staff who are studying, standardizing, and improving medical imaging safety.
The task requires exceptional diligence. Dr. Miglioretti specifically noted the efforts of digital imaging librarians, who have “retrieved and digitized hundreds of images” for the research.
This dedication to improving patient safety while maintaining clinical excellence earned a Group Health radiology team the 2013 Birnbaum Award, which honors Group Health staff who work with researchers to improve patient care. The radiology staff were nominated by their GHRI collaborators: Dr. Miglioretti, Programmer Deb Seger, Biostatistician Eric Johnson, MS, Julie Endres, and Project Manager Beth Lapham. The team received the award at the 14th Annual Birnbaum Lecture on April 25.
“We would not have succeeded without the hard work of Group Health staff and management, clinicians, and GHRI leaders,” said Radiologist Michael Maxin, MD, a member of the award-winning team. Other team members from Radiology Services are Marcy Parsons, director; Mark Steffen, former director; Ron Becker, manager; Jeffery Perez, supervisor; Neimeh Shalash, manager; and Bette Drescher, manager. The winning team also includes Denise Washburn, digital imaging librarian; Rona Weathers, patient care rep, Operations; Keri Ann DavisThy, supervisor, Care Delivery, IT Services; and Angela Proctor, analyst, Care Delivery, IT Services.
Another catalyst for the project was its initial funding, which came from the GHRI Development Fund and the Group Health Foundation Partnership for Innovation.
The researchers published a surprising finding in 2012 with collaborators from institutions including the National Cancer Institute, several Kaiser Permanente research centers, and the University of California, San Francisco. They found that the national increase in advanced medical imaging such as CT also occurs in managed health organizations such as Group Health and Kaiser Permanente, which do not have a fee-for-service system. Associated radiation exposure also increased. For patients receiving CT, the average dose per person nearly doubled from 1996 to 2010, as did the proportion of patients receiving an annual radiation exposure considered high or very high.
This finding, explained Dr. Maxin, motivated the radiology staff to find practical ways to reduce radiation exposure from CT. But this is easier said than done. CT is an excellent noninvasive tool for early, accurate diagnosis of cancer and other diseases. But some studies predict that frequent and high-dose CT scans could increase the number of future cancers. The researchers and clinical staff went through many rounds of feedback to find a balance that retained CT image quality while reducing patient exposure to radiation.
“This work has been very meaningful to our technologists and radiologists,” said Ms. Parsons. “The projects with GHRI helped put effective tools and resources in their hands for delivering high-quality, safe imaging services to our patients. I am very proud of our radiology team’s commitment to this goal.”
The hard work is paying off. Results are still being gathered and published—including an upcoming paper on CT and associated radiation dose and cancer risk in children. But simple clinical interventions developed by the research team are turning out to be effective at reducing patient radiation doses. One example is giving radiology technologists information that compares patient radiation exposure from imaging exams they performed with exams performed by their peers. Steps like these are easily transferred to health care systems outside of Group Health.
“This research is having an impact beyond the Group Health community,” said Eric B. Larson, MD, MPH, Group Health’s vice president for research and GHRI executive director and senior investigator. “That’s what the Birnbaum Award recognizes: clinicians working with researchers to improve patient care locally and nationally.”
There were two additional nominees for this year's Birnbaum Award, including a group led by Cindy Johnson, executive vice president, Human Resources (HR), whose team supported the evaluation of Total Health, Group Health’s value-based insurance product. Her team members are Michael Harrington, executive director, Labor Relations; Joe Meadows, executive director, HR; Marian Geddes, benefits manager, HR; and Kathryn Bergmann, project manager, HR.
Sean Adelman, MD, Orthopedics, was also nominated for his research on ultrasound for helping to diagnose shoulder problems.
by Chris Tachibana