My five-year-old daughter broke her wrist last week — on the monkey bars, of course. The break was right on the growth plate, so there was concern about the need for surgery. Yesterday we went to see the orthopedist to get a cast and an X-ray. What an adventure!
Knowing that my daughter had already been X-rayed and then hit with an old flouro in the ED and that she might need surgery, I wanted to go the minimal-dose route. While waiting for the doctor, I found out that the X-ray machine at the office was a plain-film unit. An X-ray of the wrist would not have been a ton of dose, but because we were not in an emergency situation anymore, I had a choice. I mentioned this to the receptionist, who talked to the nurse. The nurse proceeded to tell me that digital and plain-film X-rays have basically the same dose. I explained that I work with radiology professionals and hear routinely that digital X-rays have about 50 percent less dose than plain-film ones. She seemed stunned that I had a clue what I was talking about.
I’m sure I wasn’t their favorite patient of the day, but I wanted what was best for my little princess. When we finally got back to get the cast on, the doctor, aware of the situation, said she would have done the exact same thing. Points for me, since by that time my wife was thinking I had been a complete jerk. I wish that was where the story ended.
After the cast was on, my daughter, wife, and I headed over to the outpatient imaging department at the nearby hospital for a DR X-ray. The technologist snapped the first view but said it was somewhat grainy because of the cast. She informed us she was going to change some settings and shoot the X-ray again. I quickly responded that I didn’t want her to increase the dose or shoot the image again. Despite the cast shadow, the outline of the bones was clearly visible to my layman’s eyes. The whole point of the X-ray was to see the bone alignment, so all that was needed was a diagnostic image, not something to frame on the wall.
I write this not only to be cathartic, but to illustrate where dose monitoring can improve care. Since the events in California a few years ago that triggered CA Law SB1237, radiation dose has been a hot topic. The law in CA requires radiology departments across the state to record the patient dose delivered from CT cases. Since that law took effect last July, Massachusetts has now required ACR certification. Texas has also jumped on the regulation band wagon by requiring regulation training and safety committees.
At KLAS, we are just starting our investigation into the vendors and solutions that are available to help meet the new requirements and make improvements. DoseMonitor and Radimetrics (acquired by Bayer) are currently receiving a lot of energy, but several other companies, including GE, Sectra, and NovaRad, are also investing in dose. As we continue our research, I look forward to finding out how well the systems actually record dose regardless of modality age, manufacturer, or type, and to learning what providers are doing with this information. My hope is that it will be a tool for patients to make better decisions about their own x-rays, CTs, and other procedures, as well as a tool that helps providers appropriately lower the dose they deliver.