Actions to Help Dial Down You Radiation Exposure

DiD You Ask Your Ordering Doctor?

Why am I getting the CT scan and how will it affect my treatment?

It is important that the CT scan is going to provide information to aid in your diagnosis or guide your treatments. If the CT scan is being used just to confirm what is already known then perhaps it is not necessary. This is obviously a decision your doctor has to make but the question is worth asking.

Are there alternative tests that do not involve radiation?

In some instances tests that do not involve radiation, such as ultrasound and Magnetic Resonance Imaging (MRI), can be used instead of CT scans. Another alternative may be conventional X-Rays, which usually offer less radiation than CT scans. There may not be an alternative but it is worth asking.

Do I need a CT scan now or can I get it later and how often am I going to need CT Scans?

It may be that your doctor is curious to see how your condition is doing, such as like with an abdominal abscess (infection), even though you appear to be doing well on the outside (no fevers, your blood counts are good). If your condition is improving then maybe you can delay getting your next CT scan. If you are getting routine follow up for a condition such as cancer be sure that your physician is following the latest guidelines. For example, with testicular cancer the guidelines used to recommend getting a CT scan every 3 months for the first three years, then every 6 months for years 4-5. In 2012, the guidelines were changed to recommending a CT scan every 6 months for the first two years and then every 12 months through year 5. This difference in the 2011 (16 CT scans) to 2012 guidelines (7 CT scans) eliminates the need for 9 CT scans and their additional radiation exposure.

Is there a facility that has a low dose CT scanner?

Odd are that the doctor ordering your CT scan has never walked into the department where you get your CT scan and most likely has no idea as to the availability of low dose CT scanners. This does not mean that you have a bad doctor; it is just the nature of the medical system. By asking your doctor about the availability of low dose CT scanners, they can have their staff call around and find a low dose scanner for you. This question will not only help you but also the other patients in your doctor’s office. Also, just because your doctor normally uses one imaging facility doesn’t mean that you can’t go somewhere else for your CT scan if the normal facility doesn’t have a low dose CT scanner. Ask your doctor to find a facility with a low dose CT scanner.

Are you ordering my CT scan with and without contrast?

CT scans can be done before, during and after injection of IV contrast. This means that multiple phases (CT scans) are being done (before, during and after IV contrast injection) and each phase involves radiation exposure. Many times all of these phases are not necessary. Depending on why you are getting a CT scan, the pre or non-contrast studies can often be eliminated. Also, delayed scans, done several minutes after the contrast can be eliminated as well. Be sure you ordering physician discusses with the radiologist if you need with and without contrast CT scans and if additional phases are really needed. Often times your ordering physician may not know exactly what is needed and order your CT scan with and without contrast assuming that the radiologist will chose which one they need. Unfortunately, the radiology department may simply follow your ordering physician instructions and do both the with and without CT scans, meaning that you receive double the dose of radiation. Make sure your ordering physician and radiologist are communicating on which CT scan is best for you.

What are the risks of not having the CT scan?

There may not be other non-radiation testing alternatives and low dose CT scanners may not be available. However, the risk of not having the scan may far outweigh the risks of exposure to a little additional radiation. Remember that CT scans have revolutionized medicine since the early 1970’s and have helped save millions of lives. In the vast majority of cases, if there aren’t any alternatives then a regular CT scan is still well worth the risk so don’t just avoid them.

DiD you Ask at Your CT Scan?

Are you accredited in CT by the American College of Radiology (ACR)?

The American College of Radiology (ACR) has a CT Accreditation program that requires:

The physician interpreting the CT scans has met stringent education and training requirements. The technologist operating the CT scanner are certified by the appropriate body

That the CT scanner is surveyed regularly by a qualified, trained and experienced medical physicist who verifies that the scanner is functioning properly, taking optimal images and utilizing appropriate radiation doses.

You can also search the ACR Accreditation Database to be sure that your imaging center is CT Accredited. CT scanners use protocols, or predetermined scanner setting based on the type of test, body part being scanned and body size of the patient. Protocols for use in pediatric patients have been used for several years now. You can ask if the facility uses low dose protocols on adults, when their protocols were last reviewed and specifically when their protocols were last reviewed by a medical physicist. This information should be available from any ACR CT Accredited facility. If the Radiologic Technologist (RT) getting you ready for your exam doesn’t know then you can always ask them to find out.

Do you have a Low Dose CT Scanner?

Even if a facility is an ACR CT Accredited it does not mean that their CT scanners are newer and have low dose capabilities so be sure to ask before your CT scan.

Are you going to be using the Low Dose CT Scanner on me?

Most facilities have multiple CT scanners. Some scanners may be newer low dose technology and some may be older CT scanners. Some facilities may reserve their low dose scanner for certain patients, such as pediatric patients or Emergency Room patients. If their low dose scanner is currently being used then explain that you have time to wait until it can be used on you.

Is the dose adjusted to by body size/type?

The amount of radiation needed to get a clear image depends on your body size and the area of your body being scanned. Larger patients need larger doses and smaller patients can use smaller doses. Likewise, your chest area requires less radiation that your abdomen and pelvis. Even with older CT machines, the settings can be changed according to your body size and the area of your body being examined. The facility should have protocols in place to make these adjustments.

Do you know why I am having this scan?

This may seem like a dumb question but it isn’t. Depending on why you’re having the CT exam makes a difference on the amount of radiation you may need. For example, you may be going in to have a check up for testicular cancer, in which they are looking for enlarged lymph nodes in your pelvis and abdomen. However, your doctor’s office may have accidently noted your diagnosis as hematuria (blood in the urine) and the Radiologist is going to want to get extra images of your kidneys that are delayed until the IV contrast get to them. These added delayed images increase the amount of radiation that you receive. Again, it may sound like a dumb question but the exact scenario happened to the founder of the Testicular Cancer Society, so ask the question.

Is my CT scan with and without contrast? Do I need both?

Again, often times your ordering physician may not know exactly what is needed and order your CT scan with and without contrast assuming that the radiologist will chose which one you need. Unfortunately, the radiology department may simply follow your ordering physician instructions and do both the with and without CT scans, meaning that you receive double the dose of radiation. Make sure your ordering physician and radiologist are communicating on which CT scan is best for you and double check with the RT before the scan starts. Depending on why you are getting a CT scan the pre or non-contrast studies can often be eliminated. Also, delayed scans, done several minutes after the IV contrast injection may be able to be eliminated as well.

Can you give me the effective dose amount that I receive during my scan?

Federal Regulations are starting to push for CT facilities to track your radiation dose as part of your medical record and most new scanners will display the dose after your exam. While the recording of the dose isn’t officially a requirement as of yet asking for it is still reasonable. By asking for your dose to be given to you may help ensure that the lowest reasonable dose will be used. The dose may not be able to be given to you but at least you can ask.

Ask if they have a previous CT scan for comparison?

If you have had all of your CT scans done at one place then this isn’t an issue. However, if you have had multiple CT scans at multiple facilities then this can be an issue. The radiologist can get a ton of information from comparing your current CT scan to your past CT scans to note any changes over time. Most facilities can probably get a copy of your previous scans from the other facilities in your area but check to be sure that is the case or just in case take a copies of your previous CT scans with you on a disc. Also, the current facility will need to know when and where your previous CT scans were done. That is why an imaging history card is so important to keep. You can simply call the facility where your other CT scans were done and ask them how to get a copy of your CT scan on a disc. You most likely will have to go to the facility to sign a release form and pick up the disc but it will be well worth it. You may also see if they can make a disc for you at the time of your CT scan just so you can take a copy of it home with you to keep in your records in case you need it in the future.

 DiD You DO?

Keep records of your CT scans?

Just because you have a CT scan or any medical test for that matter, it does not mean that every one of your doctors will know about it. Keeping a history of your previous imaging tests can help reduce duplicate tests. A physician may be able to look at a previous exam to get the information that they need.

Make your ordering physician aware of your CT/medical imaging History?

Just because you gave your imaging history to the nurse does not mean that your doctor is aware of all the tests you have received. Be sure to mention to your doctor that you have had tests in the pasts. Sometimes, even other medical history can keep you from having more tests. For example, if you fall and appear to break your ribs the Emergency Room doctor may have you give a urine sample to make sure that you haven’t inured your kidneys. The urinalysis may indicate faint amounts of blood and the concerned ER doctor may want to do a ultrasound or CT scan to be sure you haven’t severely injured your kidneys. However, if you know that you have a recent urinalysis or that you typically have faint amounts of blood in your urine then you can avoid additional tests. Again, this happened to the founder of the Testicular Cancer Society and by knowing his medical history he avoided more tests.

Go to the same CT scanner facility?

Going to the same facility isn’t an absolute requirement but it may be able to help you to reduce your dose over time. For example, if you’re receiving follow up scans for testicular cancer then you may be able to talk to the radiology department and strike up a conversation about your radiation dose and how to Dial it Down. If they have the setting in their system that they used on your last CT scan then maybe they can adjust the setting to give you less radiation on your next scan. Also, if you do go to a different facility, then be sure to take a copy of your previous CT scans on a disc so that the radiologist can look at the past images. Most facilities can probably get them from the other facilities in your area but check to be sure that is the case or take a copy with you. You can simply call the facility where your other CT scans were done and ask them how to get a copy of your CT scan on a disc. You most likely will have to go to the facility to sign a release form and pick up the disc but it will be well worth it. You may also see if they can make a disc for you at the time of your CT scan just so you can take a copy of it home with you to keep in your records in case you need it in the future.

DiD You Do During the CT Scan?

Follow the Radiologic Technologists (RT) instructions.

Laying down in a CT scanner may seem simple and it is but you still need to listen and follow everything that the RT tells you. Simple positioning in the CT scanner can reduce the amount of radiation that you receive. The RT will position you perfectly in the center and being off center in the CT scanner can increase your radiation exposure. Likewise, with your arms down to your side, it can interfere with the quality of the images and that is why the RT will usually have you keep your arms above your head as you are laying down.

Stay still

When the RT places you in the scanner they will do two quick, whole body X-Ray scans, usually called scout scans, to assess your body size and positioning. The regular CT scan is then based on these first two images. If you move around the scout scans can be off and the images for the CT can be of as well. Thus, you may need to be re-scanned, which increases your radiation dose. Likewise, movement affects the quality of the CT scan images so lying as still as possible for the few minutes that the scan takes is best.

Hold your breath

If you have had a CT scan before then you probably remember the computer voice telling you to, “breathe deep and hold your breath.” He reason for this is again, motion can adversely affect the quality of the CT images. With modern day scanners, the time you need to hold your breath is very short so just pay attention and listen to the computerized voice. It will help make sure that your Radiologist obtains the best images possible.