Image Gently Works to Optimize Dental Radiation

The following post was contributed by guest blogger Marilyn J. Goske, MD, co-chair of the Alliance for Radiation Safety in Pediatric Imaging

As medical professionals, we know individualized care often yields better results. Especially for our youngest patients, radiation exposure may have effects. It is critical that we “child-size” imaging protocols.

The Alliance for Radiation Safety in Pediatric Imaging recently welcomed the American Dental Association, American Dental Hygienists’ Association, American Dental Assistants Association, American Academy of Oral and Maxillofacial Radiology and other dental organizations to the Image Gently campaign.

Dental imaging is a component of maintaining good oral health. houses materials to help dental professionals optimize dose in imaging performed on children and urges dental professionals to do the following in those instances:

•   Select X-rays for an individual patient’s needs, not merely as a routine
•   Use the fastest image receptor possible: E- or F-speed film or digital sensors
•   Collimate beam to area of interest
•   Always use thyroid collars
•   Child-size the exposure time
•   Use cone-beam CT only when necessary

We are thrilled that the dental societies, which represent nearly half a million professionals, have pledged their support and involvement in expanding this campaign to the dental community.

I urge you to take the Image Gently Pledge and do your part to image gently in your practice.

A Resident’s View: Reengineering the Radiology Enterprise

The following post was written by guest blogger Dr. Maya Hartman, radiology resident at Weill Cornell Medical Center.

I was recently fortunate enough to attend the ACR-sponsored annual Intersociety Summer Conference, which was held in Santa Fe, New Mexico.

This year’s topic was “Reengineering the Radiology Enterprise,” emphasizing the need for change and radiology value creation within an evolving health care environment. The meeting provided a realistic outlook on the current landscape and the need for us to be proactive about change, not only for the benefit of our field but, more importantly, for patients. A general theme was that change should be “patient-centered, data –driven and outcome-based” and should be achieved using process-improvement frameworks, which was exemplified with an interesting case study about the evolution of an emergency department in Colorado.

A meeting highlight was the breakout sessions, where the meeting attendees divided into subgroups to discuss ways in which the imaging process can be improved using a framework of “pre-imaging,” “imaging,” and “post-imaging.” One group interestingly pointed out that the mere division of imaging into such stages/classifications may be inhibiting progress and that perhaps the whole framework needs to be reconsidered.

Of course there was a session on Imaging 3.0TM and the concept that radiologists should take ownership over all aspects of imaging and outcome improvement. Some examples included clinical and radiologist decision support and a session about a new technology called REACH (Radiologists Engaging and Collaborating in Healthcare), which is an on-demand virtual radiology consultation technology.

Overall, the meeting was a great success and, as a group, we were able to identify many ways in which we can improve quality and value for our patients. As an added bonus, during the free afternoons, I was able to explore the various wonderful Santa Fe attractions including the Georgia O’Keefe Museum and Los Alamos!

Clinical Decision Support: What Does It Mean for You?

The following post was written by guest blogger Woojin Kim, MD, assistant professor of radiology at the Perelman School of Medicine at the University of Pennsylvania.

Clinical decision support (CDS) is a central component of the Imaging 3.0™ initiative. Use of such systems will be required in 2017 as part of the recently passed “Protecting Access to Medicare Act of 2014.” But, how many of us really know what the term means as applies to radiology?

When you do a Google search for “clinical decision support radiology,” the results are primarily that of CDS systems designed to ensure appropriate imaging studies are ordered and performed, such as by integrating the ACR Appropriateness Criteria® into CPOE via ACR Select™. However, this is only a portion of CDS.

  • A working definition proposed by Robert Hayward of the Centre for Health Evidence states, “Clinical decision support systems link health observations with health knowledge to influence health choices by clinicians for improved health care.”
  • According to, “CDS encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include computerized alerts and reminders to care providers and patients; clinical guidelines; condition-specific order sets; focused patient data reports and summaries; documentation templates; diagnostic support, and contextually relevant reference information, among other tools.”

Hence, what radiologists think most often when they hear CDS is a system designed for the ordering clinicians. What about the radiologists? I am organizing a course for ACR 2015 titled, “Clinical Decision Support for Radiologists.” It will address this very concept including opportunities around CDS for radiologists, and how both commercially available tools – as well as ACR-led initiatives like actionable findings and clinical guidelines – can help radiologists and practices generate value through higher-quality reporting and improved efficiency.

Within this course, Dr. Chuck Kahn will give a presentation titled “Decision support systems: An introduction for radiologists.” Dr. Tarik Alkasab will present “Bringing evidence-based standards to the radiologist point of care.” And I will discuss “High-quality reporting and improved efficiency through clinical decision support.”

I invite every radiologist, radiation oncologist and medical physicist to attend ACR 2015 to learn about informatics and other forces shaping our profession. Health care is changing. We can either shape that change or be shaped by it (maybe not to our liking). If you need an informatics fix in the meantime, check out the ACR Imaging Informatics Summit October 29-30, 2014, in Washington, DC.