Introducing Radiology Select: Radiation Dose and Dose Reduction

As a consequence of the success of medical imaging over the past decades for aid in accurately diagnosing disease or injury and guiding therapy, the collective radiation dose delivered to the U.S. population from medical imaging has increased six-fold since the 1980s (1,2). This has resulted in substantial concern from physicians, patients, and regulators. Consequently, radiation dose management and reduction have become one of the most important challenges facing medical imaging providers (3). Radiation protection in medicine is based on two guiding principles: (a) the examination or procedure must be medically indicated, and (b) the examination or procedure must use doses that are as low as reasonably achievable—the ALARA principle—without compromising the diagnostic task (4). However, these simple principles can be difficult to apply in clinical practice, because quantification of either the risks or the benefits associated with exposures to ionizing radiation is not always straightforward. Even the standard metrics for describing the amount of radiation dose delivered to a patient and the optimal methods for dose reduction are still a matter of debate, as is the role of industry, professional organizations, and regulatory agencies. In addition, the rapidly improving technology and the ever increasing number of articles published on the topic of radiation dose reduction every year indicate that we are far from a stable situation from which the medical community could develop universal consensus on best practices for radiation dose management. The aim of this edition of Radiology Select was, therefore, to collect the best articles published in Radiology from 2008 to mid-2013 that address these important and rapidly evolving issues. We reviewed articles with the general topic of radiation dose, defined major categories for subtopics, and selected five to eight articles for each subtopic. The category and the number of articles within each category were greatly influenced by the extent to which the articles addressed the challenges facing the imaging community with regard to radiation exposure and risk from medical imaging, as well as by the quality of the respective articles. The selected categories include (a) Challenges Associated with the Safe Use of Ionizing Radiation in Medical Imaging, (b) Quantifying Radiation Exposure and Patient Dose from Medical Imaging, (c) Quantifying Radiation Risk From the Low Doses Used in Medical Imaging, (d) Quantifying Radiation Risk in a Medical Population, (e) Dose Optimization in CT of the Abdomen, (f) Dose Optimization in CT of the Heart and Lungs, and (g) Dose Management in Interventional Radiology and Neuroradiology. Although a majority of the publications are related to dose issues arising from medical uses of computed tomography (CT) (probably because CT is responsible for the largest part of collective dose delivered by medical imaging, followed by nuclear medicine and interventional radiology), we have also included articles related to radiography, mammography, and interventional