Radiology Outcomes Research Lab

Dr. Rebecca Smith-Bindman Vision

Directed by Rebecca Smith-Bindman, MD, the Radiology Outcomes Research Laboratory (RORL) was founded in 2010, and focuses primarily on ways to increase the benefits and minimize the harms of widely used screening and diagnostic imaging tests that use ionizing radiation.

Mission

The principal objective of RORL research is to provide rigorous evidence of the value of testing to allow patients to make more informed decisions about how and when to undergo imaging. This research will also aid health policymakers in making informed recommendations to the public about when and how to use such tests.  

Specifically, the goal is to demonstrate the impact of tests on health, identify the value of certain tests, decrease the use of tests where the evidence has shown the costs or harms outweigh the benefits, and do research to improve the performance of tests with proven clinical value but whose accuracy or precision can be raised.

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Partnership for DOSE

Purpose:

  • To explore variation in doses used for diagnostic CT by pooling radiation dose data across diverse healthcare delivery systems.
  • To identify the barriers and facilitators to implementing successful dose optimization strategies and standardizing practice.

Computed Tomography Radiation Basics

  • Computed tomography imaging helps doctors in the diagnosis, management, treatment, and prevention of serious diseases
  • CT scans emit x-ray radiation, which deposits energy in tissues
  • With the potential to excite elections, photons from X-rays can damage molecular bonding within body tissues
  • Some radiation-induced damages affecting DNA molecules can lead to the development of cancer
  • While radiation levels from CT scans may be considered "low-dose," a linear dose-response risk relationship is used to estimate cancers resulting from imaging radiation
  • The linear dose-response risk relationship was observed by studying the population of survivors from the Hiroshima and Nagasaki atomic bombs who were exposed to similar levels of radiation (Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2; 2006)
  • In comparion, the average radiation dose from a CT Abdomen/Pelvis exam is equivalent to the dose from 100 chest x-rays
  • Some studies have estimated that 2% of future cancers will result from CT radiation (Brenner, Hall; New England Journal of Medicine; 2007)
  • If we reduce the highest quartile of radiation dose levels, we have the potential to reduce the number of future cancers resulting from CT by 44% 
  • Several hospitals have overexposed patients to unnecessarily high radiation doses from CT scans, which has resulted in patient illness (Bogdanich; NY Times; 2010)
  • Currently, there is no governmental oversight, comprehensive standards or guidelines on how CT exams should be conducted
  • There is a need to establish acceptable dose levels that are as low as reasonably achievable (ALARA Principle)
  • Facility and physician awareness of the risks of CT radiation is low (Lee; Radiology; 2004)
  • Studies have shown that dramatic variation in dose both within and across institutions exists (Smith-Bindman, et al.; Archives of Internal Medicine; 2009)
  • Most of the variation in dose results from the variation in the adoption of multiphase protocols, larger scanning regions, or doses set to unnecessarily higher levels without any attention to the resulting increased cancer risk