Over radiating What is the right thin...

Over radiating What is the right thing to do morally and ethically

Posted in the Radiology Forum


Indianapolis, IN

#1 Jan 11, 2011
"What is the right thing to do?"

I worked at a previous job for 17 yrs as a staff CT Tech and Supervisor and
basically there was really no need for non contrast studies(per radiologist) with a few exceptions(nodule follow ups, kidney stones, multi phase exams of liver,panc,renals,cta's, trauma heads are they few that come to mind). We rarely would scan some with and without for general abd pain(just with oral and IV) and definetly no delays unless a liver,renal lesion was seen.No sense in irradiating someone when it was not neccesary. Thats how we operated and the CT dept was ran. We had a protocol book in our scheduling dept on what was to be ordered(or suggested) when an office called in with a diagnosis when scanning . According to the radiologists having contrast gave more information, than what a non con could do(except for certain studies) so no sense exposing someone when it's not needed or would not be benefical.
I moved on to a different job as a regular staff CT tech. I work for another
very large group of radiologist. I expected things to be a little different, no problem.
I will try and keep this part short. I feel at this time we are over scanning way to much and nothing is being done about it and I am very frustrated and do not know what to do.Basically a good part of our exams are ordered with and without and delays are routine on all abd/pel CT's. I have been able to change some orders when doing so, just to a with only, but I feel that is not doing enough. The first thing I wonder is," why arent the radiologist calling and complaing to us or they should be calling the ordering dr's on why the exams are being ordered that way?" If I was back at my old job we would have been called on the carpet for that. Here it is a different story. It's like they don't care or want to step up and say and do whats right. It just blows me away that a physician(radiologist) who reads these exams,aware of radiation and what it can do lets this go. Maybe I am wrong and scanning some with and without is acceptable and the without phase and delays are benefcial. If thats the case I can live with that and go on . Example, I called a radiologist about scanning someone with and without and I felt it only needed to be done one way and I suggested that when I called. They agreed with me, but then they asked who ordered it and they said just do it with and without because the ordering physician would through a fit. Or if it was ordered that way they would just say "do as ordered".So basically somone was scanned one to many times for the sake of an ordering Dr not throwing a fit.
It's like they don't want to be bothered with it, or I hope not, but for financial benefits for reading and billing for a with and without study. I have approached my supervisors and they do feel the same, but it's like the pink elephant in the room. Everybody knows it's there but does nothing about it. I am dumbfounded by this!
If I am wrong on this principle I would like to know. I know there is no law on saying how someone should be scanned. But it seems like to me any radiologist with a conscious would know better morally,ethically. I am hoping some governing body will step up and start looking at doses more and putting the clamps on the physicians being more responsible..As we all know there is alot more talk on radiation in the general public concerning CT scans. Yes they are benefical and a great and valuable diagnostic tool, but it needs to be used in a more responsible manner with clinical corralation and evaluation of the patient.
Is it wrong to scan someone with and without and delays? I know
there are exceptions, but this situation weighs heavy on my mind and the radiologist that I work for seem to not even bother if someone is scanned that way. A lot of politics involved,radiologist having different opinions among themselves in the group and etc. I was trained a ceratin way for many years and now it's the opposite and does not seem right.

Evansville, IN

#2 Jan 24, 2011

I recently underwent sergery for an aoritc defect that I was diagnosed with some years ago. I came into a University ER with chest pain and was ordered to have an MRI with and without contrast. I am nor sure what you meant by "delays" but I was told that I was done both with and without contrast die. Anyway, that was like CT # 5 in the last 5 years and I am begining to become concerned with the level of radiation I have absorbed. Along side the flouascope (sp?) Stress tests, chest X-rays and other radiological exposures in the last 5 years, I would have to immagine I should be very concerned about the damage done to my body by radiation. Granted, almost all facilties are using digital Xray and CT equipment, I am still concerned.

Can you elaborate on the issue of "delays" and offer your profesional opinion on how much is too much? Also, Can I assume that radiation damage is cumulative?

Thanks for your consideration

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