Heart Radiation Test Can Be Cut By 50%
The radiation dose for a diagnostic scan of the heart and blood vessels was cut on average by more than half for almost 5,000 patients through a Michigan quality improvement project with no effect on image quality. Doctors and hospitals statewide have helped protect patients from the potential risks of radiation exposure as a result.
Details of the project – a quality improvement initiative funded by Blue Cross Blue Shield of Michigan – are published in the June 10 issue of JAMA.
The project not only involved 15 hospitals working together in the first multicenter trial of its kind, it also included heart specialists and radiologists working side by side.
Known as heart CT angiography, or coronary computed tomography angiography, the procedure has a 90-percent success rate in diagnosing heart disease. It is especially useful in identifying whether low-risk patients with symptoms do, in fact, have heart disease. It uses contrast, or dye, in the arteries and high-resolution CT to get detailed images of blood vessels and the heart to identify possible blockages or structural problems. But the exposure of patients to ionizing radiation during the test is a barrier to its widespread use.
The project participants were able to reduce the radiation dose by an average of 53.3 percent, to about the equivalent of three years’ “background radiation.” This refers to radiation one would get from such sources as sunlight and radioactivity from the earth. They were able to reduce the heart CT radiation dose through the use of seven risk-reduction protocols such as limiting the area scanned and by adjusting the power of the scanner depending on the patient’s weight.
“The public should be reassured that Blue Cross and the participating hospitals are monitoring radiation doses and looking for ways to reduce them,” says cardiologist Gilbert L. Raff, M.D., medical director of the Ministrelli Center for Advanced Cardiovascular Imaging at Beaumont Hospitals (Royal Oak, Mich.), who leads the project. “By doing this in a voluntary and collaborative way, we’ve been successful in improving health care overall, especially for those with medical conditions requiring frequent CT imaging.”
Data for the radiation-reduction project were collected on 4,995 patients at hospitals in the Advanced Cardiovascular Imaging Consortium. The consortium was organized in 2006 with ongoing financial support from Blue Cross Blue Shield of Michigan and Blue Care Network to provide administrative, logistical, statistical and analytical support for the quality improvement work.
"The coronary CT angiography initiative is one of our organization's Value Partnerships - a collection of collaborative initiatives among Blue Cross Blue Shield of Michigan and hospitals and physicians throughout the state," says David A. Share, M.D., M.P.H., senior associate medical director, Blue Cross Blue Shield of Michigan. "Each initiative brings health professionals together to carefully examine health care practice, generate new knowledge about which practices yield the best outcomes, and systematically apply that knowledge so that quality of care improves, health care costs are lower and patients receive the best care possible."
Participating hospitals ranged in size from small community hospitals to large university and community hospitals with more than 1,000 beds. The data were collected from July 1, 2007 to June 30, 2008.
The patient database assembled to support this quality improvement work represents the largest registry in the world of information about coronary CT angiography.
The protocols developed for this project can be used by other hospitals and imaging facilities to reduce radiation exposure for their patients. There is also potential to apply the same dose-reduction strategies when scanning other parts of the body.
In addition to Beaumont, the hospitals in the project during the time of this reported quality improvement were: Borgess Medical Center; Henry Ford Hospital; Hillsdale Community Health Center; Lakeland Regional Health System; Marquette General Health System; Mercy Health Partners-Hackley Campus; Mercy Memorial; Oakwood Hospital; Pontiac Osteopathic Hospital; St. John Hospital and Medical Center; St. John Macomb; St. John Oakland; St. John Providence Hospital; and Sparrow Health System.
The project has since grown to include 35 participating hospitals and five physician practices.
Beaumont is a world leader in the use and study of cardiac CT imaging. Research at the hospital in 2007 showed that CT heart scans are accurate, definitive, much faster and less costly than standard diagnostic testing for emergency room chest pain patients. That study was published in the Journal of the American College of Cardiology.
Beaumont’s cardiovascular imaging program is supported by philanthropists J. Peter and Florine Ministrelli of West Bloomfield, Mich., including an endowed chair in cardiovascular research held by Dr. Raff.