Image Wisely, a joint initiative of ACR, RSNA, ASRT and AAPM, provides information to the medical community to promote radiation safety in medical imaging.

November 08, 2021

Image Wisely Endorses Joint Statement on Appropriate Exam Ordering without Dose Tracking

Image Wisely has endorsed the August 2021 joint statement, reproduced below, from the American Association of Physicists in Medicine (AAPM), the American College of Radiology (ACR), and the Health Physics Society (HPS). The statement clarifies the evidence-based position and consensus of the organizations that medical imaging exams should be ordered for clinical reasons, and that exam ordering should not be based on past radiation exposures.

“This joint statement is a powerful confirmation of the medical radiological community’s commitment to providing the right exam, for the right patient, at the right time,” said Diana Litmanovich, MD, FNASCI, and Image Wisely Co-Chair. Beth Schueler, PhD, FAAPM, FACR, and Image Wisely Co-Chair, added, “The community invests so much in providing tools for appropriate exam ordering. Tracking dose indices is an important component of quality assurance and process optimization in radiology, but incorporating past radiation exposures into medical imaging exam ordering is inappropriate.”

The statement has also been endorsed by the American Society for Radiation Oncology (ASTRO), The Association for Medical Imaging Management (AHRA), the Radiological Society of North America (RSNA), the Society for Cardiovascular Computed Tomography (SCCT) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI). The statement reads: 

"It is the position of the American Association of Physicists in Medicine (AAPM), the American College of Radiology (ACR), and the Health Physics Society (HPS) that the decision to perform a medical imaging exam should be based on clinical grounds, including the information available from prior imaging results, and not on the dose from prior imaging-related radiation exposures.

AAPM has long advised, as recommended by the International Commission on Radiological Protection (ICRP), that justification of potential patient benefit and subsequent optimization of medical imaging exposures are the most appropriate actions to take to protect patients from unnecessary medical exposures. This is consistent with the foundational principles of radiation protection in medicine, namely that patient radiation dose limits are inappropriate for medical imaging exposures. Therefore, the AAPM recommends against using dose values, including effective dose, from a patient’s prior imaging exams for the purposes of medical decision making. Using quantities such as cumulative effective dose may, unintentionally or by institutional or regulatory policy, negatively impact medical decisions and patient care.

This position statement applies to the use of metrics to longitudinally track a patient’s dose from medical radiation exposures and infer potential stochastic risk from them. It does not apply to the use of organ-specific doses for purposes of evaluating the onset of deterministic effects (e.g., absorbed dose to the eye lens or skin) or performing epidemiological research."

Frequently Asked Questions on the statement are available via the AAPM website.