By Donald Elting, R.T. (CT) (MR)
Dir. of Operations at Hackensack Radiology Group

In any area of life, yet alone in healthcare, it is very unusual to find everyone in agreement on a topic. When it came to lowering CT radiation and how to achieve low dose at Hackensack Radiology Group (HRG), it was one discussion that everyone agreed on and rallied behind.


To successfully achieve dose reduction, it must be a multi-faceted approach. Ordering physician education, in regard to proper exam ordering; technologist education, in order to limit scan range and radiation; dose protocol modification to limit radiation; and the implementation of image reconstruction software to improve image quality with reduced radiation.

At HRG, by employing this combination of best practices, we are at or below the lowest 25th percentile of radiation exposure examinations in the Dose Index Registry, a data registry allowing facilities to report and measure their CT dose indices against regional and national values.

The data submitted to the registry encompasses routine body and neuro exams in our practice including multiphase exams, CT angiography, CT Colonography and Lung screening .

Three key steps to successful dose reduction

First, it starts with education and awareness. Today, many physicians and technologists learn in school about the risks of radiation exposure and the proper precautions and techniques that are needed for their safety and the safety of the patient. Since dose has become a prominent topic, more is being done to address it in training programs.

As a technologist specializing in MR before becoming an administrator 15 years ago, it was not top of mind or part of our imaging protocol to approach the patient’s imaging exam from a dose perspective. Now, we make sure technologists know when an additional dose is necessary, or when they can appropriately lower dose and still achieve the necessary image quality. Most notably, besides the establishment of the Dose Registry, the American College of Radiology (ACR) launched national campaigns known as Image Wisely™ and Image Gently™ to promote technologists pledging to take precautions and utilize all available protections for the safety of staff and patients.

Secondly, patient positioning is vital. We use the best technique possible to keep the dose as low as possible. For example, we have been able to reduce dose for our CT cervical spine exams after changing our patient position. We ask patients to pull on a strap so that their shoulders are out of the way of the lower cervical spine. Now we only need enough dose to penetrate the neck and not the shoulders as well.

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