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Overview T his report provides a summary of the presentations and discussions that took place during the December 8-9, 2011, workshop titled “Tracking Radiation Exposures from Medical Diagnostic Proce - dures.” The workshop was organized by the Nuclear and Radiation Studies Board of the National Academy of Sciences and sponsored by the Cen- ters for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA), and the U.S. Department of Health and Human Services. This workshop report was authored by a six-member committee of experts appointed by the National Academy of Sciences. To respond to its statement of task (see Appendix A), the workshop committee brought together public health regulators, physicians, manufacturers, researchers, and patients to explore “why,” “what,” and “how” to track exposure from medical diagnostic procedures and possible next steps. The committee is responsible for the overall quality and accuracy of the report as a record of what transpired at the workshop, but the points discussed do not repre- sent a consensus of the workshop participants or the authoring committee; instead, they represent views expressed by individual participants during the workshop. The growing use of medical diagnostic procedures is correlated with tremendous and undeniable benefits in the care of most patients. However, it is accompanied by growing concerns about the risks associated with diagnostic computed tomography (CT) and other procedures that utilize ionizing radiation. A number of initiatives in radiation safety in medicine have taken place in the United States and internationally, each serving dif- 1
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2 TRACKING RADIATION EXPOSURE ferent purposes. Their ultimate goals are to provide higher quality clinical management of the patient and to ensure that reasonable steps are taken to keep the exposures as low as possible without compromising diagnostic efficacy. Workshop participants discussed four goals of tracking radiation expo- sure from medical diagnostic procedures: justification, optimization, indi- vidual risk assessment, and research purposes. Many workshop participants emphasized that a primary motivator for tracking exposures was to imple- ment and maintain dose reduction strategies through optimization and justification with the ultimate goal of improving care. These participants reiterated that such strategies ought to be adopted by all facilities that per- form diagnostic imaging, including hospitals and imaging centers, as well as free-standing private physician, dental, and chiropractor practices. Several workshop participants also noted that although it would be desirable to have a national registry that tracks radiation exposures from medical diag- nostic procedures, such a national effort is not likely to be implemented in the near future for many reasons including the following: lack of sharing of medical information across different health care facilities, lack of a unique patient identifier and integrated medical records, non-automated dose infor- mation collection processes, and data protection and patient privacy issues. It is hoped that this workshop report will be a valuable testimony to the questions other groups will have to face, and the consensus they will have to achieve, if radiation exposure tracking is to become a reality institution- ally or nationally in the future.