As low as reasonably achievable, or ALARA, is a goal in radiation safety. PixelShine^® offers a technically feasible way to reduce radiation exposure within economic constraints—making it a must-have for providers seeking to achieve ALARA.

What is ALARA?

ALARA is an acronym that stands for “As Low As (is) Reasonably Achievable.” It is a principle that summarizes the approach to responsible and safe radiation usage, and it means reducing the dose of radiation as far below the dose limit as possible such that the original diagnostic goal can still be achieved while remaining within the bounds of what is technically possible and economically reasonable.

ALARA is intentionally a bit vague—the exact value for “reasonably achievable” will change as technology advances. For example, in 1983, the average exposure to radiation for a CT scan ranged from 10–70 mGy², but in 2009, exposure was around 2–30 mSv (mGy).⁴

Who regulates radiation exposure?

ALARA is officially defined by the United States Code of Federal Regulations, a document produced by the U.S. Nuclear Regulatory Commission (NRC). (10 CFR 20.1003)

The NRC exists to govern all radiation activity that happens in the U.S., which the government believes is necessary since all people are exposed to radiation, which can be harmful. Among other roles, the NRC defines ALARA, determines the acceptable radiation level for members of the general public, and governs radioactive waste disposal.

Although the NRC defines ALARA in principle, on a practical level, hospitals and other imaging facilities are regulated by The Center for Medicare & Medicaid Services (CMS), and additionally accredited or certified by the Joint Commission (JC). Both groups set some guidelines about how much radiation is permissible per person or procedure.

Other groups have an interest in reducing radiation exposure in the interest of patient safety as well, including the American College of Radiology (ACR) and the FDA (who regulates the radiology related software and hardware available on the market). However, no group can say with absolute certainty how much radiation an individual patient should have for each scan since exposure must be adjusted based on both the purpose of the scan and the size  of the patient.

Why are there laws and regulations about radiation?

Although X-rays and CT scans have greatly advanced medicine, they rely on ionizing radiation to generate images. Ionizing radiation is inherently dangerous because its high energy destabilizes atoms, like those found in DNA.¹ Any change in DNA can eventually lead to cancer, and we know that both large and small doses of radiation increase cancer risks.²

As with any intervention in medicine, risks and benefits have to be weighed. In some cases, it’s easy to see how the immediate benefit of imaging can outweigh the long-term risks of cancer. In other cases, risk may outweigh the benefits, and this is especially true for those at the highest risk for damage from radiation.

These groups include:

• Pediatric patients – exposure to radiation earlier in life means more time to accumulate DNA damage that may one day lead to cancer
• Patients undergoing high-intensity scans – some types of imaging use much higher amounts of radiation (e.g., fluoroscopy or coronary angiograms)
• Patients who need repeated scans – people who need frequent or repeated imaging to monitor a condition are exposed to higher lifetime dose (e.g., smokers who receive yearly chest CT scans)

To help balance the risks and benefits of radiating technology, the goal is to acquire medically useful information with the minimum exposure to radiation possible.³

Why reduce radiation exposure?

Although these groups may not set a single numerical threshold for safe or unsafe radiation across patients and imaging studies, there are many reasons for a facility to dramatically limit the amount of radiation exposure to its patients, as soon as possible.3

Such reasons include:

1. Patient Safety: Radiation exposure from medical imaging has risen dramatically in the last several decades—and it seems likely to continue to do so—increasing the risks posed by continued radiation exposure.⁵
2. Meeting Regulations: To limit these risks, several groups (including the FDA, CMS, and NCRP) support a national radiation dose registry as a way for all facilities to compare the average amount of exposure per procedure. Facilities that fall too far above the national average will face consequences and penalties.
3. Physician Ordering Practices: Physicians and patients are being asked to consider fewer scans because of the radiation risks by initiatives such as the Imaging Wisely campaign. Unfortunately, based on current payment models, performing fewer imaging studies may adversely affect facility earnings. Instead of forcing the choice between dangerous levels of radiation and no imaging at all, low-dose CT scans can provide an excellent compromise.

Why Choose PixelShine^®?

PixelShine^® is an innovative software,  de-noises the noisy images   and create a clear, enhanced quality  image .Noisy images could be due to high BMI of the patient, low dose protocol etc.

. Contact us today for a demonstration.

References

1. CDC. What is Radiation? Centers for Disease Control and Prevention. https://www.cdc.gov/nceh/radiation/what_is.html
2. Evens R, Mettler F. National CT use and radiation exposure: United States 1983. American Journal of Roentgenology. 1985;144(5):1077-1081. https://doi.org/10.2214/ajr.144.5.1077
3. ICRP. Radiological Protection in Medicine. ICRP Publication 105. Ann. ICRP 2007;37(6). doi: 10.1016/j.icrp.2008.08.001 https://journals.sagepub.com/doi/pdf/10.1177/ANIB_37_6
4. Smith-Bindman R, Lipson J, Marcus R, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med. 2009;169(22):2078-2086. https://dx.doi.org/10.1001/archinternmed.2009.427
5. Center for Devices and Radiological Health, U.S. Food and Drug Administration. White paper: Initiative to reduce unnecessary radiation exposure from medical imaging. First published online February 2010. https://www.fda.gov/radiation-emitting-products/initiative-reduce-unnecessary-radiation-exposure-medical-imaging/white-paper-initiative-reduce-unnecessary-radiation-exposure-medical-imaging