Governance

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.

Support and Endorsement of this Position Statement from Other Groups:

• American Society for Radiation Oncology (ASTRO)
• The Association for Medical Imaging Management (AHRA)
• Radiological Society of North America (RSNA)
• Society of Cardiovascular Computed Tomography (SCCT) (see "Expert Consensus Documents")
• Society of Nuclear Medicine and Molecular Imaging (SNMMI)

Mentions in the Media:

• Is a patient’s cumulative dose measurement relevant when ordering a diagnostic radiology exam? (ReedSmith)
• Patient’s radiation history should not guide imaging orders (AuntMinnie)
• ACR warns against using ‘arbitrary’ radiation dose metrics to guide medical imaging decisions (HealthImaging)