Q: Tell us about a time you effectively overcame an ethical dilemma as a radiologist.
Many times on overnight call, usually while searching for the appendix or trying to find a transition point, I've bemoaned my department's low-dose pediatric CT protocols, which can turn bowel loops into one big jumbled mess.
My job would be much easier if we could just juice up the scanner and make beautiful high-resolution images with every study.
“We took an oath to protect our patients, even when that means protecting them from ourselves.” — Michael J. Kelly, MD
I view patient radiation exposure as directly related to medical ethics. And it is a popular topic these days. Organized radiology has embarked on the Image Wisely® and Image Gently® campaigns to increase the awareness of practitioners. The topic has crossed the canyon from medical literature to mainstream media, and as a result, some patients do as about the safety of the study that they are about to receive. We took an oath to protect our patients, even when that means protecting them from ourselves. The practice of medicine need not be the mindless application of a diagnostic and treatment algorithm. From Roentgen's discovery to the present day, the number of imaging tools that we have developed is truly amazing. MR and ultrasound can often replace CT to answer a clinical conundrum. When a CT or nuclear medicine study is required, resources are available to help radiologists tweak imaging parameters to decrease radiation dose.
Will I ever fully embrace the grainy appearance of the low-dose CTs? Probably not. Will I resist the urge to crank up the mA and kVp to make exquisite images? Yes, I will. Am I doing my job to care for my patient while minimizing harm? I certainly hope so.
Michael J. Kelly, MD, Medical College of Georgia, at Georgia Regents University, Captain, MC, US Army