Tuesday, January 17, 2012

An Interview With James H. Thrall, MD

James H. Thrall, MD

James H. Thrall, MD
Read more at massgeneralmag.org

James H. Thrall, MD, is the chief of Radiology at Massachusetts General Hospital and the Juan M. Taveras Professor of Radiology at Harvard Medical School. He serves as a trustee of the Massachusetts General Physicians Organization. He has led Mass General’s efforts to track, mitigate and reduce radiation exposure for patients. Under his guidance, the Webster Center for Advanced Research and Education in Radiation was founded in 2010 through the philanthropic support of the late Edward (Ted) W. Webster, PhD, a former member of the Department of Radiology at Mass General.

What is the goal of the Webster Center?

Our mission is to develop and promote imaging methods that ensure the lowest achievable level of patient exposure to radiation. We have a three-pronged approach. First, we actively pursue an extensive slate of research focused on learning how to reduce radiation exposure across imaging modalities. Second, we make our clinical protocols and the results of our research freely available to other physicians and to the public. Finally, we have educational programs focused on dose reduction, including both continuing education courses available to all healthcare professionals in the field and a fellowship program for visiting radiologists and technologists.

We hosted our first annual symposium this year on CT radiation dose, and hope to continue to bring together professionals from around the world. Most radiologists spend most of their time learning how to interpret scans and make diagnoses. It takes healthcare professionals who are willing to put in additional time on the concept of the radiation dose reduction for our efforts to really take hold. The MGH culture has been instrumental in the success of our endeavors — teams that truly care about not just the results but the approach.

James H. Thrall, MD
James H. Thrall, MD

What sparked your interest in targeting radiation exposure?

My colleagues and I have been focused on this issue since the late 1990s. At that time, there was a focus on several new advances in CT scanning. A major uptick in use of CT scans occurred and Dr. Webster co-authored a study looking at the risk of cancers related to CT scans. His leadership and interest in the field were major catalysts for the foundation of the center.

Beyond that, imaging is a vital tool in our ability to diagnose and treat patients, but when patients and their doctors fear the tool, they may be hesitant about using it. We want to make sure our patients are secure in knowing that we are truly conscious of the effects of radiation and are doing everything in our power to make sure scans are as safe as possible. We can’t hold ourselves up to the public as a great place for health care without the commitment to patient welfare that is evident in this initiative.

How have you implemented your efforts?

We help referring physicians ensure that they are requesting the correct tests and avoiding prescribing unnecessary imaging. At Mass General, we use a special computerized physician order entry system adapted for medical imaging, which is focused on patient safety and on making sure the correct test is performed. Rather than make decisions about patient care in the abstract, or out of context, this system aids physicians in accurately assessing the needs of patients before sending them off for tests.

The process is extremely efficient for the entire team, including the provider and the referring physician. It makes it simpler to make decisions and provide the smartest care while incorporating these key elements of diagnosis. At the practitioner and institutional level, our systems restrict utilization of scans and associated radiation to only those situations where they are necessary and appropriate.

Please share an example of the successes you’ve experienced thus far.

One interesting example is the development of a color-coded chart created by Mass General’s Mannudeep Kalra, MD. With this tool, at a glance, a radiologist and a radiologic technologist can ascertain which of 30 categories a pediatric patient falls into, based on the reason for the scan and their size and weight. The team can then make sure the scan is specifically geared to the individual patient and their condition. Children have their whole lives ahead of them, and it is especially important to keep radiation doses as low as possible.

Comparing Mass General to national benchmarks, at minimum, we expose patients to an average of 30 percent less radiation, and as much as 85 percent less per procedure. Those are astonishing numbers. Our department has produced more than 100 articles and reviews on the topic of optimization of CT radiation dose while still producing the needed quality of images and ultimately protecting patient health by keeping radiation levels as low as possible.

Your educational materials aren’t just for physicians. Why do you feel it is so important for patients to have better knowledge of radiation?

When injuries or illnesses need to be treated quickly, it’s imperative that patients and physicians have the confidence in the appropriate scans to determine a course of action.

By adding robust educational aspects to our program, we can bring our efforts to more patients and more care providers. It’s in our best interests to help mitigate concerns across the country by teaching the greater medical community to perform radiology well — their patients may end up at Mass General. Our materials provide a higher level of education for our physicians, for referring physicians and for patients and their families.Addressing radiation concerns, in all departments, is the right thing to do for our patients.

We have developed educational materials geared to each medical specialty. If we can tell the stories of what we are doing, we can help provide patients with knowledge and reassurance. In the grand scheme of medical care, patients’ peace of mind is as important as just about anything else. We also need to provide the same educational resources for referring physicians, so that they don’t shy away from recommending what is medically necessary.

What are some of the facets of radiation you hope to continue to explore?

You can’t perform dose-ranging trials in living patients, and we are looking into a virtual autopsy series in conjunction with the pathology department. Before an autopsy, we can scan at four or five different levels of radiation, starting lower and ending higher than current clinical levels. We can use these data sets for teaching and to demonstrate acceptable quality of images produced with lower levels of radiation. You don’t need the prettiest picture in order to make the correct diagnosis. We also have dozens of organ-based projects underway, because each department in the hospital has specific exposure experience and needs.

We started our studies of radiation reduction more than 15 years ago, knowing we were focusing our energy on something important. To see those efforts now being recognized as extraordinary, and for Mass General and the Webster Center to be arguably the leading program in the world, gives me pride in radiology and the work we do for the safety of our patients.

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