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Radiation Safety Awareness Initiative

We are pleased to inform you that BlueCross BlueShield of Western New York launched a Radiation Safety Awareness Initiative in September 2017 in conjunction with National Imaging Associates (NIA), our nationally recognized Radiology Benefits Manager. We are taking this proactive approach in order to improve patient safety and raise awareness regarding radiation exposure.

As you know, radiation exposure from medical imaging is a rapidly growing patient safety issue. Patients are exposed to nearly six times more radiation from medical diagnostic tests than they were in 1980. The largest contributors to the increase in medical radiation exposure are CT scans and nuclear medicine.

How are patients identified?
'At-risk' patients are identified through radiology claims which are provided to NIA by BlueCross BlueShield twice a year for analysis of radiation exposure based on those claims.

'At-risk' patients are those with cumulative radiation exposure equal to, or over a level that has been identified as detrimental to long-term health, thus, putting the patient at an increased risk of developing radiation-associated complications such as cancer.

How are physicians notified if one of their patients is identified as 'at risk'?
Physicians will be notified by telephone, or by an online alert at the time a radiology procedure is reviewed for preauthorization. A provider alert letter will also be sent via fax or mail.

Note: The patient's level of radiation exposure does not impact the preauthorization or decision-making process for requested imaging studies.

Since Emergency Medicine physicians are exempt from the preauthorization process, they will not receive notification of a patient's exposure level. The information listed below may be considered when ordering diagnostic testing in the Emergency setting. Imaging studies ordered and performed in the ER setting are utilized when calculating a patient's estimated radiation exposure.

How can Emergency Medicine medical professionals use this information when ordering diagnostic testing?

  • Consider the risk versus the benefit of the radiology study.
  • Consider how the results of this study will help in managing this patient.
  • Consider if this ionizing radiation study is the best one to perform.
  • Consider if there are other tests such as ultrasound, lab or endoscopy testing which would be a more appropriate initial investigative study
  • Carefully consider the necessity of repeating a CT scan, especially in young girls and young women due to the radiation dose to breasts and ovaries.
  • Be aware of a patient's prior history of imaging studies. Discuss this with the radiologist.
  • Consider discussing this information with the patient as this may enable them to take a more active role in their health care.

How is radiation exposure measured?
Radiation exposure estimates are measured in milliSeiverts (mSv). Radiation effective dose is the amount of radiation received by the patient and depends on many factors including distance from the source, time of exposure, overall body and organ size, location and nature soft tissue exposed. There is some variation in the amount of radiation received. Studies suggest a significant increase in risk of cancer at radiation effective dose estimates of 50 mSv. Reaching this effective dose is not uncommon in patients having multiple CT and/or nuclear imaging studies.

The following table illustrates the estimated effective radiation dose of common medical procedures:
Diagnostic Procedure Typical Effective Dose (mSv) Number of Chest X rays (PA film) for Equivalent Effective Dose
Chest x-ray (posterior/anterior film) 0.02 1
Skull x-ray 0.07 4
Lumbar spine 1.30 65
I.V. urogram 2.50 125
US Background Radiation 3.00 150
Upper G.I. exam 3.00 150
Barium enema 7.00 350
CT head 2.00 100
CT abdomen 10.00 500

If you have any questions regarding this bulletin, please contact Project Coordinator Michael Zaunick, RN, at 1-716-887-9976 or National Imaging Associates at  Individuals can also view an interactive tool to help estimate the radiation dose associated with medical tests at

Should you receive a provider alert, NIA peer discussion contact information will be included.

1U.S. Food and Drug Administration, Center for Devices and Radiological Health. Adapted from European Commission, Radiation Protection Report 118, "Referral guidelines for imaging. Directorate-General for the Environment of the European Commission." 2000.