Dr. Smith-Bindman's research concentrates on the impact of diagnostic testing on important patient outcomes and on understanding differences in access to various tests, as well as the variance in accuracy of these tests. Dr. Smith-Bindman's interest in diagnostic testing was inspired by her clinical work. She became concerned about the highly variable doses used in CT scans. Often, the doses of radiation delivered were far higher than anyone realized, as the doses used in actual practice differ substantially from those that are used when phantoms (sophisticated plastic models used for quality assurance in radiology) are scanned.

Dr. Smith-Bindman's first small pilot study in this area demonstrated that in routine clinical application, there was a 20-fold variation in radiation dose between patients and institutions for the same clinical condition. This is in line with larger studies that have demonstrated 50-fold, and even 200-fold, variations in radiation dose between patients imaged for the same clinical reason. It appears that these differences are not driven by patient factors (such as weight), but rather caused by institutional preference. Despite how frequently computed tomography is used and the high doses of radiation being delivered, there are few standards for the conduct of CT examinations. Now that research has demonstrated the variations in dose and the need for improvement, Dr. Smith-Bindman is working to standardize, optimize, and improve practice. This involves not only providing feedback to sites regarding their imaging practices, but also understanding factors that might accelerate or hinder optimization, so that effective interventions can be expanded.

Dr. Smith-Bindman's current study, the "Partnership for DOSE", is a multi-site collaboration focused on implementing improved standards for CT dosing and studying strategies to implement and disseminate these standards across diverse institutions. The project uses a mixed methods design and will use the results from a randomized control trial, observational data, and key informant interviews to meet the project goal of improving the safety of CT scans by lowering the doses to which patients are exposed. The findings of the study and the best approaches for lowering radiation dose will then be broadly disseminated.