Radiation risks of CT scans need to be taught to patients

Radiation is emitted in various forms. Recently, CT scan radiation has preoccupied (or “absorbed”) the attention of the public and media. As explained: “X rays, γ rays, and neutron beams are considered ionizing radiation. Ionizing radiation may break molecules into pieces, creating ionic free radicals that can be very damaging to tissue.”

For this reason, it is imperative that the use of radiation is only by highly trained personnel and that the public is appropriately educated so that they understand their risks as it relates to their health care.

People come in all different sizes, and CT scans are obtained of different areas of the body, so routinely radiation doses vary. Unfortunately, there have also been some recent examples of over-exposure of patients due to computer errors that resulted in some individuals being scanned multiple times over the usual amount. These errors must obviously be corrected. There is no excuse.

The good news, however, is that radiologists are focused on the issue of decreasing radiation dose.

But the public and media, and even many doctors and other health care personnel, must be educated as to the actual known risks of radiation. Speculative risks should be discussed and understood in context and without emotional hype. If the health care system is well-informed, then the public and media will be better able to understand our message regarding this very important issue.

When needed, CT imaging is useful to your health. Judicious use of CT imaging is essential. The risk of cancer from imaging-related radiation, if used appropriately and only when necessary, is small. No cancers have been proven to be caused by CT imaging radiation exposure.

Recently, the Society of Interventional Radiology (SIR) formally presented written testimony to the Energy and Commerce Committee on “Medical Radiation: An Overview of the Issue.” Most of the time was spent discussing ways to prevent further radiation overexposure and the means by which such prevention should be accomplished.

The SIR also recently published a position statement on imaging-related radiation use, which appropriately concludes: “We recognize that the physician has a responsibility to advise patients of the potential risks of radiation in a particular procedure so they can be weighed against possible benefits. The best decisions can be achieved when an informed physician and patient work together as a team.”

I think the most important aspect of CT scan radiation exposure is that patients and physicians balance the risks with the benefits. As an interventionalist, I discuss both of those aspects of every procedure with my patients. A biopsy carries the risks of bleeding, infection and, in the case of a lung mass, pneumothorax (or collapse of the lung), in addition to a small amount of radiation exposure related to the CT scan used for needle guidance. But the benefits, one would hope and assume, outweigh those risks and include obtaining a rapid diagnosis so that treatment can be initiated.

In the case of a person who suffers a car accident, the ER physician may request extensive CT scanning to evaluate for any potentially life-threatening injuries. These are not trivial decisions, although they may seem to be by a non-physician observer. The majority of the time, a CT scan is obtained because the clinician wants to know what is going on with his/her patient.

The bottom line is that we weigh the risks and benefits of each decision. Hopefully, through continued discussion by medical personnel through posts like these and other forms of media, the public and mainstream media will realize and acknowledge the fact that health care personnel are interested mainly in ensuring the health and well-being of their patients. CT scans are a powerful tool in that process. Typically the benefits far outweigh the risks, especially when it comes to imaging-related ionizing radiation.

Paul Dorio is an interventional radiologist who blogs at his self-titled site, Paul J Dorio, MD.

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