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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  • http://skepticalscalpel.blogspot.com/ Skeptical Scalpel

    I have no faith in the public’s desire or ability to be educated. They would rather risk excessive radiation and testing to be given a correct diagnosis. Woe to the MD who omits a scan and later finds out he/she missed a diagnosis. I blogged about this topic last month.

    • http://drpauldorio.com Paul Dorio

      Thanks for the comment. I agree with you, which is exactly why the system should allow and protect doctors to freely counsel their patients that they do not need every test they think they do. While the blame often lies with the over-ordering physician, perhaps, patient-driven scans happen alarmingly often, as we know.

      • HJ

        “I agree with you, which is exactly why the system should allow and protect doctors to freely counsel their patients that they do not need every test they think they do.”

        I have had 3 CT scans, and not one doctor counseled me on the risks. But it’s always blame the patient when the medical systems fails.

  • http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.

    Well done! I still think that the greater risk of CAT scans is the discovery of incidental lesions that precipitate a cascade of medical testing and anxiety.

  • S

    Can you teach the radiation risks of CT scans to my doctor? She wants to CT me for a small thyroid nodule, found incidentally on second followup CT for small stable lung lesion, found incidentally on workup for seizure. I said no, but I wish I’d stopped all this nonsense six months earlier. For what it’s worth, I am a young woman who is trying to conceive.

    • http://drpauldorio.com Paul Dorio

      Of course, it’s challenging to reach everyone, but I’m always happy to teach anyone who is willing to listen and learn. Hopefully each of us try to at least follow the standards of care, as set out by the slew of medical boards and societies. Feel free to recommend a site or two to your doctor!

  • http://www.kevinmd.com/blog/2010/09/radiation-risks-ct-scans-taught-patients.html M.A. Padmanabha Rao, PhD

    This comment provides latest research results why CT scan and other ionizing radiation sources cause more radiation dose to patients than expected. Ionizing radiation sources emit two more emissions, according to the following peer reviewed paper. X-rays (say from CT scanner, X-ray tube etc), gamma rays, and beta radiations are followed by Bharat radiation (predicted) having energy higher than that of UV at eV level, and the newly detected UV dominant optical radiation. While UV from CT scanner may subject the patients to higher skin dose than previously thought, Bharat radiation does to skin and outer layers of the body. The UV emission from CT scanner,
    radioisotopes and XRF sources has bearing in radiation biology in contributing more radiation dosage to patients of Radiotherapy and Nuclear Medicine than expected. Radiation dose data may need entry of UV as one more component, besides ionizing radiations in giving radiation dose to the patients. Bharat radiation and UV can be cut off from CT scaner by introducing a very thin Aluminium sheet or some other dark and thick material in the X-ray beam. Presently, Bharat radiation cannot be detected by any commercially avaialble detectors like Photomultiplier tube, since Bharat radiation energy lies in between X-rays and UV or EUV.

    M.A. Padmanabha Rao,
    UV dominant optical emission newly detected from radioisotopes and XRF sources,
    Brazilian Journal of Physics, Vol.40, no.1, March 2010.

    M.A. Padmanabha Rao, PhD
    Former Professor of Medical Physics, New Delhi, India

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