UC Davis radiology expert leads published review of radiation exposure risks from medical tests
Amid increasing fear of overexposure to radiation from CT scans, a panel of experts has recommended more research on the health effects of medical imaging and ways to reduce unnecessary CT tests, as well as industry standardization of CT machines.
The recommendations, published in the November 2012 issue of Radiology, were developed at the Radiation Dose Summit, organized by the National Institute of Biomedical Imaging and Bioengineering (NIBIB). The summit included more than 100 medical physicists, radiologists, cardiologists, engineers, industry representatives and patient advocates. The proceedings, held in Bethesda, MD in early 2011, covered currently understood risks of radiation exposure from CT scans, set priorities for future research, and called for changes to industry practices.
"The number of CT exams in the U.S. has increased by about 10 percent each year over the past decade," said John Boone, UC Davis professor of radiology and lead author of the Radiology article. "This trend underscores the importance of developing a better understanding of the health risks of radiation exposure versus the benefits of enhanced diagnosis."
The experts conceded that despite widespread public concern about radiation risks, the biologic effects from medical imaging tests are not entirely understood. Most direct evidence comes from the effects of instantaneous, high-dose, whole-body exposures due to industrial accidents and from survivors of the atomic bombs in Hiroshima and Nagasaki, Japan. Whether these findings can be extrapolated to people exposed to occasional and much smaller dosages applied to only parts of the body is uncertain.
"The standards regarding 'safe levels' of radiation were designed for workplace safety and are very conservative," said Boone. "We don't know whether the established thresholds are really meaningful for exposure from medical testing."
The experts pointed out that because there is a high background incidence of cancer worldwide, the small incremental increase in cancer that may be attributable to low doses of radiation from medical imaging is extremely difficult to ascertain. They stated that national and international registries that track cancers and patient exposures to medical radiation may one day make it possible to conduct large epidemiological studies that could help make such associations.
"In reaction to media coverage of radiation overexposure cases, some patients refuse to undergo medical imaging procedures," said Boone. "Yet for almost all patients, the risks of foregoing a needed medical procedure far outweigh any potential radiation-associated risks."
Even accurately recording patient exposures of radiation from medical imaging is extremely difficult, according to the authors. Although it is easy to ascertain how much radiation a machine administers during an imaging study, the amount actually received by a patient depends on various factors including body size. For example, because of differences in body mass, children and small adults can receive a dose of radiation two to three times that of larger people, even when the dose administered is the same.
Other factors, such as whether the patient lies on a moving or stationary table, also affect the radiation dose received. Federally sponsored research is needed to develop methods to more accurately measure patient exposures from different types of CT scans, the authors suggested.
Summit participants also discussed the role of human error in CT scanning, which has resulted in widely publicized instances of radiation overexposure. They point out that CT operators frequently are responsible for several machines made by different manufacturers, each of which may utilize dissimilar nomenclature and control consoles, thereby increasing the chance for error.