Abstract
Examinations that use medical ionizing radiation consisting of radiography, fluoroscopy, computed tomography, and nuclear imaging are essential tools in healthcare. This recognition however is accompanied by the risks of radiation which at doses very much greater than used in diagnostic imaging has known biological effects. The potential risk at diagnostic levels of radiation is the stochastic effect of cancer. Because of the connotations of the term radiation, doses and risks are often misunderstood by patients/caregivers and referring providers. This results in the “safety” aspect of radiation safety and quality often being the prevailing focus. In order to address the growing accountability of the imaging team, experts must understand doses delivered and what is known about risks, and develop a practice based on the tenets of radiation protection relevant to medical use: justification and optimization. This practice should include a dose-monitoring program. In addition, one should be able to have conversations across many different levels of understanding that are balanced and informed with respect to content, and appropriately delivered.
References
Abujudeh H, Kaewlai R, Shaqdan K, Bruno MA (2017) Key principles in quality and safety in radiology. AJR 208:W101–W109
Armao DM, Smith JK, Semelka RC (2015) Debriefing the brief: it is time for the provision of informed consent before pediatric CT. Radiology 275:326–330
Bartley K, Metayer C, Selvin S, Ducore J, Buffler P (2010) Diagnostic X-rays and risk of childhood leukaemia. Int J Epidemiol 39:1628–1637
Boice JD (2015) Radiation epidemiology and recent paediatric computed tomography studies. Ann ICRP 44:236–248
Boutis K, Cogollo W, Fischer J et al (2013) Parental knowledge of potential cancer risks from exposure to computed tomography. Pediatrics 132:305–311
Brink JA, Amis ES (2010) Image wisely: a campaign to increase awareness about adult radiation protection. Radiology 257:601–602
Broder JS, Frush DP (2014) Content and style of radiation risk communication for the pediatric patients. J Am Coll Radiol 11:238–242
Brown P (1995) American martyrs to radiology. Clarence Madison Dally (1865–1904). Am J Roentgenol 164(1):237–239
Cohen MD (2015) ALARA, Image Gently and CT-induced cancer. Pediatr Radiol 45:465–470
Cohen MD (2016) Point: should the ALARA concept and Image Gently Campaign be terminated? J Am Coll Radiol 13:1195–1198
Demb J, Chu P, Nelson T et al (2017) Optimizing radiation doses for computed tomography across institutions: dose auditing and best practices. JAMA Intern Med. Epub ahead of print. Accessed 17 Apr 2017
Ditkofsky N, Shekhani HN, Cloutier M et al (2016) Ionizing radiation knowledge among emergency department providers. J Am Coll Radiol 13:1044–1049
Einstein AJ, Henzlova MJ Rajagopalan S, Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA 298:317–323
Frush DP (2014) Whats and whys with neonatal CT. Pediatrics 133(6):e1738–e1739
Frush DP (2016) Counterpoint: Image Gently: should it end or endure? J Am Coll Radiol 13:1199–1202
Frush D.P., Samei E. (2015) CT radiation dose monitoring: current state and new prospects CME. http://www.medscape.org/viewarticle/839485. Accessed 17 Apr 2017
Frush DP, Denham CR, Goske MJ et al (2013) Radiation protection and dose monitoring in medical imaging: a journey from awareness, through accountability, ability and action…but where will we arrive? J Patient Saf 9(4):232–238
Frush DP, Benjamin LS, Kadom N et al (2016) The Think A-Head campaign: an introduction to Image Gently 2.0. Pediatr Radiol 46:1774–1779
Fuchs VR, Sox HC (2001) Physicians’ views of the relative importance of thirty medical innovations. Health Aff 20:30–42
Goske MJ, Applegate KE, Frush DP et al (2008a) Image Gently: a national education and communication campaign in radiology using the science of social marketing. J Am Coll Radiol 12:1200–1205
Goske MJ, Applegate KE, Frush DP et al (2008b) The image gently campaign: increasing CT radiation dose awareness through a national education and awareness program. Pediatr Radiol 38:265–269
Hartwig HD, Clingenpeel J, Perkins AM, Rose W, Abdullah-Anyiwo J (2013) Parental knowledge of radiation exposure in medical imaging used in the pediatric emergency department. Pediatr Emerg Care 29:705–709
Harvey HB, Brink JA, Frush DP (2015) Informed consent for radiation risk from CT is unjustified based on the current scientific evidence. Radiology 275:321–325
Hendee WR, O’Connor MK (2012) Radiation risks of medical imaging: separating fact from fantasy. Radiology 264:312–321
Hendee WR, Becker GJ, Borgstede JP et al (2010) Addressing overutilization in medical imaging. Radiology 257:240–245
Hopkins KL, Pettersson DR, Koudelka CW et al (2013) Size-appropriate radiation doses in pediatric body CT: a study of regional community adoption in the United States. Pediatr Radiol 43:1128–1135
Huang WY, Muo CH, Lin CY et al (2014) Paediatric head CT scan and subsequent risk of malignancy and benign brain tumour: a nation-wide population-based cohort study. Br J Cancer 110:2354–2360
International Commission on Radiological Protection (ICRP) (2007) Radiological protection in medicine. ICRP publication 105. Ann ICRP 37(6):1–6
Jolly D, Meyer JA (2009) A brief review of radiation hormesis. Australas Phys Eng Sci Med 32:180–187
Journy N, Rehel J-L, Ducou Le Pointe H et al (2015) Are the studies on cancer risk from CT scans biased by indication Elements of answer from a large-scale cohort study in France. Br J Cancer 112:185–193
Khong P, Ringertz H, Frush D et al (2013) ICRP publication 121: radiological protection in paediatric diagnostic and interventional radiology. Ann ICRP 42(2):1–63
Krille L, Dreger S, Schindel R et al (2015) Risk of cancer incidence before the age of 15 years after exposure to ionising radiation from computed tomography: results from a German cohort study. Radiat Environ Biophys 54:1–12
Lam DL, Larson DB, Eisenberg JD, Forman HP, Lee CI (2015) Communicating potential radiation-induced cancer risks from medical imaging directly to patients. J Am Coll Radiol 205:962–970
Levetown M (2008) Communicating with children and families: from everyday interactions to skill in conveying distressing information. Pediatrics 121:e1441–e1460
Levin DC, Rao VM, Parker L, Frangos AJ, Sunshine JH (2007) Recent trends in utilization rates of noncardiac thoracic imaging: an example of how imaging growth might be controlled. J Am Coll Radiol 4(12):886–889
Levin DC, Laurence Parker L, Palit CD, Rao VM (2017) After nearly a decade of rapid growth, use and complexity of imaging declined, 2008–14. Health Aff 36(4):663–670
Mathews J, Forsythe A, Brady Z et al (2012) Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ 346:1–18
McCollough CH, Bushberg JT, Fletcher JG, Eckel LJ (2015) Answers to common questions about the use and safety of CT scans. Mayo Clin Proc 90:1380–1392
McCullough CH (2010). Diagnostic reference levels. http://www.imagewisely.org/~/media/ImageWisely-Files/Medical-Physicist-Articles/IW-McCullough-Diagnostic-Reference-Levels.pdf. Accessed 17 Apr 2017
Menoch MJA, Hirsh DA, Khan N et al (2012) Trends in computed tomography utilization in the pediatric emergency department. Pediatrics 129:e690–e697
Mettler FA, Huda W, Yoshizumi TT, Mahesh M (2008) Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 248:254–263
Mettler FA, Bhargavan M, Faulkner K et al (2009) Radiologic and nuclear medicine studies in the United States and worldwide: frequency, radiation dose, and comparison with other radiation sources—1950–2007. Radiology 253(2):520–531
Miglioretti DL, Johnson E, Williams A et al (2013) The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 167:700–707
Mileto A, Nelson RC, Larson DG et al (2017) Variability in radiation dose from repeat identical CT examinations: longitudinal analysis of 2851 patients undergoing 12,635 thoracoabdominal CT scans in an academic health system. Am J Roentgenol 28:1–12
NCRP (2009) Ionizing radiation exposure of the population of the United States. National Council on Radiation Protection and Measurements, Bethesda, MD. Report No. 160
Nievelstein RJ, Frush DP (2012) Commentary. Should we obtain informed consent for examinations that expose patients to radiation? Am J Roentgenol 199:664–669
Parker MW, Shah SS, Hall M et al (2015) Computed tomography and shifts to alternate imaging modalities in hospitalized patients. Pediatrics 136:e573–e581
PiDRL—European Diagnostic Reference Levels for Paediatric Diagnostic Imaging. http://www.eurosafeimaging.org/pidrl. Accessed 17 Apr 2017
Pearce MS, Salotti JA, Little MP et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukemia and brain tumors: a retrospective cohort study. Lancet 380:499–505
Perez M, Miller D, Frush DP, et al. 2015 Communicating radiation risks in pediatric imaging to support risk-benefit dialogue. Who Health Organization. http://www.who.int/ionizing_radiation/pub_meet/radiation-risks-paediatric-imaging/en/. Accessed 17 Apr 2017
Puri S, Hu R, Quazi RR et al (2012) Physicians’ and midlevel providers’ awareness of lifetime radiation—attributable cancer risk associated with commonly performed CT studies: relationship to practice behavior. Am J Roentgenol 199:1328–1336
Redberg R.F., Smith-Bindman R. (2014) We are giving ourselves cancer. The New York Times. http://www.nytimes.com/2014/01/31/opinion/we-are-giving-ourselves-cancer.html. Accessed 17 Apr 2017
Rehani MM, Berris T (2012) International Atomic Energy Agency study with referring physicians on patient radiation exposure and its tracking: a prospective survey using a web-based questionnaire. BMJ 2:1–10
Robey TE, Edwards K, Murphy MK (2014) Barriers to computed tomography radiation risk communication in the emergency department: a qualitative analysis of patient and physician perspectives. Acad Emerg Med 21:122–129
Sadigh G, Khan R, Kassin MT, Applegate KE (2014) Radiation safety knowledge and perceptions among residents. Acad Radiol 21:869–878
Schein EH (2004) Organizational culture and leadership, 3rd edn. John Wiley and Sons, Inc., San Francisco
Sexton JB, Grillo S, Fullwood C, Pronovost PJ. (2009) Assessing and improving safety culture. In: Frankel A, Leonard M, Simmonds T, Haraden C, Vega KB (eds) The essential guide for patient safety officers, vol 2009. Chicago, IL: Joint Commission Resources with the Institute for Healthcare Improvement: pp 11–20
Smith-Bindman R, Lipson J, Marcus R et al (2009) Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 169:2078–2086
Steele JR, Jones AK, Clarke RK et al (2016) Oncology patient perceptions of the use of ionizing radiation in diagnostic imaging. J Am Coll Radiol 13:768–774
Steele JR, Jones AK, Clarke RK et al (2017) Use of an online education platform to enhance patients’ knowledge about radiation in diagnostic imaging. J Am Coll Radiol 14:382–392
The State of California SB 1237 (2010). http://www.leginfo.ca.gov/pub/09-10/bill/sen/sb_1201-1250/sb_1237_bill_20100929_chaptered.html. Accessed 17 Apr 2017
United Nations Scientific Committee on the Effects of Atomic Radiation (2013) UNSCEAR report sources, effects and risks of ionizing radiation. Vol. II: scientific annex B: effects of radiation exposure in children
UNSCEAR (2000) Sources and effects of ionizing radiation. Vol. 1: sources
UNSCEAR (2008) UNSCEAR report Vol. I: sources and effects of ionizing radiation
Vassileva J, Rehani M (2015) Diagnostic reference levels. Am J Roentgenol 204:W1–W3
WHO Factsheet (2016) Ionizing radiation, health effects and protective measures. http://www.who.int/mediacentre/factsheets/fs371/en/. Accessed 17 Apr 2017
http://www.nationalacademies.org/hmd/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx. Accessed 17 Apr 2017
http://www.nytimes.com/2011/02/28/health/28radiation.html. Accessed 17 Apr 2017
http://www.nytimes.com/2010/11/23/us/23scan.html. Accessed 17 Apr 2017
http://www.nytimes.com/2009/10/16/us/16radiation.html. Accessed 17 Apr 2017
http://articles.latimes.com/2009/oct/14/local/me-cedars-sinai14. Accessed 17 Apr 2017
http://www.jointcommission.org/assets/1/18/AHC_DiagImagingRpt_MK_20150806.pdf. Accessed 17 Apr 2017
https://www.acr.org/Quality-Safety/Accreditation. Accessed 17 Apr 2017
https://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalx-rays/ucm115354.htm. Accessed 17 Apr 2017
https://www3.epa.gov/radtown/medical-xrays.html. Accessed 17 Apr 2017
https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-15-38.pdf. Accessed 17 Apr 2017
http://www.medicalimaging.org/policy-and-positions/mita-smart-dose/. Accessed 17 Apr 2017
http://www.medicalimaging.org/policy-and-positions/mita-smart-dose/mita-smart-dose-interventional/. Accessed 17 Apr 2017
http://www.medicalimaging.org/policy-and-positions/radiation-dose-safety/. Accessed 17 Apr 2017
http://www-ns.iaea.org/standards/review-of-the-bss.asp?s=11&l=88. Accessed 17 Apr 2017
https://rpop.iaea.org/RPOP/RPoP/Content/AdditionalResources/Bonn_Call_for_Action_Platform/. Accessed 17 Apr 2017
http://www.who.int/ionizing_radiation/about/med_exposure/en/index1.html. Accessed 17 Apr 2017
https://rpop.iaea.org/RPOP/RPoP/Content/InformationFor/Patients/information-public/index.htm. Accessed 17 Apr 2017
http://www.aapm.org/org/policies/details.asp?id=318&type=PP. Accessed 17 Apr 2017
http://hps.org/documents/risk_ps010-3.pdf. Accessed 17 Apr 2017
http://ncrponline.org/publications/reports/ncrp-report-174/. Accessed 17 Apr 2017
https://www.acr.org/~/media/9E2ED55531FC4B4FA53EF3B6D3B25DF8.pdf. Accessed 17 Apr 2017
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Frush, D.P. (2017). Informed Use of Medical Radiation in Diagnostic Imaging. In: Donoso-Bach, L., Boland, G. (eds) Quality and Safety in Imaging. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2017_84
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