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Radiation Exposure in Medical Imaging

In light of recent media coverage focusing on increased cancer risk from computed tomography (CT) scans, Cottage Center for Advanced Imaging and Cottage Health System are dedicated to improving the understanding of radiation risk in medical imaging.

The December 2009 issue of the Archives of Internal Medicine published a paper suggesting that radiation from medical imaging-in particular, CT scans, may contribute to an increased risk of cancer (29,000/per yr), suggesting that 1.5%-2% of all cancers in the US may be attributed to CT scans and overexposure to radiation.

While the underlying theme of the paper suggests that over-utilization should be carefully monitored and considered; there were several pitfalls to the publication, such as:

  1. the exclusion of patients with cancer or within five years of the end of life,
  2. the assumption that those undergoing CT scans have the same life expectancy as the general population, and
  3. equating radiation exposure from CT scans and its effects to those experienced the by Japanese atomic bomb survivors.

The American College of Radiology recently issued this statement on the recent studies regarding CT scans and Increased cancer risk:

“Medical imaging exams have been directly linked to greater life expectancy, declines in cancer mortality rates, and are generally less expensive than the invasive procedures that they replace. However, widespread use has resulted in increased radiation exposure for Americans.”

The American College of Radiology (ACR) advises that no imaging exam should be performed unless there is a clear medical benefit that outweighs any associated risk. The ACR supports the "as low as reasonably achievable" (ALARA) concept which urges providers to use the minimum level of radiation needed in imaging exams to achieve the necessary results. ACR is a founding participant in the Image Gently™ campaign for dose reduction in pediatric imaging and has launched an adult radiation dose reduction effort.

Specific to the Archives of Internal Medicine studies:
“No published studies show that radiation from imaging exams causes cancer. The conclusions of the authors of the Archives’ studies rely largely on data which equates radiation exposure and effects experienced by atomic bomb survivors in Japan to present day patients who receive CT scans. Most CTs are performed in controlled settings and results in limited radiation exposure to a small portion of the body. Atomic bomb survivors experienced instantaneous exposure to the whole body. CT exams expose patients solely to X-rays. Atomic blast survivors were exposed to X-rays, particulate radiations, neutrons, and other radioactive materials. The known biological effects are very different for these two scenarios. Cancer assumptions based on this paradigm should be considered, but not accepted as medical fact."

At Cottage Center for Advanced Imaging and Cottage Health System, we practice evidence-based medicine by strictly adhering to the ALARA principle "as low as reasonably achievable," and the Image Gently campaign, without compromise to image quality or patient safety. In fact, minimizing dose in CT exams has always been a priority at our inpatient and outpatient locations. We have been aggressive in our approach to radiation safety and have the support and guidance of a radiation physicist who reviews our radiation protocols and settings.

  • All of our radiologists are board certified and have extensive knowledge and training on techniques that reduce radiation exposure to patients.
  • All imaging modalities are accredited by the Joint Commission, and follow strict policy and guidelines set forth by the ACR and the Radiation Safety Committee of Cottage Hospital.
  • The licensed radiologic technologists are all trained to monitor and minimize radiation exposure on an ongoing basis (ALARA principle).
  • Our facilities participate in the Image Gently campaign, an initiative of the Alliance and Radiation Safety in Pediatric Imaging -- strictly adhering to the lowest possible doses when imaging children.
  • On an ongoing basis the radiation safety committee meets regularly to continuously evaluate quality improvement measures.
  • During CT examinations, we provide protective eye gear and breast / abdomen shields which decrease radiation by 50% to 60% to these sensitive areas.

Quoted from the ACR, “Medical imaging exams have been directly linked to greater life expectancy and by early detection -- declines in cancer mortality rates.”

The diagnostic benefits for clinical outcome may outweigh the radiation risk.  Together, patient and physician should consider the risk-to-benefit ratio before proceeding with a CT exam; (i.e. the risk in not having the CT study; using other modalities- ultrasound, MRI, X-ray for diagnosis, etc).


For more information on radiation safety visit:

Download this paper as WORD document >>

Feb. 2010