Dangers of Radiation Exposure

CT-Computed-Tomography2There's a long term health consequence from exposure to the type of radiation used for many medical imaging studies. That fact emerges clearly from the burgeoning literature on the subject. Questions that remain unanswered are just how significant is the risk? Are certain types of studies most problematic? And how big is the problem anyway? This week's NEJM attempts to get a handle on this last, with some rather astonishing results.

Exposure to Low-Dose Ionizing Radiation from Medical Imaging Procedures reveals that after surveying almost a million people aged 18 to 64 (!) just about 70% of them had some sort of medical imaging study in the previous two years. Yikes. Talk about a number that's simply huge. For most of these folks CT and nuclear imaging studies were the radiation source, and as might be predicted, exposure increased with increasing age. Yet the point to be made is these were relatively young, healthy people, so exposure is taking place earlier in life than we'd probably like.

That is the issue, of course. The dangers of radiation exposure are cumulative, and the younger someone is when exposure begins the more potentially hazardous this may be down the road.

Medical imaging equipment manufacturers are acutely aware of this and to their credit, are constantly improving capabilities to minimize exposure as much as possible. There's no doubt that physicians are also becoming much more tuned in to the issue and are questioning the need for such studies as well, although as our colleague Elliot Fishman, professor of radiology points out, if it's exploratory surgery to assess an inflamed appendix or abdominal CT, the risk benefit analysis is quite clear.

For now, a couple of things to keep in mind when your physician orders a study: ask about the need for the study, choose a center with the latest equipment, and inform your physician about your history of such imaging studies. Yet one more place where your best health advocate is yourself, and one more reason to keep your own complete health record.

Early Diagnosis of Myocardial Infarction with Sensitive Cardiac Troponin Assays and Sensitive Troponin I Assay in Early Diagnosis of Acute Myocardial Infarction, also in NEJM, and Association of Cytochrome P450 2C19 Genotype With the Antiplatelet Effect and Clinical Efficacy of Clopidogrel Therapy and Hormonal Therapy Use for Prostate Cancer and Mortality in Men With Coronary Artery Disease–Induced Congestive Heart Failure or Myocardial Infarction in JAMA rounded out the podcast for this week. Until next week, y'all live well.

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