The New England Journal of Medicine has just published a report, "Exposure to Low-Dose Ionizing Radiation from Medical Procedures." The report tracks nearly one million non-elderly patients (18 to 64) from 2005 to 2007 and estimates their exposure to radiation from medical imaging.

The authors conclude that imaging procedures are in fact "an important source of ionizing radiation in the United States and can result in high cumulative effective doses of radiation." (N Eng J Med 2009; 361:849-57)

Specifically, the authors, led by Reza Fazel, M.D., express concern that, while health care professionals are monitored carefully in terms of their radiation exposure, patients are not. "Given the growing use of medical imaging procedures, our findings have important implications for the health of the general population," the report notes.
The retrospective study focuses on five health care markets: Arizona, Dallas, Orlando, South Florida, and Wisconsin. The analysis uses claims data from UnitedHealthcare. There was no external funding for the research other than a grant from the National Institute on Aging.

The report breaks down by demographic factors which patients received low, moderate, high, and very high radiation doses from medical imaging. Overall, approximately 786 patients per thousand received a low annual dose, 194 per thousand a moderate dose, 19 a high dose and 2 per thousand a very high dose.

The medical imaging tests with the largest doses were myocardial perfusion imaging, CT of the abdomen, CT of the pelvis, CT of the chest, and diagnostic cardiac catheterization. Twenty types of studies were considered.

While dose exposure varies and estimates were used, the findings show that "the current pattern of use of medical imaging in the U.S. among non-elderly patients is exposing many to substantial doses of ionizing radiation." The authors recommend strategies be adopted for ensuring appropriate use of the procedures.

Fallout from the Report

DOTmed has reported extensively on this topic and spoke with Michael Hanley, M.D., a second-year radiology resident at the Medical University of South Carolina. His new web site, www.xrayrisk.com, allows patients to calculate their lifetime increased risk of cancer based on the CT scans or X-rays performed. Dr. Hanley expressed concern that the media would overreact to the NEJM report.

"What the authors didn't discuss in the article is what benefit radiology provides to patients. That wasn't the point of the study but you really need to look at that," Dr. Hanley said. "If we are scanning people and not getting useful information back, that is not good for patients. But if you are scanning people head to toe who were in a car accident and finding lacerations and injuries to the liver or bowel and saving lives, then no one should argue about the radiation dose."

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