Medical imaging exams and image guided procedures are increasingly replacing more invasive and often more costly techniques, while saving and extending lives every day. The American College of Radiology, in conjunction with other imaging stakeholders, has long been effectively addressing issues regarding radiation dose from medical imaging exams and inappropriate utilization of these scans. Patients are urged not to delay or avoid seeking needed imaging care because of radiation concerns raised in a study and an ill-advised and misinformed perspective published in the August 27 New England Journal of Medicine (NEJM).

Fazel NEJM Study

In "Exposure to Low-Dose Ionizing Radiation from Medical Imaging Procedures," Reza Fazel, M.D., M.Sc., and colleagues reported that imaging procedures are a key source of ionizing radiation exposure in the U.S. and that repeat exams can result in high cumulative doses of radiation. They also recognize that: "An important reason for the growing use of such procedures stems from their ability to radically improve patient care." The ACR thanks the study authors for addressing these issues.
However, it should be made clear that the patients who experienced the higher doses of radiation (and repeated exams) outlined in the study were almost certainly cancer patients and others with chronic illnesses whose conditions necessitated repeat exams to gauge effectiveness of their treatment and/or help ensure their short term survival. For these patients - who would otherwise be forced to undergo invasive surgeries, and who, without the information gleaned from these scans, might have suffered serious health setbacks, or even death - the benefits of these exams clearly outweigh the risk of long-term adverse health effects from radiation. For most other patients, repeated exams and the high levels of radiation discussed in the study are not a reality. It is important to understand this to provide context and avoid unnecessary hysteria that may lead to patients foregoing necessary imaging care and placing their health in jeopardy.

The Fazel study also points out that nearly 82 percent of the total administered dose occurred outside of the hospital setting. Radiologists perform less than a third of non-hospital imaging.1 Most of the scans explored in the study were performed by non-radiologist providers that self-referred patients to their own imaging equipment. Studies have shown that when providers can refer patients to their own scanners or those in which they have a financial interest, imaging is greatly increased.2,3,4 Many of these providers have little to no imaging or radiation safety training. Knowledge of the correct use of these technologies is not universal.

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