No word in radiology has more power than the "r" word. Radiation represents the energy that fueled the birth of the specialty, and radiologists—and radiation oncologists—know best the power of that energy to enlighten and heal. Now is the time to acknowledge its power to hurt.

Like dandelions in a perfectly manicured lawn of fescue, voices are being raised regarding, first, the need to control dose for pediatric patients, next, the relationship between the number of detectors in a CT scanner and the related radiation dose, and now the BEIR report ¹ and Semelka's article ² on what it means for patients, referring physicians, and radiologists.

In his opening session talk at the recent RSNA meeting, John M. Boone, PhD, warned against installing a 64-detector scanner and using it like a 16-detector scanner, without adjusting protocols and without considering the patient's age, weight, and health issues. Explaining that one study on a 64-detector scanner entails the equivalent dose of five CTs, Boone told the audience: "This year 62.8 million CT scans were performed, one for every five people in the United States. If this isn't a dose issue...?"

In his most recent Medscape article on the subject, Richard C. Semelka, MD, cites the latest BEIR report, which effectively doubled the radiation risk of developing cancer from a 10 mSv radiation dose to 1 in 1,000. In calling for patient disclosure and aggressive education of referring physicians, Semelka noted: "I think that a 1 in 1,000 chance of developing cancer from undergoing a single CT of one region of the chest, abdomen, and pelvis should be mentioned."

Radiology has led health care into the electronic age with its enthusiastic adoption of radiology information systems and picture archiving and communications systems, and indeed, few institutions' electronic medical records are as pervasive as PACS. Finding a way to include patient dose in the patient's radiology record would mark a significant step toward radiology becoming a responsible custodian of the energy that gave the specialty its start.

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Cheryl Proval

References:

1. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII-Phase 2. 2005. Available at: books.nap.edu/catalog/11340.html. Accessed February 27, 2006.
2. Semelka RC. Imaging x-rays cause cancer: a call to action for caregivers and patients. Medscape. Available at: www.medscape.com/viewprogram/5063?src=mp. Accessed February 27, 2006.