Best Practices for Radiation-Induced Cancer

The benefits of ionizing radiation (IR) medical imaging often outweigh the risks of exposure to radiation. Likewise, risks associated with radiologic examinations are low compared to those associated with natural causes. However, any additional exposure, no matter how minor, is worth investigating and approaching with caution. Therefore, the radiology and medical communities should take proactive measures to prevent radiation-induced cancers.  

Optimizing and standardizing medical imaging procedures

In a recent study, roughly 320 children with minor head injuries in the emergency department were evaluated. The findings revealed that around half of CT scans were unnecessary, given that they were not recommended appropriately according to international guidelines. According to another study, approximately a quarter of CT scans conducted on children are unneeded. 

Thus, it's critical to optimize the medical imaging process from the start based on accurate patient assessments through the implementation and maintenance of international protocol-compliant standards. Lack of adherence to clinical guidelines and miscommunication in pediatric care are prominent reasons for unnecessary medical imaging. Another factor might be an incompetency in non-pediatric settings, such as the emergency department. A recent study found that children in non-pediatric hospitals received double the amount of radiation as children in pediatric hospitals during CT scans.  

Due to the approximation of effective doses and their correlation to cancer being imprecise, it is not appropriate for radiologists and clinicians to provide specific data on severe effects or projected mortality.  However, based on clinical guidelines, radiologists and doctors should inform patients about the general risks associated with a radiologic operation in order to obtain consent and to breed trust between patients and medical staff. 

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Rapid technological advancements in radiology have had a beneficial impact on pediatric patient care; unfortunately, this evolution has also resulted in a massive rise in medical imaging IR doses provided to children. Although there are differing viewpoints on cancer risks and levels of IR coming from medical imaging, most scientific studies agree that IR in pediatric imaging is frequently associated with unknown cancer risks, since no lower threshold of IR exposure has been yet determined as risk-free. The total impact on cancer risks, in the long run, should not be underestimated. 

For healthcare providers such as radiologists, technologists, and physicians, medical imaging radiation doses that are as low as reasonably achievable (ALARA) and used only when necessary are two critical methods that can lessen long-term cancer risks. What's more, communication about radiation use and potential risks with minor patients and their parents is crucial to achieving a trustworthy and optimal medical care. 

References: 

Elmoheen, A., Salem, W., & Bashir, K. (2021). Reducing unnecessary CT scan of the head for minor pediatric head injuries at the emergency department. BMJ open quality, 10(1), e000973. 

Guillerman, R. P. (2014). From ‘Image Gently’to image intelligently: a personalized perspective on diagnostic radiation risk. Pediatric radiology, 44(3), 444-449. 

Nabaweesi, R., Ramakrishnaiah, R. H., Aitken, M. E., Rettiganti, M. R., Luo, C., Maxson, R. T., ... & Robbins, J. M. (2018). Injured children receive twice the radiation dose at nonpediatric trauma centers compared with pediatric trauma centers. Journal of the American College of Radiology, 15(1), 58-64. 

Shahi, V., Brinjikji, W., Cloft, H. J., Thomas, K. B., & Kallmes, D. F. (2015). Trends in CT utilization for pediatric fall patients in US emergency departments. Academic radiology, 22(7), 898-903.