Talk about risks of radiation in medical imaging

THERE is a lack of understanding among the general public in Malaysia about radiation, with many perceiving it as dangerous. Such perceptions are reinforced when they hear or read about the effects of accidents in nuclear power plant like Chernobyl and Fukushima.

We have a huge problem with communication about radiation because we use too much jargon. There is also a lot of misinformation about this subject on the Internet.

We really need to start talking about this and make people understand the relevance of radiation in human health, especially since several medical procedures, including angiography, fluoroscopy, computed tomography ( pic, courtesy of Schering AG) and radiographic imaging use ionising radiation.

The primary purpose of radiological imaging is to achieve the optimum quality image using the minimum possible dose.

However, most patients who attend the radiology department in hospitals do not receive proper information about radiation. And most believe that radiation is dangerous even at low levels because that is what they keep hearing. In this regard, counselling patients who express concern about this issue would be useful.

In most cases, the benefits of medical imaging would outweigh the relatively small risk of exposure to ionizing radiation.

The American Association of Physicists in Medicine (AAPM) has stated that: “Risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable and may be non-existent. Predictions of hypothetical cancer incidence and deaths in patient popula- tions exposed to such low doses are highly speculative and should be discouraged. These predictions are harmful because they lead to sensationalistic articles in the public media that cause some patients and parents to refuse medical imaging procedures, placing them at substantial risk by not receiving the clinical benefits of the prescribed procedures.” (AAPM, 2011).

The role of medical imaging in healthcare dictates the need for quality and competence. Knowledge of radiation risks has been enhanced, and medical imaging facilities should be able to augment employee and public knowledge regarding these procedures.

In this regard, radiographers and radiologist and other healthcare personnel should be prepared to discuss the benefits and risks of medical imaging, the different modalities involved and dose protocols with their patients to ease the latter’s anxiety, if any, about the procedure.

An area of special concern is the unnecessary use of radiation in medical imaging when clinical evaluation or other imaging modalities could provide an accurate diagnosis. The referral criteria for medical imaging are consensus statements based on the best available evidence to assist the decision-making process when choosing the best imaging procedure for a given patient. Although they are advisory rather than compulsory, there should be good reasons to deviate from them.

Justification of procedures and optimization of protection are the two pillars of radiological protection in healthcare, and they are embedded in the notion of good medical practice. The new International Radiation Basic Safety Standards (BSS) have expanded the requirements for justification of medical exposures and optimization of protection and safety in medicine.

However, some health professionals are not familiar with these principles and have a low awareness of radiation protection aspects. A stronger collaboration between radiation protection and healthcare communities is needed to improve the radiation protection culture in medical practice.

Courses on radiation and the biological effects of radiation should be included in the training of healthcare professionals during and after their medical courses to increase awareness of the safety protocols required to protect from the hazardous effects of ionising radiation.

Indeed, fewer than one-third of individuals receive any sort of education from their healthcare professional before undergoing a medical imaging test involving ionizing radiation. Given not only the increasing use of medical imaging tests but also the need for healthcare professionals to inform their patients, it is essential that medical workers be effectively equipped with the skills to put the information into a context that the public understand.