Medical doctors aren’t aware of radiation risks

Although the use of radiation for medical examinations and tests is the largest manmade source of radiation exposure, most medical doctors aren’t aware of the long-term health risks associated with radiological imaging. “Few doctors know the level of radiation that their patients are exposed to during radiological investigations,” stated Eugenio Picano, senior medical researcher at the Institute of Clinical Physiology in Italy.

According to Picano’s report, published in BMJ (formerly, the British Medical Journal), up to a third of radiological examinations are totally or partially inappropriate. To make matters worse, long-term risks are often ignored in cost-effectiveness analysis of medical imaging.

“The use of procedures with a high load of radiation continues to grow steadily,” Picano notes. “The medical sources of radiation in industrialised countries may therefore soon be greater than natural sources. Ivan Illich wrote in 1976 (at the beginning of the imaging era): ‘Act so that the effect of your action is compatible with the permanence of genuine human life. Very concretely applied this could mean: Do not raise radiation levels unless you know that this action will not be visited upon your grandchild.’ The contemporary practice of imaging seems to ignore this sound advice.”

To avoid this misuse, he believes that doctors should be required to have a radiological “driving licence” with penalty points given for inappropriate prescriptions.

The researcher suggested that patients be required to sign a very clearly written informed consent form for each radiological examination. This would help reduce pressure from patients for redundant examinations, they noted. Journals should also encourage reporting of radiation doses in papers.

The current culture has taught patients that the most expensive tests are likely to be the most effective, says the author. In a culture of shared responsibility, any useless risk – no matter how small – should be avoided.

SOURCE: “Sustainability of medical imaging,” by Eugenio Picano. BMJ, March 6, 2004.