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rstanley{at}ajroffice.org
This past summer, the Committee on the Biological Effects of Ionizing Radiation (BEIR) VII report was released with the conclusion that "even low doses of ionizing radiation, such as gamma rays and X-rays, are likely to pose some risk of adverse health effects" [1]. The study committee defined low doses as those ranging from nearly 0 to about 100 mSv. According to the report authors, "The health risks—particularly the development of solid cancers in organs—rise proportionally with exposure. At low doses of radiation, the risk of inducing solid cancers is very small. As the overall lifetime exposure increases, so does the risk" [1].
Some reading this Editor's Notebook might be nodding their heads in agreement with these statements while others are shaking their heads, wondering why they have to put up with another report about radiation risks. ARRS Gold Medalist William Hendee critiques the BEIR VII report in the Policy Brief "BEIR VII and Separating Fact from Fear" in this issue [2]. He clarifies some of the report's findings and puts the topic into perspective.
I will keep them from harm and injustice.Hippocratic Oath, classic version
Whether you agree with the BEIR VII authors or not, the findings of the report are a reminder that all of us who use radiation to diagnose and treat patients have a responsibility to ensure that each patient receives the best possible care. It is our responsibility that the lowest level of radiation dose is used in the examinations and procedures that we perform.
Some may argue, and accurately too, that much of the radiation exposure is from natural sources. In fact, the National Research Council states that "People are exposed to natural background ionizing radiation from the universe, the ground, and basic activities such as eating, drinking, and breathing. These sources account for about 82% of human exposure" [1].
Man-made radiation comprises 18% of human exposure, with medical X-rays and nuclear medicine procedures accounting for 79% of that. This is the area in which we should be—and are—making a difference. This issue of AJR has several examples of new technologies and techniques that have the potential for reducing radiation exposure. Two articles in particular, "Radiation Dose to Patients and Radiologists During Transcatheter Arterial Embolization" by Shigeru Suzuki and colleagues [3] and "Detection of Pulmonary Nodules Using a 2D HASTE MR Sequence" by Tobias Schroeder et al. [4], illustrate the steps we as professionals are taking to ensure the safety of our patients.
Because AJR strives to provide you with information that translates into improved patient care, radiation dose reduction is a topic we have often addressed in the past and will continue to address in the future.
We all have altruistic reasons for wanting to reduce the radiation dose, but there are practical reasons for doing so as well. The U.S. Nuclear Regulatory Commission subscribes to the ALARA philosophy, which requires all of us to make every reasonable effort to maintain radiation exposures, and releases of radioactive materials in effluents to unrestricted areas, as low as is reasonably achievable. We should not, and in fact we cannot, practice radiology if we do not subscribe to this philosophy as well.
I will keep them from harm and injustice.Hippocratic Oath, classic version
Another article in this month's issue, Leonard Berlin's commentary on "Using an Automated Coding and Review Process to Communicate Critical Radiologic Findings: One Way to Skin a Cat" [5], discusses the responsibility to our patients to ensure that diagnostic findings are communicated to referring physicians. It is, in fact, an injustice if we fail to fulfill this role. There are altruistic reasons as well as practical reasons for doing this. The altruistic reasons might get lost in the day-to-day chaos that makes up our workday. If we think about it, though, there is a story that each one of us can tell that illustrates we do make an impact on the lives of patients.
The unexpected finding is the one with potential great risk. The report of the "routine" chest radiograph before a cardiac catheterization study or a total knee replacement, which reveals a small nodule in the periphery with some features indicative of bronchogenic carcinoma, might theoretically be filed but not interpreted by the referring physician. Our policy of communicating our findings accurately and effectively, established quite a few years ago, has effectively reduced the chance to zero, or very near zero, that the referring physician will not be made aware of the potentially curable lesion in a timely way. It is our solemn duty to adhere to this policy.
Dr. Berlin's article [5] focuses on the practical reasons for ensuring proper communication, noting that breakdown in communication is a cause in up to 80% of all malpractice lawsuits. Dr. Berlin offers solutions for ensuring timely communication.
We are physicians first. With that title come certain responsibilities to our patients—keeping them from harm and injustice under our care is foremost.
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