Radiation Exposure Due To CT Exams - How Real Are The Risks?
The following is an excerpt from an opinion article by noted radiologist and legal expert Leonard Berlin, MD. The article can be found here.
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"The word fact is defined as “something that has been objectively verified” [7]. The claim that cancer will develop as a result of radiation exposure to diagnostic radiologic examinations is not, nor based on, fact. Indeed, a Kansas federal court [8] stated,
In matters of determining the cancer risk from low doses of radiation, scientists do not deal with what exists in fact; rather, they deal with theory, hypothesis and assumption which cannot be used to establish legal cause
....Law needs to be founded on more than a theory or hypothesis.
Mayo Clinic medical physicist Cynthia McCollough [9] and others [10, 11] doubt that there may be any risk whatsoever from the radiation received from a CT scan. Emphasized McCollough [9],
The US judicial system is based on the premise “innocent until proven guilty.” Low-levels of ionizing radiation have not been proven beyond a shadow of a doubt to be harmful to human health. Rather, considerable evidence to the contrary exists.
Thus, contended McCullough, obtaining “informed consent” may do far more harm than good, for it may encourage unnecessary and unsubstantiated worries about radiation that will dissuade patients from obtaining needed CT examinations. Elsewhere, McCullough and Fletcher [12] concluded that they do “not consider CT examinations performed as part of noninterventional procedures to meet the threshold of risk at which information consent is appropriate.”
In summary, here is the dilemma that confronts radiologists: yes, of course we have a legal and moral duty to disclose potential complications based on facts to patients and to obtain informed consent on the basis of those facts. But when it comes to conjectures and unproven theories regarding the question of whether diagnostic-level radiation causes cancer, what, if anything, does our legal and moral duty require us to disclose to patients? It is a dilemma that has no solution today and indeed may not have a solution in the foreseeable future."
References
7. . In: Boston: Houghton Mifflin; 1995;p. 484
8. Johnston v United States, 597 F Supp 374 (D Kansas 1984).
9. . Defending the use of medical imaging. Health Phys. 2011;100:318–321
10. . The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology. 2009;251:13–22
11. . Radiation exposure from medical imaging procedures. N Engl J Med. 2009;361:2290
12. . Is this appropriate: will CT take my life?. AJR Am J Roentgenol. 2011;196:218
Paul Dorio
