Death of the ALARA Radiation Protection Principle as Used in the Medical Sector

Abstract

ALARA is the acronym for “As Low As Reasonably Achievable.” It is a radiation protection concept borne from the linear no-threshold (LNT) hypothesis. There are no valid data today supporting the use of LNT in the low-dose range, so dose as a surrogate for risk in radiological imaging is not appropriate, and therefore, the use of the ALARA concept is obsolete. Continued use of an outdated and erroneous principle unnecessarily constrains medical professionals attempting to deliver high-quality care to patients by leading to a reluctance by doctors to order images, a resistance from patients/parents to receive images, subquality images, repeated imaging, increased radiation exposures, the stifling of low-dose radiation research and treatment, and the propagation of radiophobia and continued endorsement of ALARA by regulatory bodies. All these factors result from the fear of radiogenic cancer, many years in the future, that will not occur. It has been established that the dose threshold for leukemia is higher than previously thought. A low-dose radiation exposure from medical imaging will likely upregulate the body’s adaptive protection systems leading to the prevention of future cancers. The ALARA principle, as used as a radiation protection principle throughout medicine, is scientifically defunct and should be abandoned.

X-Ray Hesitancy: Patients’ Radiophobic Concerns Over Medical X-rays

“…Regardless of actual patient concerns, radiophobia results in the unnecessary wasting of time, energy and resources as doctors are forced to sympathize and abate X-ray hesitancy in order to pursue warranted radiological diagnostics for assessment, diagnosis and monitoring of specific medical conditions. 5 In actuality, X-ray hesitancy should be viewed as a contemporary crisis to front line medical professionals who attempt to deliver efficient healthcare considering there is no evidence that X-rays and CT scans present any real health risk. We concur with Wagner who states "diagnostic radiology has an image problem."…”

5 Reasons Why Scoliosis X-Rays Are Not Harmful

“…The extrapolations of estimated or measured radiation exposures to theoretical carcinogenic risks leads to public fear and dissuades the use of essential medical X-rays. 17,78…”

“…Real harms as well as presumed harms (i.e. increased radiation exposures) from medical radiation reduction campaigns include propagating radiophobia, 7 increased patient refusal for medically warranted X-rays, 11,16 increased burden to medical professionals attempting to deliver high-quality medical care, 17 reduced image quality, 18,19 increased potential missed diagnoses, 20,21 increased radiation exposures (via retakes due to too little exposure or gonadal shielding covering targeted anatomy), 17,18,22,23 increased use of alternate imaging methods that presents other unique risks (e.g. sedation for MRI), 18,24 and increasing liability to physicians.…”

“…sedation for MRI), 18,24 and increasing liability to physicians. 17 Despite medical radiation reduction campaigns, there are conditions that warrant routine radiological imaging, this includes the condition of scoliosis. Scoliosis is a spinal deformity or curvature in the coronal plane as viewed on the antero-posterior (AP) or posterior-anterior (PA) spinal radiograph and is diagnosed as a curve greater than 9 as measured by the Cobb angle-the gold standard assessment method.…”

Paradigma baru konsep proteksi radiasi dalam pemeriksaan radiologi kedokteran gigi: dari ALARA menjadi ALADAIP

“…25 Istilah 11,26 Prinsip ALARA pada satu dekade belakangan menjadi kontroversi dan telah banyak disanggah ketidak-benarannya oleh banyak peneliti seiring dengan perkembangan ilmu pengetahuan. 22,27,28 Konsep ALARA yang didasarkan pada teori LNT dinilai konservatif dan tidak sesuai dengan hasil penelitian ilmiah biologis mengenai efek stokastik/ karsinogenik dari radiasi pengion. Teori LNT dianggap oleh sebagian peneliti telah menyebabkan kecemasan irasional tentang radiasi, dimana tiap mikrosievert dapat langsung menginduksi terjadinya kanker.…”