Higher patient doses through X-ray imaging procedures

Abstract

Medical imaging using X-rays has been one of the most popular imaging modalities ever since the discovery of Xrays 125 years ago. With unquestionable benefits, concerns about radiation risks have frequently been raised. Computed tomography (CT) and fluoroscopic guided interventional procedures have the potential to impart higher radiation exposure to patients than radiographic examinations. Despite technological advances, there have been instances of increased doses per procedure mainly because of better diagnostic information in images. However, cumulative dose from multiple procedures is creating new concerns as effective doses >100 mSv are not uncommon. There is a need for action at all levels. Manufacturers must produce equipment that can provide a quality diagnostic image at substantially lesser dose and better implementation of optimization strategies by users. There is an urgent need for the industry to develop CT scanners with sub-mSv radiation dose, a goal that has been lingering. It appears that a new monochromatic X-ray source will lead to replacement of X-ray tubes all over the world in coming years and will lead to a drastic reduction in radiation doses. This innovation will impact all X-ray imaging and will help dose reduction. For interventional procedures, the likely employment of robotic systems in practice may drastically reduce radiation exposures to operators-but patient exposure will still remain an issue. Training needs always need to be emphasized and practiced.

Systematic literature review on the benefit of patient protection shielding during medical X-ray imaging: Towards a discontinuation of the current practice

“…Based on the current hot topic debate about the significance of patient shielding, this review not only summarizes the evidence presented in the literature, but also puts it in the context of the technical developments in the same period [54][55][56][57]. In addition, non-dose-related aspects are considered in order to evaluate whether patient protection by means of contact shielding should be maintained or discontinued.…”

Patient Perceptions and Knowledge of Ionizing Radiation From Medical Imaging

“…Owing to the development and widespread availability of cross-sectional imaging, in the last several decades, radiology has become pivotal in the diagnosis and management of many diseases. The use of medical imaging, including ionizing radiation-based modalities, continues to increase, raising concerns about patients’ radiation exposure, with reported cumulative effective doses exceeding 100 mSv for single procedures . Although accounting for only 17% of all medical examinations, multidetector computed tomography (CT) alone makes up approximately 50% of the total radiation burden for medical purposes, and a large multicenter trial by Rehani et al revealed that more than 1% of patients undergoing multiple CT examinations over 1 to 5 years received a cumulative effective dose above 100 mSv.…”

Editorial

“…It is always a dilemma in all radiation practicing to balance the benefits against the risks. The article of M. Rehani and D. Nacouzi [15] highlights this problem emphasizing the concerns with the cumulative dose absorbed from multiple examination procedures. This requires focussing even more on dose minimizing technical solutions in the equipment, for instance with the recent development of the monochromatic X-ray sources, may be in the future also with the application of robotics.…”