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Practice

Radiation dose and protection

Mark O. Baerlocher, Stefanie Leung, Murray Asch and Andy Myers
CMAJ March 06, 2012 184 (4) E240; DOI: https://doi.org/10.1503/cmaj.090754
Mark O. Baerlocher
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  • For correspondence: mark.baerlocher@alumni.utoronto.ca
Stefanie Leung
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Murray Asch
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Andy Myers
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Imaging examinations are guided by the ALARA principle (“as low as reasonably achievable”) for radiation dose and exposure

All studies should involve the minimum amount of radiation required to provide the required information.

Children are more susceptible than adults to the oncogenic effects of radiation

Children have an increased risk from radiation exposure because of a longer expected lifespan and increased tissue radiosensitivity. Children also receive a larger relative dose of radiation because of their smaller size.1 Radiation-related risks to the fetus are greatest during the first trimester. As a general rule, younger patients are at greater risk of radiation-induced adverse effects than older patients, and females are more at risk than males.

Computed tomography (CT) is associated with an increased risk of cancer because of the potential for higher doses of radiation compared with plain radiographs

Nuclear medicine, interventional radiology and barium studies also have the potential for higher doses of radiation. There has been a large increase in the number of CT scans performed because of wider availability.2 In 2007, researchers estimated that 1.5% to 2% of all cancers in the United States in the future could be attributable to radiation exposure from CT scanning.3 By reducing the number of unnecessary scans and the radiation dose per scan, the total dose from CT imaging may be reduced.2 Shielding areas such as the breasts, the thyroid and gonadal tissue in some instances can also decrease exposure.

The number of CT scans can be reduced by considering alternative imaging modalities such as ultrasound and magnetic resonance imaging where appropriate

Ultrasonography and magnetic resonance imaging are effective in detecting certain pathologies. Evidence-based guidelines are available to guide the selection of imaging for many common presenting complaints.4

The benefit versus harm of CT scanning as a screening tool in asymptomatic patients depends on the application

For example, CT colonography (or virtual colonography) has an accepted role in clinical care.5 However, full-body CT scanning to screen asymptomatic patients delivers a high radiation dose with an expected high false-positive rate.

Footnotes

  • Competing interests: Mark Baerlocher was the co-creator of an application for iPhone/iPad/iPod that tracks radiation exposure and estimates the associated risks; he received no payment for this work. No competing interests declared by the other authors.

  • This article has been peer reviewed.

  • CMAJ invites submissions to “Five things to know about … .” Submit manuscripts online at http://mc.manuscriptcentral.com/cmaj

References

  1. ↵
    1. Brody AS,
    2. Frush DP,
    3. Huda W,
    4. et al
    . Radiation risk to children from computed tomography. Pediatrics 2007;120:677–82.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Hall EJ,
    2. Brenner DJ
    . Cancer risks from diagnostic radiology. Br J Radiol 2008;81:362–78.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    1. Brenner DJ,
    2. Hall EJ
    . Computed tomography — an increasing source of radiation exposure. N Engl J Med 2007;357:2277–84.
    OpenUrlCrossRefPubMed
  4. ↵
    Canadian Association of Radiologists. Diagnostic imaging referral guidelines: a guide for physicians. Ottawa (ON): The Association; 2005. Available: www.car.ca/en/standards-guidelines.aspx (accessed 2011 Dec. 2).
  5. ↵
    1. El-Maraghi RH,
    2. Kielar AZ
    . CT colonography versus optical colonoscopy for screening asymptomatic patients for colorectal cancer a patient, intervention, comparison, outcome (PICO) analysis. Acad Radiol 2009;16:564–71.
    OpenUrlCrossRefPubMed
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Canadian Medical Association Journal: 184 (4)
CMAJ
Vol. 184, Issue 4
6 Mar 2012
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Radiation dose and protection
Mark O. Baerlocher, Stefanie Leung, Murray Asch, Andy Myers
CMAJ Mar 2012, 184 (4) E240; DOI: 10.1503/cmaj.090754

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Radiation dose and protection
Mark O. Baerlocher, Stefanie Leung, Murray Asch, Andy Myers
CMAJ Mar 2012, 184 (4) E240; DOI: 10.1503/cmaj.090754
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  • Article
    • Imaging examinations are guided by the ALARA principle (“as low as reasonably achievable”) for radiation dose and exposure
    • Children are more susceptible than adults to the oncogenic effects of radiation
    • Computed tomography (CT) is associated with an increased risk of cancer because of the potential for higher doses of radiation compared with plain radiographs
    • The number of CT scans can be reduced by considering alternative imaging modalities such as ultrasound and magnetic resonance imaging where appropriate
    • The benefit versus harm of CT scanning as a screening tool in asymptomatic patients depends on the application
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