About twelve years ago the headlines in Time magazine1 and USA Today newspaper warned people that radiation from CT scans was causing cancer. The reports stated there was roughly a 1 in 200 chance of getting a fatal radiation-induced cancer from each CT scan. The data was extrapolated from survivors of the nuclear bomb explosions in Japan at the end of the Second World War. Think of all those emergency room (ER) frequent fliers who get a scan each month. Are they already dead men (and women)?
It was big news for the lay public and the radiology community. Patients didn’t want to be imaged despite the need for the scan in fear of getting “cancer.” Some patients were significantly harmed by the delay in diagnosis and treatment. It was terrible for a while.
The radiology community reacted like any other business entity would when confronted with such news: they tried not to panic and checked their liability policies. I hoped that I would be retired before the wave of radiation-induced cancers began to hit. I thought about all of the unnecessary CT scans performed on my shifts covering the ER. We always thought of it as job security. Now it was a huge liability.
For those of you who ask, “Why did you scan those people,” I will add that it’s complicated and beyond the scope of this blog. Radiologists no longer control imaging but are at the mercy of the ordering physician and the hospital. The ordering physician has no incentive to not order tests. In fact, they have incentive to order the tests. It prevents any possible liability since they were thorough, and they can profit from it at times. The hospitals like CT scans because they generate a tidy profit and increase ER throughput. Don’t kid yourselves. The ER is a mill for churning patients so the hospital can fill its inpatient beds. Also, ER visits are paid without having to be pre-approved, unlike outpatient visits.
But back to the topic at hand: radiation-induced cancers. A study was published in 2017 in the Journal of Nuclear Medicine refuting the claim2. They stated there is a radiation threshold that has to be met before cancers will occur. The data shows that the typical CT scan dose is about ten times too low. The current information fits what we are seeing. There has not been a rise in the cancer rate. All the worry was for nothing. It is safe to have your CT scan without worrying about what cancer you will get. And I don’t have to retire anytime soon to avoid a barrage of lawsuits. A win-win.
1 Masters, Coco. Should You Have a CT Scan?. Time Magazine. 2007 July 17. http://content.time.com/time/health/article/0,8599,1644250,00.html.
2 Weber and Zanzonico. The Controversial Linear No-Threshold Model. J Nucl Med. 2017 January 1. DOI: 10.2967/jnumed.116.182667.
Michael Esposito, M.D. is a practicing radiologist, two-times former group president of RIS Imaging, Inc., Medical Director of South Florida Baptist Hospital, Baycare, and a successful entrepreneur. He attended the University of Florida for his undergraduate degree in Chemical Engineering, the University of South Florida for his Medical Degree and conducted his fellowship at Duke University. Dr. Esposito founded PACS Harmony, LLC in 2009 to develop a software solution to fill a gap in workflow at his own radiology group practice. Today, PACS Harmony enables intelligent workflow orchestration for leading commercial enterprise imaging portfolios (www.pacsharmony.com).