Articles Posted in Radiation Safety

Magnetic resonance imaging (MRI) is a body scan that provides detailed images particularly good for viewing soft tissue (versus a traditional X-ray that’s better for seeing bone). Sometimes, drugs are injected before you have an MRI to add contrast, making the images sharper. But some of the drugs in those agents might be toxic.

We recently wrote about another risk of certain diagnostic scans including MRIs, when people are not told about the risks of radiation. Now, according to ProPublica.org, it seems as though the brain can be damaged by a heavy metal the contrast drugs contain called gadolinium.

Marcie Jacobs, a woman profiled in the story, had a family history of breast cancer. In 2001, she decided to have an MRI for preventive care. She was injected with a contrast agent, and later began experiencing strange cognitive effects. At first they were fairly minor, like forgetting about work meetings.

A couple of months ago, the U.S. Preventive Services Task Force (USPSTF) stirred the cancer screening pot with its opinion that mammograms are of limited use as cancer screenings for younger women and that, mostly, only women 50 and older should get them regularly. This month, its recommendation (in draft form) received support from the World Health Organization.

As NPR explained, “The WHO’s International Agency for Research on Cancer has just finished its review of mammography to screen for breast cancer, and it, too, concludes that the value of these screening X-rays is ‘limited’ for women in their 40s.”

Both organizations fully support regular mammography for women in their 50s and 60s, and offer their advice for younger women only if they don’t have complicating factors, such as a family history of breast cancer. As usual, mammography is not a one-size-fits-all diagnostic tool, and the USPSTF and the WHO advise women in their 40s to discuss with their doctors their individual circumstances.

Earlier this month, the New York Times wrestled with the thorny issue of lung cancer screenings, and whether people who are entitled to certain screenings through their Medicare coverage should get them. As the paper pointed out, “… screening will not help everyone who is eligible, experts warn. Like any medical test or procedure, it will subject some patients to harm.”

According to HealthNewsReview.org (HNR), which rates media on how well they cover health and medicine news, The Times did a superior job of explaining why a yearly computed tomography (CT) scan is a good idea for some people, and maybe not for others.

Smoking, of course, is a huge risk for contracting lung cancer, and Medicare recently approved subsidizing a low-dose CT scan every year for people 55 to 77 years old who have a smoking history of at least 30 “pack years”; that is, they smoked a pack a day for 30 years, or two packs a day for 15, etc., and still smoke or have quit only within the last 15 years. (See our blog about the advisory panel’s analysis that informed Medicare’s decision.)

Another unsettling study indicates that people undergoing diagnostic scans involving radiation are not given information about the risks of the procedure. As reported by AboutLawsuits.com, less than half of those patients are aware of the scan’s potential health risks.

The study, published in the Journal of the American College of Radiology, found that 1 in 3 patients did not have a full understanding of testing procedures to which they were about to submit, and they were particularly unaware of the radiation risks.

The inappropriate or overuse of nuclear scans (those involving radioactive agents) and X-rays when diagnosing an injury or disease, over time, can cause cancer.

Cardiac stress testing can be a useful tool to assess heart function, but since it became trendy for companies to subject their executives to treadmill stress tests as part of their annual checkups, the technology has grown too big for its britches.

That’s paraphrasing the results of a study published recently in the Annals of Internal Medicine. The study, as summarized by MinnPost.com, showed that “Inappropriate use of cardiac stress testing – particularly testing done with imaging – is costing the U.S. health care system more than half a billion dollars,…”

But in addition to the cost, cardiac stress tests with imaging subject people to radiation, which the study says each year might lead to as many as 500 future cases of cancer. So the overuse of this technology isn’t just a waste of money, it’s a threat to patient safety.

Despite the increased use of CT scans to diagnose kidney stones for emergency department patients, the imaging technology is no better than an ultrasound exam, and ultrasound is safer.

Ultrasound, according to a recent study published in the New England Journal of Medicine, (NEJM) is the preferred first-line diagnostic tool when someone presents at the ER with the extreme pain characteristic of kidney stones. It was clear that although ER physicians routinely turn to CT scans for kidney stone diagnosis, “Ultrasound is the right place to start,” concluded the study’s senior author, Dr. Rebecca Smith-Bindman. She’s a professor at UC San Francisco.

The issue, as readers of this blog will recognize, is radiation. CT scans expose patients to significant amounts of radiation; ultrasound scans don’t.

Texas has about 28,000 licensed X-ray technicians, but if the state follows the recommendation of an advisory commission, the piece of paper that certifies that they’re qualified to dose you with radiation won’t be necessary.

The state, according to the Texas Tribune, might decide that radiologic technologists, as well as several other categories of health professionals, no longer need a license to do their jobs. What the members of the Department of State Health Services’ Sunset Advisory Commission don’t seem to understand is that licensing the people with the potential to cause serious harm is a measure of protection against lack of training and ability. (See our backgrounder on radiation overdose injuries.)

The commission, which is charged with identifying inefficiencies in state government, believes licensing is regulatory redundancy because people receive X-rays, MRIs and CT scans in health-care facilities that themselves are highly regulated. By that logic, no hospital that surpasses all oversight measures ever grants practice privileges to a surgeon who – oops! – leaves a sponge inside a patient.

Writing last month in the New York Times, Dr. Rita F. Redberg, a cardiologist, and Dr. Rebecca Smith-Bindman, a radiologist, applauded the advances made in preventing and treating cancer. But they also deplored the fact that the rate of cancer “remains stubbornly high and may soon surpass heart disease as the leading cause of death” in the U.S.

Even more alarming to patient safety advocates, their essay, “We Are Giving Ourselves Cancer,” suggests that the reason for cancer’s intractability might be our own fault; we are, they say, “silently irradiating ourselves to death.”

As we have written before, the growth in the use of diagnostic imaging, particularly technology such as CT scans that use high doses of radiation, presents the real risk of overexposure. Redberg and Smith-Bindman, of the University of California, San Francisco Medical Center, note that, between the 1980s and 2006, our exposure to medical radiation has increased sixfold. They say that radiation from a CT scan, which uses multiple X-rays to put together an image, can be 1,000 times higher than a conventional X-ray.

Although radiation can be a vital diagnostic tool and a life-saving cancer treatment, its dangers are well-documented (see our backgrounder on radiation overdose injuries).

A recent study published in the Journal of the American Medical Association (JAMA) suggests that doctors might be using radiation therapy too often for patients with advanced-stage prostate cancer. That puts them at risk of normal cell damage, skin irritation, diarrhea, bleeding and other problems. It also adds to the cost of their treatment.

Radiation therapy is prescribed to treat pain in patients whose prostate cancer has spread to their bones. This intervention is not for improving chances of survival in these advanced-stage cases, only to address severe pain. Radiation treatment of 10 sessions or more is recommended only in fewer than 10% of cases, and only if the patient’s cancer also might have spread to nearby soft tissue.

We’ve all found ourselves in the middle of conflicting opinions about the advisability of a certain health procedure. A TV news report, a newspaper analysis and a disease website advisory all might offer different takes on the same situation.

Often in those circumstances, the U.S. Preventive Services Task Force (USPSTF), an independent medical expert advisory panel that uses objective science to formulate “best practice” recommendations, helps to sort the wheat from the chaff. As we’ve written, to reduce overdiagnosis and its consequent risks, the task force promotes caution, not indiscriminate testing, in prostate testing and mammography. So its decision last week about CT scans for some smokers and ex-smokers can seem confusing.

As recently as a few months ago, we discussed people who have lung cancer surgery when they don’t have lung cancer, and how widespread screening for lung cancer with CT technology is misguided. So what’s the deal?

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