In December 2009 the Archives of Internal Medicine (now JAMA Internal Medicine) published two studies that found that CT scans were exposing patients to far more radiation than anyone realized, and in doses that could result in tens of thousands of future cancer cases.
Journal editor Rita Redberg, M.D. (pictured), wrote an editorial accompanying the articles, arguing that in light of the data, "physicians [and their patients] cannot be complacent about the hazards of radiation or we risk creating a public health bomb."
Now, more than four years later, Redberg, a cardiologist at the University of California, San Francisco and Rachel Smith-Bindman, a radiologist at UCSF (and co-author of one of the 2009 studies), have written an opinion piece in the New York Times provocatively titled "We are Giving Ourselves Cancer," in which they express their continuing concerns that we still aren't doing enough to reduce patient exposure to medical radiation.
Redberg recently took some time to talk to FierceMedicalImaging about issue.
FierceMedicalImaging: Why write this piece in the New York Times now?
Rita Redberg: After the articles were published in 2009 there were some Congressional hearings, and lots of different things were discussed about monitoring and reducing radiation exposure, but not a lot of things have been implemented. We've had four more years of high exposure to medical imaging. And we've seen more studies since then, such as an Institute of Medicine report--and we mentioned it in the Op-Ed--that found that medical imaging is now the No. 1 environmental cause of breast cancer.
FierceMedicalImaging: What are some of the steps the medical profession can take to better tackle this problem?
Redberg: Everyone agrees that some percentage of medical imaging is currently inappropriate, and doing less of that--or eliminating it--will help, as will using appropriate criteria put out by the American College of Radiology and the American College of Cardiology. And there's the Choosing Wisely Campaign--about one-third of the items that various medical societies have put into Choosing Wisely include imaging with radiation exposure.
And for appropriate imaging, there are still a lot of ways that we can continue to reduce radiation exposure. We know there is a tremendous variation in radiation exposure from the same CT exams at different hospitals or different facilities, and even in the same test at the same facility on different days, so if everyone paid attention to using low-dose radiation protocols, we could reduce radiation exposure.
So just these two things would tremendously reduce radiation exposure and cancer risk.
FierceMedicalImaging: What kind of a response have you received to your Op-Ed?
Redberg: There's been lot's of positive response. This is a big problem and we need to do more about it. Emergency room physicians felt they were unfairly identified as using inappropriate testing and I can understand how they felt that, but we didn't mean to imply that they were the only people that overused CT scans.
FierceMedicalImaging: How do you strike a balance between putting more focus on the issue of radiation overexposure and making sure that patients aren't deterred from getting necessary imaging tests?
Redberg: Paying more attention to the appropriate use guidelines and low-dose protocols is necessary, and so is having more discussion with patients.
Currently, a lot of patients get high-dose radiation CT scans without even being aware they're getting them. And that's a particular concern when we have young people and women who we know have much higher cancer risks from radiation exposure. We're getting an increasing number of children under the age of 18 getting CT scans, and we've received lots of emails from parents who have gotten CT scans for one reason or another who now think they weren't necessary.
More informed discussions with patients will lead to making better decisions and being able to balance risks and benefits. I give patients more credit with being able to make an informed decision and I don't they are going to say no to necessary medical imaging.
Editor's note: This interview has been edited for length and for clarity.