Radiology = Cancer?

Plue00 said:

What are the chances of getting cancer from being a radiologist?

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Slim to none.

Or is that something that happened a while back, and now theres technology to do it without contact?

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You are talking about the 1930s here.

You will find case reports and funny clusters, but no classic empiric evidence to show that radiologists today have an increased risk of cancer.

Very little is known about the bioeffects of low doses of radiation. The guidelines and numbers used today are the result of political decisions in the 1960s.

Stay away from microwave ovens and cell phones too.

If you're not scared, then you're not paying enough attention.

I'm pretty sure that being a radiologist is safe, but radiology in some cases isn't so safe for the patients:
http://jama.ama-assn.org/cgi/content/abstract/298/3/317

I'm just posting that because sometimes I get the impression from some people in medicine and radiology in particular that they feel that radiation doses from diagnostic scans are so low as to be negligible. For CT, that certainly isn't the case, especially in young patients. As always, the benefits of a scan should be weighed against the risks.

Plue00 said:

What are the chances of getting cancer from being a radiologist? Or is that something that happened a while back, and now theres technology to do it without contact?

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I was under the impression that radiologists had a slightly higher than background risk of developing certain types of cancer; namely skin cancer & leukemia.

ApacheIndian said:

Well we proabably have a higher risk of skin cancer because we're often in the sun -- on the golf course or on the beach or cruising around in our convertible Ferrari 360 Modenas, and maybe oral cancer too since we often lounge around in robes smoking cigars while doing telerad at home. Lastly, and this has nothing to do with the big CA of course, we tend to get laid quite a bit with very high numbers of hot babes, so I guess our risk of STD's is higher as well.

These are all of course associations, not causations.

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LOL

In response to the OP, I hope you are not serious, if you are then you must know Rads dont usually even take the scans as far as I know, they just read images.
Also interventional rads I think may have a slightly higher chance as they actually use radioactive materials quite often, at least this was my impression? I could be wrong though...

ApacheIndian said:

Well we proabably have a higher risk of skin cancer because we're often in the sun -- on the golf course or on the beach or cruising around in our convertible Ferrari 360 Modenas, and maybe oral cancer too since we often lounge around in robes smoking cigars while doing telerad at home. Lastly, and this has nothing to do with the big CA of course, we tend to get laid quite a bit with very high numbers of hot babes, so I guess our risk of STD's is higher as well.

These are all of course associations, not causations.

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hahahahaha

threemae said:

I'm pretty sure that being a radiologist is safe, but radiology in some cases isn't so safe for the patients:
http://jama.ama-assn.org/cgi/content/abstract/298/3/317

I'm just posting that because sometimes I get the impression from some people in medicine and radiology in particular that they feel that radiation doses from diagnostic scans are so low as to be negligible. For CT, that certainly isn't the case, especially in young patients. As always, the benefits of a scan should be weighed against the risks.

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Usually it is the radiologists telling other clinicians about the harm from radiation. That article is pointless; all it says is CCTA exposes pt's to radiation, low dose radiation causes cancer (we think), so CCTA must cause cancer. No one knows the exact relationship between low dose radiation exposure and cancer, the cancer risks cited in the article are pure speculation.

That's not to say radiation exposure shouldn't be taken seriously. However, I question the motives of the authors of the article. First of all, did you notice all of the authors are cardiologists? Second, why didn't the authors compare the radiation dose of CCTA with the radiation dose of the other commonly used modality for assessing CAD, cardiac catheterization? Cardiac catheterization exposes patients to almost as much radiation as CCTA, and cardiac caths use higher doses of IV contrast and are much more invasive. The only reason this article was written was to raise concerns about CCTA, so cardiologists can continue to perform their much more expensive and risky cardiac caths.

-Goose- said:

I was under the impression that radiologists had a slightly higher than background risk of developing certain types of cancer; namely skin cancer & leukemia.

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So we had a physicist in the rad dept give a lecture on radiation during our rad elective. Basically he said according to studies radiologists get exposed to about the same radiation/year as someone who lived at higher altitudes (ie. Denver, areas in Colorado, etc.) So it's really negligible. He also cited that back in the day (cant remember how many decades ago), radiologists had a decreased life expectancy compareed to other physicians when there were no safety measures. Now though, studies have shown that radiologists actually have a greater life expectancy compared to other physicians. They attribute this to possible lower stress, less exposure to infectious diseases, etc.

I do not have links to these studies, but I think the PhD wouldnt lie.

Caffiend_79 said:

Usually it is the radiologists telling other clinicians about the harm from radiation. That article is pointless; all it says is CCTA exposes pt's to radiation, low dose radiation causes cancer (we think), so CCTA must cause cancer. No one knows the exact relationship between low dose radiation exposure and cancer, the cancer risks cited in the article are pure speculation.

That's not to say radiation exposure shouldn't be taken seriously. However, I question the motives of the authors of the article. First of all, did you notice all of the authors are cardiologists? Second, why didn't the authors compare the radiation dose of CCTA with the radiation dose of the other commonly used modality for assessing CAD, cardiac catheterization? Cardiac catheterization exposes patients to almost as much radiation as CCTA, and cardiac caths use higher doses of IV contrast and are much more invasive. The only reason this article was written was to raise concerns about CCTA, so cardiologists can continue to perform their much more expensive and risky cardiac caths.

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Too bad Medicare has a slew of reimbursement cuts for caths and stents this yr. Crazy stent happy cardiologists.

I know of several med students who don't want to go into radiology because of this misconception.

I'm all in favor of perpetuating it if it means fewer people interested in radiology.

Caffiend_79 said:

No one knows the exact relationship between low dose radiation exposure and cancer, the cancer risks cited in the article are pure speculation.

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Your point is well taken regarding the possible bias of the author's as cardiologists. Also, I have no idea about who might be more blase about radiation, ER docs that have a lot of patients to push through or radiologists, but here's another article that does an even better job in my opinion of discussing the risks. It also has some background on the historical data collection where we got most of our info about the risks of low-dose radiation exposures from the atomic bombs in Hiroshima and Nagasaki and I find it fairy convincing. To begin with, the added risk isn't simply extrapolated from higher-dose exposures nor from rats, but from people that actually had comparable low-dose exposures.

http://content.nejm.org/cgi/reprint/357/22/2277.pdf

"

Depending on the machine settings, the organ
being studied typically receives a radiation dose
in the range of 15 millisieverts (mSv) (in an adult)
to 30 mSv (in a neonate) for a single CT scan, with
an average of two to three CT scans per study. At
these doses, as reviewed elsewhere,​

​

survivors.
"

I'm not trying to be chicken-little, I'm just saying that the risks are definitely there and should correspond to the clinical utility of the scan. I don't think the authors are anti-radiology; their most applicable arguemnet is just that peds with suspected appendicitis should be getting US instead of CT's.

I'll keep the elevated STD risk in mind.

threemae said:

Your point is well taken regarding the possible bias of the author's as cardiologists. Also, I have no idea about who might be more blase about radiation, ER docs that have a lot of patients to push through or radiologists, but here's another article that does an even better job in my opinion of discussing the risks. It also has some background on the historical data collection where we got most of our info about the risks of low-dose radiation exposures from the atomic bombs in Hiroshima and Nagasaki and I find it fairy convincing. To begin with, the added risk isn't simply extrapolated from higher-dose exposures nor from rats, but from people that actually had comparable low-dose exposures.

http://content.nejm.org/cgi/reprint/357/22/2277.pdf

"

Depending on the machine settings, the organ
being studied typically receives a radiation dose
in the range of 15 millisieverts (mSv) (in an adult)
to 30 mSv (in a neonate) for a single CT scan, with
an average of two to three CT scans per study. At
these doses, as reviewed elsewhere,​

​

24 the most likely
(though small) risk is for radiation-induced carcinogenesis.
Most of the quantitative information that we
have regarding the risks of radiation-induced cancer
comes from studies of survivors of the atomic
bombs dropped on Japan in 1945.25 Data from
cohorts of these survivors are generally used as
the basis for predicting radiation-related risks in
a population because the cohorts are large and
have been intensively studied over a period of
many decades, they were not selected for disease,
all age groups are covered, and a substantial subcohort
of about 25,000 survivors26 received radiation
doses similar to those of concern here —
that is, less than 50 mSv. Of course, the survivors
of the atomic bombs were exposed to a fairly uniform
dose of radiation throughout the body,
whereas CT involves highly nonuniform exposure,
but there is little evidence that the risks for
a specific organ are substantially influenced by
exposure of other organs to radiation.
There was a significant increase in the overall
risk of cancer in the subgroup of atomic-bomb
survivors who received low doses of radiation,
ranging from 5 to 150 mSv27-29; the mean dose in
this subgroup was about 40 mSv, which approximates
the relevant organ dose from a typical CT
study involving two or three scans in an adult.
Although most of the quantitative estimates
of the radiation-induced cancer risk are derived
from analyses of atomic-bomb survivors, there
are other supporting studies, including a recent
large-scale study of 400,000 radiation workers in
the nuclear industry30,31 who were exposed to an
average dose of approximately 20 mSv (a typical
organ dose from a single CT scan for an adult).
A significant association was reported between
the radiation dose and mortality from cancer in
this cohort (with a significant increase in the
risk of cancer among workers who received doses
between 5 and 150 mSv); the risks were quantitatively
consistent with those reported for atomicbomb​

survivors.
"

I'm not trying to be chicken-little, I'm just saying that the risks are definitely there and should correspond to the clinical utility of the scan. I don't think the authors are anti-radiology; their most applicable arguemnet is just that peds with suspected appendicitis should be getting US instead of CT's.

I'll keep the elevated STD risk in mind.

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Peds should not receive US instead of CT for appendicitis diagnosis. US is too operator dependent. When on my Peds rotation, I asked a peds surgeon if we should get US instead and he even said that unless there's a guarantee that the US can detect it he'd rather get a CT. I know this is probably the wrong way to go, but why risk being wrong with a diagnosis.

threemae said:

I'm not trying to be chicken-little, I'm just saying that the risks are definitely there

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The risks are far from being 'definite'. All the data we have is extrapolated from populations not comparable to todays. KZ survivors and uprooted refugees in a wartorn country (who suffered incorporation of long-lived isotopes) are our control group to define public health policy of today.

The LNT (linear no threshold) hypothesis that spawns such nonsense as 'doing a CT on a child will cause cancer with a 1:x chance' is based on political decisions taken at one of the initial ICRP conferences in the 60s. It was NOT a decision based on the best science at the time.

their most applicable arguemnet is just that peds with suspected appendicitis should be getting US instead of CT's.

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The patient should get the study clinically most appropriate. For a skinny 6 year old, that is certainly Ultrasound. For your typical corn-fed 12 year old heifer, doing US is a waste of time and resources and will lead to suboptimal patient care. In the setting of appendicitis, time is rupture. Diddling around with a suboptimal modality is poor patient care.
Mortality of operated non-ruptured appendicitis: 0.xxxxx%
Mortality of operated ruptured appendicitis: higher

The best modality for a male 12 year old with peritoneal signs and anorexia are the hands of an experienced surgeon with some balls connected to a brain that is able to rule out the obvious differentials based on history.

OHMAN0125 said:

Peds should not receive US instead of CT for appendicitis diagnosis. US is too operator dependent. When on my Peds rotation, I asked a peds surgeon if we should get US instead and he even said that unless there's a guarantee that the US can detect it he'd rather get a CT. I know this is probably the wrong way to go, but why risk being wrong with a diagnosis.

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Not saying you're wrong, but I know several pediatric radiologists who would vehemently disagree.

The way I figure it, the clinician is going to want the CT if the US is negative anyway, so why not just do the CT and get it over with.

colbgw02 said:

so why not just do the CT and get it over with.

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Because you might actually not do the best study for the patient in front of you. The advantage of CT over US is slim to none in younger kids with little intraperitoneal fat.

OHMAN0125 said:

Peds should not receive US instead of CT for appendicitis diagnosis. US is too operator dependent. When on my Peds rotation, I asked a peds surgeon if we should get US instead and he even said that unless there's a guarantee that the US can detect it he'd rather get a CT. I know this is probably the wrong way to go, but why risk being wrong with a diagnosis.

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Do you understand the concepts of sensitivity and specifity? This is very relevant to the question you are asking.

A lot of tests are very good at ruling OUT disorders (meaning a negative test gives you confidence that the condition is not present) but are not good at ruling them in (meaning a positive test doesn't tell you anything). The reverse applies as well, where tests can be very informative if positive but offer little information if negative.

In this case, if you do an ultrasound that tells you with a strong degree of confidence that the condition (e.g. appendicitis) is present, why would you get another test? The real question you have to ask is: would a POSITIVE ultrasound be enough for the surgeon to operate? If so, then getting a cheap, easy, and consequence-free test has no drawbacks at all and might save you the need for a CT scan later (saving money and obviating the need to irradiate the patient). If the U/S is negative, you can ALWAYS follow it up with a CT scan anyway. In other words, the only reason to go straight to CT would be if the surgeon felt an u/s would not influence his management no matter what the result, which is the same as saying it is a useless test in this clinical setting.

Zweihander said:

In other words, the only reason to go straight to CT would be if the surgeon felt an u/s would not influence his management no matter what the result, which is the same as saying it is a useless test in this clinical setting.

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The CT would be treating the surgeons insecurity in that scenario....

f_w said:

Because you might actually not do the best study for the patient in front of you. The advantage of CT over US is slim to none in younger kids with little intraperitoneal fat.

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Yeah, I understand. I'm just saying that the staff pediatric surgeon or senior surgery resident doesn't always understand the the best test for the patient. And when it's 2am and my list keeps growing, I'm not going to get into a pissing contest when they're screaming to get a CT even when they're holding the negative US result in their hands. Maybe that's not a problem for you, but it happens all the time where I am. During the light of day, with staff in-house to back me up, then it's a different story.

colbgw02 said:

Yeah, I understand. I'm just saying that the staff pediatric surgeon or senior surgery resident doesn't always understand the the best test for the patient.

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If a staff pedi surgeon or senior surg resident has actually laid hands on the patient, I give them whatever they want. If the only medical provider who has seen the patient is the fresh out of school ER PA: no soup for you.

And when it's 2am and my list keeps growing, I'm not going to get into a pissing contest when they're screaming to get a CT even when they're holding the negative US result in their hands.

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'Your insecurity pays the new rims for my car' is what I usually think in that situation.... Life is so much better once you are not a resident anymore.