The radiation dose dilemma: Risk, rewards and the real story about radiation dose

By Dominic Siewko, Philips

Dec. 27, 2014 - Radiation dose from diagnostic procedures has become a topic of debate in the popular press. And with the Medicare payments for some higher-dose CT scans on the chopping block starting in 2016, the red flag has been effectively raised. Rightfully so – health care providers and manufacturers need to take every step to ensure the safety of both patients and clinicians. But there’s still confusion in the market about the definition of safety when it comes to diagnostic scans, and as a health physicist, I’m compelled to set the record straight on the real risk and reward of radiation dose. 


The Benefit is Clear 

In the U.S., the use of CT scans nearly tripled, from 52 scans per 1,000 patients to 149 scans per 1,000 patients between 1996 and 2010. According to the American College of Radiology (ACR), nearly 68 million CT scans are performed annually in the U.S. today. Put another way, nearly 1 in every 5 Americans will receive a CT scan this year. The reason is simple – CT scans can yield a better, more precise image than a standard x-ray, and can even eliminate the need for exploratory surgery in some cases. That’s the benefit part of the equation.


But What’s the Risk? 

Radiation dose is the other half of the equation. With CT scans, technicians can protect themselves or limit their doses by stepping out of the room or behind a barrier during the procedure. Patients, as the subjects of the procedure, receive the exposure. But while a CT scan adds to our dose burden, let’s put it in perspective. The amount of “background” radiation we’re all exposed to in a year is actually higher on average than some diagnostic CT scans:



The average natural/environmental (“background”) radiation dose per person in the U.S. is 3 mSv per year. 


With that said, how are patients supposed to be informed about their right dose for them? And perhaps even more importantly, what’s the best way for health care providers to protect and inform people? 

Striking the Balance with Exposure Data 

The overall goal is to provide clinicians with the best possible diagnostic information at the lowest possible dose. There are a number of ways of striking a balance between dose and benefit: 


Like most things in life, diagnostic radiology is enhanced when the balance is found between the diagnostic benefits and the dose required to get there. Striking that balance is becoming easier through a combination of evidence, technology and intelligence, and I have faith that advancements will continue. And as they do, patients and clinicians should continue to keep the real story – the real risk and rewards – in mind.