1. Communicating Radiation Risk
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2. Lifestyle Choices Modify Risk
Communicating Radiation Risk V1 Created 18/3/2008

3. Radiation Phobia
Our clients by and large perceive radiation as sinister.
Chernobyl
Overall 56 people died as a consequence of the 1986 Chernobyl reactor accident.
There have been cases of childhood thyroid cancer.
15 Million people in Belarus, Ukraine and Russia developed psychosomatic disorders post the Chernobyl accident10.
Communicating Radiation Risk V1 Created 18/3/2008

4. Risk Perception
Underestimate large risks and over estimate small risks2
Most people regard activities in involving a risk of 1 in a 1,000,000 or below as exceedingly safe2
People find it less easy to ignore a risk of death of 1 in a 1,0002
Communicating Radiation Risk V1 Created 18/3/2008

5. Risk Perception Perceive as less risky Voluntary Personal control Fair
Credible source
Perceive as greater risk
Man made
Delivery in an environment or by a person we don’t trust1
Communicating Radiation Risk V1 Created 18/3/2008

6. Balancing Radiation Risk
Justification - restrict use of diagnostic imaging to only those who will benefit.
Informed of risk
Patients should not refuse diagnostic tests based on exaggerated estimations of the risk.
Communicating Radiation Risk V1 Created 18/3/2008

7. Radiation Effects Evidence
Hiroshima and Nagasaki
Chernobyl and other radiation incidents
Occupationally exposed groups
Populations in high background radiation areas
Medical radiation groups
Communicating Radiation Risk V1 Created 18/3/2008

8. Available http://www.fda.gov/cdrh/rsnaii.html, 5/6/07
Radiation Bioeffects
Immediate Effects
Skin necrosis / erythema
Alopecia
Cataracts
Available 5/6/07
Thorat J & Hwang P. Journal of Stroke and Cebrovascular Diseases Vol 16 (1) 2007
Communicating Radiation Risk V1 Created 18/3/2008

9. Follow-up
All patients with estimated skin doses of 3 Gy should be followed up days after exposure.
Radiation skin injury may present late and the association not considered if no documentation
A system to identify repeat procedures should be set up9
Communicating Radiation Risk V1 Created 18/3/2008

10. Radiation Bioeffects Long Term Effects Cancer (primary risk)
Genetic defects in the children of exposed parents
Mental retardation in the children of mothers exposed during pregnancy
Image available on 15/4/2008
Communicating Radiation Risk V1 Created 18/3/2008

11. Source: http://www.bmj.com/cgi/content/full/328/7439/578
Leukaemia and Cancer
Attributable lifetime risk for a single small dose of radiation according to age at time of exposure.
Radiation has been shown to increase the risk for leukaemia and many types of cancer in adults and children
The radiation risk is higher in younger age groups
Source:
Communicating Radiation Risk V1 Created 18/3/2008

12. Cancer Risk 64 Slice CT Coronary Angiography
Source Einstein A. Cardiosource 2007
Available on 18/03/2007
Communicating Radiation Risk V1 Created 18/3/2008

13. Radiation Fact or Fallacy?
About 413 cancers per (1.3% of all cancers) in Australia could be attributable to diagnostic x-rays6
There is a 1:1000 chance of developing cancer from a single CT Chest (10 mSv)8
The risk of cancer from a single CT Chest are < 1:10,000 if the patient is older than 50 years and 1:550 for a 1 year old patient 8.
Communicating Radiation Risk V1 Created 18/3/2008

14. Scientific Conjecture
New research indicates that low doses of radiation are actually beneficial and reduce these natural risks. (Available 13/03/2007). This is controversial
LNT Model
Radiation Hormesis Model
Communicating Radiation Risk V1 Created 18/3/2008

15. Prenatal Exposure Childhood Cancer Risk
Radiation Dose
Radiology Procedure X-ray Dose to Conceptus4,5
Estimated Childhood Cancer Incidence
Estimated Lifetime Cancer Incidence (after exposure at age 10)
No Radiation Exposure above background
MR & US mGy
0.30%
38%
< 50 mGy
Chest mGy
Bone Scan mGy
Ba Enema mGy
W/Body PET mGy
CT Pelvis mGy
0.3% - 1%
38% - 40%
50 – 500 mGy
1% - 6%
40% - 55%
Potential Childhood Cancer health Effects From Acute Prenatal Radiation Exposure
Source adapted from: Centers for Disease Control Fact Sheet Radiation Emergencies Available on 18/03/2008
Communicating Radiation Risk V1 Created 18/3/2008

16. Prenatal Exposure Non Cancer Risk
Acute Radiation Dose to the Embryo / Foetus
Radiology Procedure
X-ray Dose to Conceptus4,5
Time Post Conception
Blastogenesis
Organogenesis
Foetogenesis
(Up to 2 wks)
( wks)
( wks)
( wks)
( wks)
< 50 mGy
MR & US mGy
Chest mGy
Bone Scan mGy
Ba Enema mGy W/ Body PET mGy
CT Pelvis mGy
Non - cancer health effects not detectable
50 – 500 mGy
Failure to implant
Malformations. Growth Retardation
Growth Retardation Reduction in IQ Mental retardation
Non - cancer health effects unlikely
Potential Non Cancer health Effects From Acute Prenatal Radiation Exposure
Source adapted from: Centers for Disease Control Fact Sheet Radiation Emergencies Fact Sheet Radiation Emergencies Available on 18/03/2008
Communicating Radiation Risk V1 Created 18/3/2008

17. Informed Consent
The modern maxim is to allow patients to make informed decisions on their own health care
The current lack of consistency in obtaining informed consent for radiation risk clashes with the accepted legal and ethical standards for giving patients information2.
There is suboptimal awareness of radiation risks by both health care providers and clients.
We declare the risk for anaphylactoid reactions for I.V. contrast (1:250,000) in a CT Abdomen but do not stress the radiation risk (1:1000)
Communicating Radiation Risk V1 Created 18/3/2008

18. Radiation Risk Disclosure Approaches
No mention of the risk2 Such practices disregard patients rights and violate basic principles of informed consent
Understate the risk2
“A nuclear medicine scan is safe with an exposure almost always less than a common x-ray”
Specific detailing of the risks2 “Your Nuclear Medicine scan involves exposure to radiation. Although it can vary from person to person your whole body exposure will be about 15 millisieverts. This is about 6 times the average annual background radiation exposure in South East Queensland. Although no harmful effects are expected , your long term risks from this exposure may be 1 in Harmful effects could include the development of cancer and genetic changes.”
Communicating Radiation Risk V1 Created 18/3/2008

19. How to Explain Radiation Risk
Be honest, clear and compassionate
Be clear about what you do know and open about what you don’t know.
To the extent possible tell people they are safe and why this is true
Listen and deal with specific concerns1
Communicating Radiation Risk V1 Created 18/3/2008

20. Communication Approaches
All education strategies on radiation exposure risk have limitations
Use a variety of media
Dose Quantification
Risk Comparisons
Avoid conflicting messages
Communicating Radiation Risk V1 Created 18/3/2008

21. Relative Radiation Risk
Adapted from American College of Radiology Relative Radiation Level Information available at on 18/03/2008
Communicating Radiation Risk V1 Created 18/3/2008

22. Relative Radiation Risk
Picano E., B.M.J 2004 available on 3/3/2008
Communicating Radiation Risk V1 Created 18/3/2008

23. Relative Radiation Risk
Adapted from RadiologyInfo available on 13/3/2007
Communicating Radiation Risk V1 Created 18/3/2008

24. Ordinary Life Equivalent Risk
An Abdominal CT Scan (10 mSv) has the following equivalent risks:
Smoking 140 cigarettes Driving 6,000 Km in a car Flying 40,000 Km in a jet Canoeing for 5 hours
Adapted from information by H.S. Low Sir Charles Gairdner Hospital available on 11/3/2008
Communicating Radiation Risk V1 Created 18/3/2008

25. Consent Language Generator
Chest.
This research study involves exposure to radiation from a Chest (PA), ... The total amount of radiation that you will receive in this study is about 0.02 mSv, and is approximately equivalent to a uniform whole body exposure of 2 days of exposure to natural background radiation. This use involves minimal risk ….
CT Chest
This research study involves exposure to radiation from a CT chest - helical, ... The total amount of radiation that you will receive in this study is about 13 mSv, and is approximately equivalent to a whole body exposure of 1582 days (4.333 years) of exposure to natural background radiation. This use involves minimal risk ...
RADAR Medical Procedures Dose Calculator and Consent Language Generator Available on 03/03/2008
Communicating Radiation Risk V1 Created 18/3/2008

26. Radiation Exposure
Radiation is an inevitable component in our society and is capable of both good and harm.
Careful decision making is necessary if we are to reap its benefits and avoid unnecessary risks.
Communicating Radiation Risk V1 Created 18/3/2008

27. Conclusions
The principal of patient autonomy in radiology procedure participation might be reinforced by making it mandatory to obtain informed consent for all examinations with an associated radiation risk of 1 in 10,000 or worse22.
Better knowledge of radiation risks will help us avoid perpetuating small individual risks into substantial population risks22
Communicating Radiation Risk V1 Created 18/3/2008

28. References
Washington State Department of Health – Office of Radiation Protection Fact Sheet 17, How to explain radiation risk. Available on 18/03/2008
Picano E., Informed consent and communication of risk from radiological and nuclear medicine examinations: how to escape from a communication inferno, BMJ
Stewart et al., Computed radiography data mining and surveillance as an ongoing quality assurance improvement process., American Journal of Roentgenology, Vol 189, 2007.
McCollough C.H., Radiation exposure and pregnancy: When should we be concerned, Radiographics, 27(4) 2007.
Kettunen A., Radiation dose and radiation risk to foetuses and newborns during x-ray examinations, STUK-A204, May 2004.
Dickie G.J. & Fitchew R. S., Medical radiation and the risk of cancer, MJA 180 (11) 2004.
Martin D.R. & Semelka R.C., Health effects of ionising radiation from diagnostic CT imaging: Consideration of alternative imaging strategies, Applied Radiology 36 (6) 2007.
ICRP Report 85, International Commission on Radiological Protection:
Jaworowski Z., Radiation risk and ethics, Phsysics Today 52 (9) 1999
Communicating Radiation Risk V1 Created 18/3/2008

29. Gold Coast Health Service District
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Thank You
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