Dose Optimization to Minimize Radiation Risk for Children Undergoing CT and Nuclear Medicine Imaging Is Misguided and Detrimental

Abstract

A debate exists within the medical community on whether the linear no-threshold model of ionizing radiation exposure accurately predicts the subsequent incidence of radiogenic cancer. In this article, we evaluate evidence refuting the linear no-threshold model and corollary efforts to reduce radiation exposure from CT and nuclear medicine imaging in accord with the as-low-as-reasonablyachievable principle, particularly for children. Further, we review studies demonstrating that children are not, in fact, more radiosensitive than adults in the radiologic imaging dose range, rendering dose reduction for children unjustifiable and counterproductive. Efforts to minimize nonexistent risks are futile and a major source of persistent radiophobia. Radiophobia is detrimental to patients and parents, induces stress, and leads to suboptimal image quality and avoidance of imaging, thus increasing misdiagnoses and consequent harm while offering no compensating benefits.

Reply: Radiation Dose Does Matter: Mechanistic Insights into DNA Damage and Repair Support the Linear No-Threshold Model of Low-Dose Radiation Health Risks

“…We therefore reaffirm the need to optimize radiation use in medical imaging, especially in children (15). We strongly disagree that such efforts are detrimental (16).…”

Overview of Biological, Epidemiological, and Clinical Evidence of Radiation Hormesis

“…Soon after publication, these studies were heavily criticized; comparing the two groups with or without CT during childhood was illogical because the CT groups contained cancer-prone individuals [94,95]. Thereafter, the authors of the paper excluded patients with cancer-prone syndromes such as Down syndrome and Noonan syndrome, and again reported that there were still differences between the two groups [96].…”

Reply: DNA Repair After Exposure to Ionizing Radiation Is Not Error-Free

“…REPLY: We thank Duncan et al (1) for their interest in and response to our article (2). However, they charge that we misunderstand the consequences of radiation-induced DNA double-strand breaks (DSBs) based on our neglect of the fidelity of repair after such damage.…”