From ‘Image Gently’ to image intelligently: a personalized perspective on diagnostic radiation risk

Abstract

The risk of ionizing radiation from diagnostic imaging has been a popular topic in the radiology literature and lay press. Communicating the magnitude of risk to patients and caregivers is problematic because of the uncertainty in estimates derived principally from epidemiological studies of large populations, and alternative approaches are needed to provide a scientific basis for personalized risk estimates. The underlying patient disease and life expectancy greatly influence risk projections. Research into the biological mechanisms of radiation-induced DNA damage and repair challenges the linear no-threshold dose-response assumption and reveals that individuals vary in sensitivity to radiation. Studies of decision-making psychology show that individuals are highly susceptible to irrational biases when judging risks. Truly informed medical decision-making that respects patient autonomy requires appropriate framing of radiation risks in perspective with other risks and with the benefits of imaging. To follow the principles of personalized medicine and treat patients according to their specific phenotypic and personality profiles, diagnostic imaging should optimally be tailored not only to patient size, body region and clinical indication, but also to underlying disease conditions, radio-sensitivity and risk perception and preferences that vary among individuals.

Person Centered Care and Personalized Medicine: Irreconcilable Opposites or Potential Companions?

“…Thus, the assumption about the relevance of the patient's genetic (or other biological) makeup for treatment outcomes is at the base of the PM model. Extracting information about this makeup through testing [12,14,16,22,39] and tailoring interventions based on that, forms the action level. These actions, moreover, are undertaken with the purpose of better control of the medical outcomes.…”

“…From the PM side, there are increasing traces of ideas hinting at a need for PCC as part of their aspirations. A few articles include focus on the person as part of the definition of PM, and highlight the idea that PM needs to involve partnership between the healthcare providers and patients [2], or taking into account the patient's personal preferences, needs, and personality [2,16,46]. From the PCC side, similar conceptual appropriation is visible.…”

JCS 2021 Guideline on Radiation Safety in Cardiology

“…116 Because of the wide variety in the background and pathologies of patients, not only in radiology, and risk communication needs to be tailored to the individual patient and family situation. 117 Appropriate communication regarding the benefits and risks of radiation is part of good medical practice. The World Health Organization also notes that risk communication is an important element of proper radiological practice,118 which is in line with the rationale of the legal amendment.…”

Reliability of chest radiograph interpretation for pulmonary tuberculosis in the screening of childhood TB contacts and migrant children in the UK

“…A more recent change in attitudes suggest that imaging benefits should be highlighted rather than the potential and highly speculative risks of radiation. 19,20 In the context of the limited number of children referred with positive Mantoux skin tests or IGRA blood tests for identification of active TB disease (125 in 7 years in the present institution) and the important management decisions regarding long-term treatment, CT is justified as a primary diagnostic tool.…”