Ionising radiation: a necessary evil?

Abstract

We agree wholeheartedly with the conclusion of Martineau-Beaulieu and Lanthier 1 that radiation doses need to be reduced in hospital inpatients. Putting aside the apparent overestimation of the radiation dose associated with a thallium scan -the figure quoted is more than 50% over that cited by most authorities 2 -we also reflect on the potentially strong diagnostic benefits of these procedures.Three of the four procedures associated with the highest radiation doses also have the greatest potential for establishing a life-saving diagnosis and/or significantly impacting on the management algorithm at the outset of hospital admission. Namely, these are coronary angiogram/angioplasty, computed tomography (CT) pulmonary angiogram and positron emission tomography with fluorodexoyglucose.On the one hand, any one of these procedures alone carries a radiation burden exceeding even the mean dose of the surveyed patients -which, in itself, is almost three times the annual background. However, these procedures may also expedite the correct diagnosis and/or instigate an appropriate treatment paradigm. This may, in fact, have greater overall benefit for the patient -and the healthcare system -in terms of time and resources. This is of particular importance given the high incidence of readmission rates among medical inpatients, as highlighted recently. 3 Certainly, we are encouraged by thoughtful application of new diagnostic techniques (where appropriate) to minimise radiation exposure to patients, such as with CT coronary angiography, 4 whose clinical value is supported by increasing volumes of evidence. 5 We also advocate for further analysis of the data as to how often the associated radiation doses directly resulted in optimal patient outcomes. Conversely, would the authors be able to garner more useful information by establishing how much of the radiation exposure of the average hospital inpatient was actually unnecessary?