Topol: Runaway Use of Radiation Harming Patients


December 17, 2012

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Hello. I'm Dr. Eric Topol, Director of the Scripps Translational Science Institute and Editor-in-Chief of Medscape Genomic Medicine and In this series, The Creative Destruction of Medicine, named for the book I wrote, I'm trying to zoom in on critical aspects of how the digital world can create better healthcare.

The topic here is radiation and how we're not doing the right things for patients. We have a serious problem with overcooking radiation in the United States. It's by far worse here than anywhere else in the world. We have runaway uses of nuclear scans, CT scans, and PET scanning, and we don't even warn our patients; we don't give patients any data on the dangers. In my book, imaging is a really important topic because there's so much progress in imaging and use of nonionizing radiation like ultrasound or MRI, but we continue to rely heavily on scans. In cardiology, for example, there are more than 10 million nuclear scans being performed each year, mostly CT scans. We know from all the data we have today that 2%-3% of cancers in this country are related to use of medical imaging and ionized radiation.

So, why don't we tell patients when they have a particular imaging scan exactly how many millisievert (mSv) they're getting exposed to? A CT angiogram of the heart is 16 mSv; a lot is being done to try to reduce that, but that is equivalent to 800 chest x-rays. How about a typical nuclear scan? A lot of patients who are treated in cardiology get this done every year. At 41 mSv, it's equivalent to 2000 chest x-rays. But patients aren't told any of this. And not only that, but we could actually measure exactly how many mSv they got by using the same type of radiation badges that the medical professionals use when they work in a cardiac cath lab or in an x-ray suite. But we don't do that. This is a serious breach of our responsibility to patients.

We have a very important problem here with this runaway use of radiation procedures but no accountability with respect to patients' exposure. This has come to a crisis point in children. Children who have a diagnosis of a pediatric malignancy, for example, go through all sorts of radiation imaging, and there have been clear-cut trends that this is increasing. It's worrisome and, in fact, it could even engender additional problems in children burdened with cancer. We really need to change this.

In a digital world, this information could be collected from birth. Every individual should have their mSv exposure through medical imaging recorded cumulatively throughout their life and added to their electronic health record. Hopefully we'll see that change come about in the future. This is something that's a big hole in the current way that we work in medicine.

Thanks so much for joining us for this segment, and stay tuned for more from Topol on The Creative Destruction of Medicine series.