Children are more radio-sensitive than adults and children undergoing CT scans have triple the risk of leukemia and brain cancer after two or three CT scans according to a recent article in the Lancet. Doctors think the benefits usually outweigh their risks, but "radiation is known to carry a hard-to-calculate, elevated, long-term probability of induced cancers", according to Marta Hernanz-Schulman, MD, chair of the American College of Radiology Pediatric Imaging Commission.

Children are especially vulnerable to ionizing radiation because they absorb more radiation per volume of tissue than adults. Ionizing radiation applied to children is especially damaging as children are growing and have more radio-sensitive cell divisions occurring than an adult. Additionally, a longer life awaits children than adults, presenting them with more time for radiation-induced cancers to develop.

Who is at risk?

The concern doesn't stop with children. Use of advanced diagnostic imaging like CT scans and MRIs has increased substantially - nearly tripling between 1996 and 2010 and climbing. Radiation exposure from CT scans quadrupled per capita and ultrasonography increased approximately two-fold during the same period. PET scans have increased by 57 percent annually since 2004.

Rebecca Smith-Bindman, MD and colleagues at UCSF studied the use of imaging in patients in HMOs to examine the patterns of imaging over time and cumulative doses of radiation that patients receive. Arguing for a more prudent use of imaging, Dr. Smith-Bindman states: "We need to change the way we practice as physicians... We need to fund comparative effectiveness research that helps us understand when imaging is helpful and when it may potentially lead to more harm than good."

In some HMOs, they are now issuing warning messages when a physician orders an imaging procedure. But as Dr. Berrington de Gonzalez told Medscape: "It would be worth investigating further whether these warnings may have impacted the levels of use."

FDA makes a "suggestion"

The U.S. Food and Drug Administration took action recently by releasing proposed guidance encouraging manufacturers to consider the safety of children in the design of new X-ray imaging devices. The federal agency recommended equipment features that would alter the performance of X-ray imaging devices designed for general clinical use to address the specific requirements of younger patients. This "suggestion" was published after more than a decade of explosive use growth and radiation damage linked to medical applications that exposed patients to ionizing radiation.

Suggested guidelines for X-ray imaging devices for pediatric imaging include features geared toward imaging smaller patients with preset pediatric control settings, such as: labeling, and protocols minimizing radiation exposure, display and recording of patient dose or dose index, interactive software display features that alert the user to special pediatric issues, automatic exposure controls calibrated for children, user guides for pediatric use with attention to dose-savings features for children.

Where the buck stops

Doctors who own their MRI machines sell more MRIs than those who send patients out. Dr. Sigvard T. Hansen, Jr., a professor of orthopedics and sports medicine at the University of Washington, says he pretty much spurns such scans because they rarely provide useful information about the patients he sees - those with injuries to the foot and ankle. "Patients often feel like they are getting better care if people are ordering fancy tests, and there are some patients who come in demanding an M.R.I. - that's part of the problem," he said.

Truth be told, studies show that outcomes between patients with MRIs vs. standard X-rays have either no difference in outcome or sometimes better outcomes with standard X-rays.

The choice is ultimately yours. People with better insurance endure more procedures than those without sufficient insurance. Question your doctor closely any time they offer ionizing radiation tests. Consider the long-term consequences. 20 years from now the cancer in your body may never be associated to the original cause.

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