Week 2: Radiation, Radiation Everywhere

Radiation is a word that induces fear in the public. Nuclear reactor accidents, nuclear weapons or general misunderstanding in science might have contributed to this reaction. As a result, it is imperative to educate the patients when they undergo radiological imaging. During this situation, how can a physician effectively present the risks and benefits to the patients? In a lecture for medical students, I discovered that there is no easy way to tackle this question. For instance, it is not enough to just provide scientific facts about radiation (i.e. the difference between ionizing and nonionizing radiation, the working mechanism of different image modalities…). To aid patients’ understanding, it is very helpful to explain the risks and benefits of a procedure by comparing the amount of radiation received from the imaging and from the natural background. As an example, I need to explain first the CT procedure, which is followed by a timeframe in which the patient will receive the same dose of radiation by just performing his or her daily activity. In this context, the patients can more easily weight in the benefit of a CT scan, which can potentially help diagnose and treat a life threatening disease. 

In addition to educating the patients, taking the necessary precautions to reduce the exposure to ionizing radiation is essential. It is true for both patients and clinicians. This was quite evident when I observed a liver embolization and IVC filter removal procedure. In both cases, clinicians always wore lead jackets and only the region of interest was irradiated with x-rays. During the IVC filter removal case, the patient had chronic thrombosis, which prevented the catheter from reaching its target. Due to the unexpected difficulty of the case and prolonged exposure to the fluoroscope, the internal radiologist needed to be extremely cautious so that each decision would not harm the patient. Finally, in the liver embolization case, I noticed how everyone in the procedure room would return to the control room during a CT scan. This was done in order to protect the clinicians from the high-dose scattered radiation of the scan.