Radiology in the News
How do we get a more balanced approach to reporting the benefits and risks of medical radiation?
Helping our patients understand the true benefits and risks of radiation exposure has been challenging. The Image Gently® and Image Wisely® campaigns, which the ACR cofounded, have had success in partnering with the media to publicize patient resources such as the top questions patients should ask their providers about prescribed medical imaging exams. Still, most patients are given little information about risks and few avenues to find more substantial answers. So it was an exciting milestone this past March, when radiologyinfo.org, the patient information site ACR co-manages with RSNA, received over one million monthly visitors.
While we’re heartened by these successes, patients still face serious obstacles to finding credible information about ionizing radiation. The task is made more difficult because the media looks to create controversy by magnifying potential risks without explaining the benefits of imaging or the risks to patients who refuse recommended care. Consider the recent articles in Consumer Reports sporting headlines like “The Surprising Dangers of CT Scans and X-rays” and “Can Mammograms Cause Cancer?”
Over the years, the ACR and other radiology and medical physics societies have responded to these stories with letters to the editor, trying to get the mainstream media to take a more balanced approach in its reporting. These efforts have met with mixed success.
ACR members, including myself, are often quoted in major news outlets, and some of you have told me that the radiology community should take a stronger public stance about the true risks of medical radiation and the continuing controversy regarding CT scans and increased risk of cancer. But when the radiology community has responded aggressively, we have often been perceived as self-interested and overly defensive, making our efforts unproductive.
In 2011, several radiological organizations established the Imaging Communication Network (ICN) to allow intergroup communication and rapid response to press reports concerning radiation exposure and radiation safety. The ICN was initially composed of radiation safety experts from the ACR, RSNA, ARRS, ABR, and ABR Foundation. Over the years membership has expanded and now includes representatives from the Canadian Association of Radiologists. In our previous letters to the editors of the New York Times, USA Today, and others, the ACR has focused on how radiation dose from modern scanners has decreased, how the radiology community is continually working to minimize dose, and how our efforts help ensure the appropriate use of medical imaging. Most of all, we have stressed that medical imaging saves lives. We encourage the public not to let the potential harms of medical radiation prevent them from getting appropriate medical care.
The Consumer Reports article about radiation from CTs, which was subsequently reported on “CBS This Morning,” cited studies from Great Britain and Australia that suggested children who received CT scans had a higher incidence of subsequent cancers than children who did not. Media outlets stated that CT scans increased the risk of cancer by 24 percent. In our response to articles in Consumer Reports, we wrote, “United Nations (UNSCEAR) and the National Council on Radiation Protection and Measurements have stated that these studies cited to show a direct risk from CT scans do not prove such claims. Recent French and German studies show no significant excess cancer risk from CT scans.” Rather than allowing us sufficient space for a more detailed explanation, the Consumer Reports editor responded to our letter, stating, “Consumer Reports does not agree with the letter writer’s description of the research linking medical radiation and cancer. The World Health Organization, the National Institutes of Health, and other expert groups say that the form of radiation that’s used in medical imaging is a known carcinogen.”
On a much more positive note, radiation experts from the ACR, Image Gently, and the National Council on Radiation Protection and Measurement met face-to-face with editorial staff and their medical advisors at Consumer Reports to discuss a more balanced approach to providing the public information on the benefits and potential harms of radiation exposure, including new research showing no significant excess cancer risk from CT scans. In the radiology literature, physicians like Mervyn D. Cohen, MD, MB, ChB, FACR, are calling out instances of unbalanced media reporting of CT-induced cancer risk and stating our concern that inaccurate reporting may turn patients away from appropriate medical care.5 It is hard to predict where these discussions will go, but we continue to seek out opportunities to discuss these issues in a direct, productive manner.
One opportunity is to bypass the media and get information directly into the hands of patients through radiologyinfo.org. Your practice can become an affiliate of the website by linking to it and sharing the link with your referrers and patients. This will save you and your colleagues time and provide your patients with reliable information. You can get more information about becoming a radiologyinfo.org affiliate at the ACR Services Area at ACR 2015.
Everything we do in medicine carries at least a small risk, whether we’re performing surgery, administering anesthesia, or prescribing drugs. Comparatively, the risks from radiation used in imaging are incredibly small, particularly compared to radiology’s value to patient care. We can continue to lower the potential risk to our patients by ensuring the examinations they receive are appropriate and necessary and that our protocols and equipment are optimized to deliver the lowest radiation levels possible for the examination. We share the desire for the public to make informed decisions about medical care, and we have been proud partners with the American Board of Internal Medicine and Consumer Reports in the Choosing Wisely ® initiative. We want the media to report imaging risks and benefits with up-to-date, unbiased information. We know we face an uphill battle, but we continue to educate the media and push for more balanced reporting of radiation safety issues.
By Bibb Allen Jr., MD, FACR