Radiation Risk From Medical Imaging

There’s been a lot in the media about radiation exposure from medical imaging, and many of my patients are asking about it. They want to know if radiation from mammograms, bone density tests, computed tomography (CT) scans, and so forth will increase their risk of developing cancer. For most women, there’s very little risk from routine x-ray imaging such as mammography or dental x-rays. But many experts are concerned about an explosion in the use of higher radiation–dose tests, such as CT and nuclear imaging.

Over 80 million CT scans are performed in the United States each year, compared with just three million in 1980. There are good reasons for this trend. CT scanning and nuclear imaging have revolutionized diagnosis and treatment, almost eliminating the need for once-common exploratory surgeries and many other invasive and potentially risky procedures. The benefits of these tests, when they’re appropriate, far outweigh any radiation-associated cancer risks, and the risk from a single CT scan or nuclear imaging test is quite small. But are we courting future public health problems?

Exposure to ionizing radiation on the rise

The radiation you get from x-ray, CT, and nuclear imaging is ionizing radiation — high-energy wavelengths or particles that penetrate tissue to reveal the body’s internal organs and structures. Ionizing radiation can damage DNA, and although your cells repair most of the damage, they sometimes do the job imperfectly, leaving small areas of “misrepair.” The result is DNA mutations that may contribute to cancer years down the road.

We’re exposed to small doses of ionizing radiation from natural sources all the time — in particular, cosmic radiation, mainly from the sun, and radon, a radioactive gas that comes from the natural breakdown of uranium in soil, rock, water, and building materials. How much of this so-called background radiation you are exposed to depends on many factors, including altitude and home ventilation. But the average is 3 millisieverts (mSv) per year. (A millisievert is a measure of radiation exposure; see “Measuring radiation.”)

Exposure to ionizing radiation from natural or background sources hasn’t changed since about 1980, but Americans’ total per capita radiation exposure has nearly doubled, and experts believe the main reason is increased use of medical imaging. The proportion of total radiation exposure that comes from medical sources has grown from 15% in the early 1980s to 50% today. CT alone accounts for 24% of all radiation exposure in the United States, according to a report issued in March 2009 by the National Council on Radiation Protection and Measurements.

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