Risks for nurses in medical radiation

For patients, unnecessary procedures (usually imaging procedures) and radiation dosing errors represent the bulk of risk from medical radiation, whereas incidental, unintended radiation exposure is the primary concern for nurses and other health care workers…

Radiation safety for patients—and nurses   Oncology Nurse Advisor, Bryant
Furlow, October 26, 2011
 Diagnostic and therapeutic radiation have prolonged and improved millions of patients’ lives, and represent indispensable and increasingly sophisticated tools in clinical oncology. But medical radiation’s gifts have come at the potential cost of unintended irradiation of patients and health care workers and increased lifetime risks of secondary cancers. This concern has grown with improving patient survival times, particularly among pediatric cancer patients.

Occupational studies have been reassuring, suggesting rates of radiation-associated cancers (with the possible exception of lung cancer, but this possible link is confounded by smoking behaviors) are not higher in nurses.1However, there is evidence that medical (imaging) radiation may increase cancer risks among other health care workers and that those risks declined during the 20th century as a result of improved radiation safety practices.

With increasing utilization of medical radiation, all health care workers should observe radiation safety practices to minimize risks to both patients and health care workers. Radiotherapeutic advances like intensity-modulated radiation therapy (IMRT), for example, allow escalated radiation dose delivery to tumors while minimizing irradiation of a patient’s healthy, nontarget tissue. However, these advances have come with increased risks when targeting errors occur, such as those caused by patient movement or improper patient setup. IMRT also requires complex three-dimensional (3-D) computed tomography (CT) planning examinations that may frequently involve unnecessarily high radiation doses. Combined with an upward trend in patient radiation doses over recent decades, and improved cancer patient survival times, such considerations raise troubling questions about medically unjustified radiation doses and secondary tumor risks.


The New York Times reported in 2009 and 2010 that serious brachytherapy dosing errors had occurred at the Veterans Affairs Medical Center in Philadelphia, Pennsylvania, and elsewhere.3 The journal Lancet Oncology had similarly warned in 2009 that staffing shortages and linear accelerator miscalibrations and quality control lapses had caused radiation dosing errors affecting thousands of cancer patients worldwide.4

News reports led to renewed calls for interdisciplinary coordination, research, education and effective, evidence-based policy-making and policy implementation to ensure radiation safety in radiation oncology and medical radiology in general.4-8 For patients, unnecessary procedures (usually imaging procedures) and radiation dosing errors represent the bulk of risk from medical radiation, whereas incidental, unintended radiation exposure is the primary concern for nurses and other health care workers……


Radiation doses used in radiation therapy are much higher than doses used in diagnostic radiography; but because radiation poses a stochastic as well as a dose-dependent risk of harm, diagnostic imaging is nevertheless receiving increasing scrutiny as a source of avoidable and therefore unjustified patient irradiation. CT procedures, in particular, can involve radiation doses 100 times those of simple chest radiographs.8

The Food and Drug Administration (FDA) called for hospitals to review safety and calibration protocols for CT scans in 2009 following the discovery that more than 200 patients at a California hospital with suspected stroke were exposed to CT radiation overdoses of up to 800% intended dose.8 More than 80 of those patients experienced radiation skin burns, hair loss, and increased risk of cataract.8 Human error and failure to implement quality assurance protocols were at fault; however, in 2010 and September 2011, the FDA announced new regulations for manufacturers, importers, and hospitals to reduce medical irradiation from CT and nuclear medicine examinations with the goal of eliminating unnecessary scans and ensuring optimization of justified diagnostic imaging.12,13

An estimated 3.6 billion diagnostic radiology procedures are undertaken worldwide every year, and 500 million are conducted in the United States.5 Most diagnostic imaging is medically justified, with overriding benefits for patients. However, up to 37% of abdominal CT scans and 77% of lumbar spine CT scans prescribed at some European facilities for patients younger than 35 years were found to be medically unjustified.14

Medically unnecessary CT scans are prescribed for up to 20 million American adults and 1 million children each year.7 A 2007 analysis concluded that up to 2% of cancers diagnosed in the United States may be attributable to CT examinations.7 The justification of any radiological imaging must always be scrutinized, particularly in pediatric cancer patients, for whom any radiation poses a larger lifetime risk for secondary cancer than for older cancer patients. The availability and sufficiency of alternative imaging modalities that do not involve ionizing radiation, such as magnetic resonance imaging (MRI), should always be considered.5,8 Despite numerous calls for electronic medical records (EMRs) to include cumulative radiation dose information, only a handful of US hospitals and medical groups have adopted such systems to date.



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