Radiation Exposure in IR?

[kaleerkalut]

I was wondering if the amount of radiation exposure in IR is concerning to anybody?

I've heard things from others in the field like Ortho Spine when I ask them about Radiation exposure they tell me "sure there is a lot in Ortho Spine, but look at how much IR gets in comparison"?

Just wondering. I mean sure radiation exposure is bad but so are needle sticks. Just curious. Thanks to all who reply.

---

Members don't see this ad.

 

[TUGM]

wear lead... apparently the human body can take 10,000mGys before you start burning/losing hair or something like that

i mean if you decide you wanna sleep in a biplane while it's running for 10 hours... could be bad, otherwise nothing to worry about as long as you take appropriate precautions

 

[shark2000]

Nobody can give you a precise answer. period.

IR doctors don't get cancer left and right. Overall, it seems that their cancer rate is similar to other physicians. The same for needle sticks. The rate of blood borne infections among surgeons is not more than other physicians.

However, the population level studies can not be used for individual risk estimation. To make it clear for you, there are surgeons that got Hep C or HIV from being a surgeon. So on individual basis, their infection is a result of their job, though their job does not increase the risk of being infected in a population basis study.

The same applies to IR with more complexity since cancer is a multifactorial disease and you can not relate a certain cancer to a certain etiology. Overall, radiation is not good. Being an IR may risk your individual cancer risk or may not. It does not increase significantly.

The lifetime risk of cancer is 25% in US. I've heard that some studies show this risk can increase 1-3% by being exposed to radiation.

 

[NWwildcat2013]

Don't mean to necro bump for no reason, but given this was 3 years ago I was wondering if there was any additional data on this?

 

[shark2000]

Nope. It is impossible to do a double blinded randomized controlled trial on this topic. Probably this question will never be answered in our lifetime.

 

[Mad Jack]

There's a few studies out there on cataracts in IR. We don't yet know how effective high molecular weight eye protection is against them, but given that the field is young and cataracts are one of the first things one would see with continual ionizing radiation exposure, it is safe to say there is some risk.

 

[Resident2015]

Radiation in IR and others (cardiology for example) is linked to certain types of cancer. These include brain, blood (leukemia), melanoma, etc. The overall rates remain low, but there are many older IR docs who have had issues due to radiation. Proper protection will cut the risk dramatically but not eliminate it. I don't think anybody really knows the risk of having a cancer say 30 years down the line after occupational exposure. No study like that exists.

 

[NWwildcat2013]

Radiation in IR and others (cardiology for example) is linked to certain types of cancer. These include brain, blood (leukemia), melanoma, etc. The overall rates remain low, but there are many older IR docs who have had issues due to radiation. Proper protection will cut the risk dramatically but not eliminate it. I don't think anybody really knows the risk of having a cancer say 30 years down the line after occupational exposure. No study like that exists.

So is this "link" that you mention purely anecdotal?


Sent from my iPhone using SDN mobile

 

[WellWornLad]

Ask any medical physicist and they'll tell you that your average IR fellow receives on the order of 5 mSv over the course of one year, and attendings (at least at academic centers) significantly less than this.

To put this in perspective, a patient gets approximately 4-8 mSv with a single CT of the abdomen and pelvis, and we all get approximately 2-3 mSv a year just from normal background radiation (depending mostly on what altitude we live at and what the radon concentrations are in our geographic area). Full-time commercial airline pilots and crew probably receive about the same dose per year. An astronaut on the ISS probably receives around 150 mSv per year.

Sieverts, being a measure of equivalent dose, are our best hand-waving way of expressing the likelihood of developing cancer for a given radiation exposure. Even though it is our best guess, it doesn't take into account certain important factors - such as the fact that receiving 5 mSv over a year is likely much less detrimental than receiving it all at once, as the body has much more time to repair any damage. It also doesn't account for lead (dosimeters are worn outside lead shielding), or the fact that we really have no idea what the relationship is between radiation exposure and cancer at doses less than 50 mSv - which is, not coincidentally, the annual limit for exposure in radiation workers. We extrapolate a linear relationship from the data we do have (mostly taken from atomic bomb survivors at Hiroshima and Nagasaki) because it is the most conservative assumption, but it is more than likely that the human body handles low levels of radiation much more efficiently, given that we have been constantly bombarded by cosmic radiation since the earth formed.

Several comments above suggest that IR is a "young field," the implication being that we won't really know until years down the road. Well, fluoroscopy and angio are actually not very new, and if anything the technology, protections, and culture of dosage reduction mean that we probably won't see in our lifetimes the kind of exposures that old-school radiologists were routinely exposed to.

TLDR; it's probably not worth your time worrying about cancer as an IR doc. Cataracts are a different story. So are people who practice bad technique, i.e. not keeping your hands out of the beam.

P.S. that is a pretty typical comment in the OP from ortho on radiation. It is stunning to me that, outside of radiology and radiation oncology, people delivering significant amounts of radiation have little to no education in this stuff. Not to mention the people ordering 10 CT scans in the space of a 2-week admission....

 

[NWwildcat2013]

Ask any medical physicist and they'll tell you that your average IR fellow receives on the order of 5 mSv over the course of one year, and attendings (at least at academic centers) significantly less than this.

To put this in perspective, a patient gets approximately 4-8 mSv with a single CT of the abdomen and pelvis, and we all get approximately 2-3 mSv a year just from normal background radiation (depending mostly on what altitude we live at and what the radon concentrations are in our geographic area). Full-time commercial airline pilots and crew probably receive about the same dose per year. An astronaut on the ISS probably receives around 150 mSv per year.

Sieverts, being a measure of equivalent dose, are our best hand-waving way of expressing the likelihood of developing cancer for a given radiation exposure. Even though it is our best guess, it doesn't take into account certain important factors - such as the fact that receiving 5 mSv over a year is likely much less detrimental than receiving it all at once, as the body has much more time to repair any damage. It also doesn't account for lead (dosimeters are worn outside lead shielding), or the fact that we really have no idea what the relationship is between radiation exposure and cancer at doses less than 50 mSv - which is, not coincidentally, the annual limit for exposure in radiation workers. We extrapolate a linear relationship from the data we do have (mostly taken from atomic bomb survivors at Hiroshima and Nagasaki) because it is the most conservative assumption, but it is more than likely that the human body handles low levels of radiation much more efficiently, given that we have been constantly bombarded by cosmic radiation since the earth formed.

TLDR; it's probably not worth your time worrying about cancer as an IR doc. Cataracts are a different story.

Cataracts are an easy surgery right? I don't know much about them. Never been interested in ophtho.

 

[WellWornLad]

Cataracts are an easy surgery right? I don't know much about them. Never been interested in ophtho.

I don't know much about them either, because eye surgery is gross. But given that cataract centers are typically outpatient facilities, I suspect it beats having a sarcoma.

The annual dose limit specifically to the eye is 150 mSv/year (this is calculated differently from the total body 50 mSv mentioned above, so just having less than 50 mSv total body dose does not mean you can't have > 150 mSv dose to the eye). There has been some push to lower this to 20 mSv/year, which would be very, very hard to achieve for anyone working 100% in IR. In any case, everyone working in IR should wear HMW glasses IMO, residents included.

 

[shark2000]

Ask any medical physicist and they'll tell you that your average IR fellow receives on the order of 5 mSv over the course of one year, and attendings (at least at academic centers) significantly less than this.

To put this in perspective, a patient gets approximately 4-8 mSv with a single CT of the abdomen and pelvis, and we all get approximately 2-3 mSv a year just from normal background radiation (depending mostly on what altitude we live at and what the radon concentrations are in our geographic area). Full-time commercial airline pilots and crew probably receive about the same dose per year. An astronaut on the ISS probably receives around 150 mSv per year.

Sieverts, being a measure of equivalent dose, are our best hand-waving way of expressing the likelihood of developing cancer for a given radiation exposure. Even though it is our best guess, it doesn't take into account certain important factors - such as the fact that receiving 5 mSv over a year is likely much less detrimental than receiving it all at once, as the body has much more time to repair any damage. It also doesn't account for lead (dosimeters are worn outside lead shielding), or the fact that we really have no idea what the relationship is between radiation exposure and cancer at doses less than 50 mSv - which is, not coincidentally, the annual limit for exposure in radiation workers. We extrapolate a linear relationship from the data we do have (mostly taken from atomic bomb survivors at Hiroshima and Nagasaki) because it is the most conservative assumption, but it is more than likely that the human body handles low levels of radiation much more efficiently, given that we have been constantly bombarded by cosmic radiation since the earth formed.

Several comments above suggest that IR is a "young field," the implication being that we won't really know until years down the road. Well, fluoroscopy and angio are actually not very new, and if anything the technology, protections, and culture of dosage reduction mean that we probably won't see in our lifetimes the kind of exposures that old-school radiologists were routinely exposed to.

TLDR; it's probably not worth your time worrying about cancer as an IR doc. Cataracts are a different story. So are people who practice bad technique, i.e. not keeping your hands out of the beam.

P.S. that is a pretty typical comment in the OP from ortho on radiation. It is stunning to me that, outside of radiology and radiation oncology, people delivering significant amounts of radiation have little to no education in this stuff. Not to mention the people ordering 10 CT scans in the space of a 2-week admission....

Since there is not randomized controlled study, it is very hard to give any opinion on this topic. Your conclusion is based on nothing.

 

[WellWornLad]

Since there is not randomized controlled study, it is very hard to give any opinion on this topic. Your conclusion is based on nothing.

Interesting argument. By that logic we're not sure if smoking causes cancer, because no one has ever done an RCT randomizing people to smoking and non-smoking groups for life and compared the cancer rates.

RCTs are the best way we have of studying differences in exposure. The idea that we cannot know anything without doing an RCT is ridiculous. The vast majority of what we accept to be true (in medicine, and in life) is not based on an RCT. If you go back and read my post, I think you'll see that my conclusion is indeed based on something. If you don't agree with that something that is up to you, but I'd be interested to hear what specific points you disagree with.

Personally, I find it helpful to know approximately what sort of exposures I can expect. If I'm worried about the sort of exposures I receive as an IR fellow, then I should also be warning people in Denver to move to a lower city, or consulting airline pilots to find a new line of work. Nothing supports that idea, however, and I try not to fall into the trap of statistical solipsism that is fanatical devotion to the RCT as the sole gateway to all knowledge.

 

[shark2000]

Interesting argument. By that logic we're not sure if smoking causes cancer, because no one has ever done an RCT randomizing people to smoking and non-smoking groups for life and compared the cancer rates.

RCTs are the best way we have of studying differences in exposure. The idea that we cannot know anything without doing an RCT is ridiculous. The vast majority of what we accept to be true (in medicine, and in life) is not based on an RCT. If you go back and read my post, I think you'll see that my conclusion is indeed based on something. If you don't agree with that something that is up to you, but I'd be interested to hear what specific points you disagree with.

Personally, I find it helpful to know approximately what sort of exposures I can expect. If I'm worried about the sort of exposures I receive as an IR fellow, then I should also be warning people in Denver to move to a lower city, or consulting airline pilots to find a new line of work. Nothing supports that idea, however, and I try not to fall into the trap of statistical solipsism that is fanatical devotion to the RCT as the sole gateway to all knowledge.

A good example of a straw man argument.

Your reaction is very defensive and immature. There is not enough evidence that radiation is 100% safe. period. As an IR doc you may or may not have increased risk of developing cancer. Absence of evidence is totally different than evidence of absence.

There is a report of increased risk of head and neck cancers in interventional cardiologist and radiologists disproportionally involving the left hemisphere that is exposed to much more radiation. But again you can not do an RCT. If you don't believe in RCT, then you have to accept the conclusion of the case report that says the risk of head and neck cancers is higher among IC and IR docs.

Bottom line: There may be a higher risk of developing cancer but not enough evidence is available. You can not just say that occupational radiation exposure is 100% safe. Whoever says otherwise is B$ing.

 

[Lostin_space]

A good example of a straw man argument.

Your reaction is very defensive and immature. There is not enough evidence that radiation is 100% safe. period. As an IR doc you may or may not have increased risk of developing cancer. Absence of evidence is totally different than evidence of absence.

There is a report of increased risk of head and neck cancers in interventional cardiologist and radiologists disproportionally involving the left hemisphere that is exposed to much more radiation. But again you can not do an RCT. If you don't believe in RCT, then you have to accept the conclusion of the case report that says the risk of head and neck cancers is higher among IC and IR docs.

Bottom line: There may be a higher risk of developing cancer but not enough evidence is available. You can not just say that occupational radiation exposure is 100% safe. Whoever says otherwise is B$ing.

Unfortunately I was one of those people who developed a head/neck tumor from IR, and had to have surgery to remove it. this was while in Rads residency, one of the reasons I transferred out. Still pissed about it. I wonder if I have a legal case against my program?

 

[DrBowtie]

Unfortunately I was one of those people who developed a head/neck tumor from IR, and had to have surgery to remove it. this was while in Rads residency, one of the reasons I transferred out. Still pissed about it. I wonder if I have a legal case against my program?

If your only exposure was during residency, and the tumor developed during residency, I doubt they are causal given what we know about latency periods.

 

[Lostin_space]

If your only exposure was during residency, and the tumor developed during residency, I doubt they are causal given what we know about latency periods.

I disagree. I have 0 family history of head/neck things, never had issues before, after surgery, transfer, and never coming in contact with radiation again, never had a problem again. They also tried to force me to continue doing fluoro procedures after I resigned because they said that my 60 days of notice was not enough, even though the contract said so, because they did not want me to leave, and tried to repeatedly convince me to say. My PD was like - well the time frame is up to the PD. I was like, umm no, the time frame is based upon the CONTRACT signed. I'm sure a good lawyer would say otherwise. I bet there probably was some issue with the lead. i should request to see if I can get my lead from the hospital. How is that even transported I wonder?

 

[WellWornLad]

A good example of a straw man argument.

Ah, no. If I had implied somehow that the relationship of smoking and cancer was (inversely?) related to occupational radiation exposure, that would be a straw man. Your logic is still flawed, I just provided an analogy to make that clear.

Your reaction is very defensive and immature.

Pot, meet kettle. I've done nothing but address your arguments and you attack my character. I'm particularly curious how you got "immature" out of all that.

There is a report of increased risk of head and neck cancers in interventional cardiologist and radiologists disproportionally involving the left hemisphere that is exposed to much more radiation. But again you can not do an RCT.

I know the report you're speaking about [1], and I'm highly skeptical of it. It is a case series of 30-odd interventionalists. The cases were gathered from around the world - so we have no idea what the denominator is to calculate any meaningful incidence statistics. Cases were solicited, which makes the whole series highly susceptible to recall bias, particularly as cancer is not exactly a rare thing in the general population. 2/3 of the docs were interventional cardiologists, who in my personal opinion do not share the training or culture of dose reduction prevalent in IR, and which is reflected by exposures of 20-30 mSv per year that the author quotes - ridiculously high compared to what is measured in my department.

If you don't believe in RCT, then you have to accept the conclusion of the case report that says the risk of head and neck cancers is higher among IC and IR docs.

False dichotomy, while we're on the subject of fallacies. Also pretty close to a red herring, since I never suggested that I don't "believe" in RCT, whatever that means.

Bottom line: There may be a higher risk of developing cancer but not enough evidence is available. You can not just say that occupational radiation exposure is 100% safe. Whoever says otherwise is B$ing.

There may be a higher incidence of cancer from drinking water from my faucet. Just because there is not enough evidence available doesn't mean I won't drink it. Nothing in life is 100% safe. There may indeed be a risk of increased cancer, but personally I spend more time worrying about heart disease than radiation-induced cancer. I certainly wouldn't let it dictate what I'm going to spend my life doing.

[1] Roguin A. Radiation hazards to interventional cardiologists: A report on increased brain tumors among physicians working in the cath lab. SOLACI 2014; April 23, 2014; Buenos Aires, Argentina.

 

[shark2000]

I know the report you're speaking about [1], and I'm highly skeptical of it. It is a case series of 30-odd interventionalists. The cases were gathered from around the world - so we have no idea what the denominator is to calculate any meaningful incidence statistics. Cases were solicited, which makes the whole series highly susceptible to recall bias, particularly as cancer is not exactly a rare thing in the general population. 2/3 of the docs were interventional cardiologists, who in my personal opinion do not share the training or culture of dose reduction prevalent in IR, and which is reflected by exposures of 20-30 mSv per year that the author quotes - ridiculously high compared to what is measured in my department.

There may be a higher incidence of cancer from drinking water from my faucet. Just because there is not enough evidence available doesn't mean I won't drink it. Nothing in life is 100% safe. There may indeed be a risk of increased cancer, but personally I spend more time worrying about heart disease than radiation-induced cancer. I certainly wouldn't let it dictate what I'm going to spend my life doing.

[1] Roguin A. Radiation hazards to interventional cardiologists: A report on increased brain tumors among physicians working in the cath lab. SOLACI 2014; April 23, 2014; Buenos Aires, Argentina.

But there are no case reports of people getting cancer from drinking wanter from your faucet. There is also no evidence that someone drank 10000 tons of water from your faucet and got cancer (unlike radiation).

As you mentioned, a case report is a case report and you can not make a scientific conclusion out of it. It needs several RCTs which is not doable. This was what I said in the first place. But you jumped in and in your immature way completely dismissed the value of RCTs.

When the discussion is about radiation induced cancer and you talk about heart disease, this is called a straw man argument.

I work with radiation here and then. Most of my exposure is during kypho/vertebroplasty. My opinion is the same. To our knowledge there is a small increase in chance of developing cancer by being chronically exposed to radiation. period. It doesn't mean that driving is 100% safe or the wanter in your faucet is 100% safe (just to address your weird logic).