When I started out as an EM trainee, having dated a radiographer I was very cognisant of the radiation penalties from medical imaging as well as the associated risks of developing a new malignancy. Over time my conscientiousness in requesting radiology has waned.
My individual threshold for imaging remains relatively high, especially in circumstances where validated clinical decision instruments determine further work-up to be unnecessary. Nevertheless, arguing the toss over imaging vs not imaging with other teams (who will likely ultimately be responsible for the patient’s care) becomes intellectually frustrating. It is usually easier to facilitate care by ordering a scan and saving one’s energy for something else. Like stroke care. No wait…. forget that one too.
In equivocal cases, appealing to the attendant radiation penalty of a study may encourage deferment in favour of clinical observation. I put together this infographic to help facilitate such a conversation, and to help me quantify radiation dose and risk of malignancy in preparation for my fellowship exam.
Another way to look at it: if you’ve spent a metaphorical $20,000 worth of medical radiation you’ve probably given someone cancer. And made a radiologist wealthy. Let’s budget our radiation wisely.
P.S. If you’re prepared to pay with personal time to study and scan, ultrasound is free 🙂