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Ionizing radiation is a risk factor for malignancy after prolonged exposure. Evidence from studies conducted following the Chernobyl accident, nuclear tests, environmental radiation pollution, and accidental indoor contamination reveals consistently increased chromosome aberration and micronuclei frequency in those exposed to ionizing radiation. Ionizing radiation is of significant concern in the United States due to the ubiquitous imaging of patients with computerized tomography (CT) and x-rays. Multi-slice CTs are increasingly in use and have expanding indications. Although CT scans are helpful for the clinician in diagnosing, they are not without risks; ionizing radiation is cumulative, and the effects are potentially lifelong. The greater the exposure to ionizing radiation, the greater the risk of malignancy. The cumulative risk of malignancy due to ionizing radiation is higher in children and pregnant women. After completing this course, learners will comprehensively understand ionizing radiation risks, its cumulative nature, and the increased susceptibility in specific patient populations. The interprofessional approach ensures that healthcare professionals collaborate effectively, leading to improved competence in evaluating and mitigating the potential effects of radiation exposure on patient health. Objectives: Determine the adverse long-term effects of ionizing radiation, with an emphasis on at-risk populations. Differentiate the sources of ionizing radiation and how this impacts the treatment of affected patients. Identify the symptoms or signs of malignancy from ionizing radiation. Collaborate with the interprofessional team to reduce the adverse effects of ionizing radiation on patients and radiation workers. Access free multiple choice questions on this topic.

The use of ionizing radiation for therapeutic purposes can be traced back to the work of scientists in the early to late 1900s. While the medical community has embraced and utilized this technology, they have recognized its potential risks. Standard imaging techniques such as x-rays and CT scans use this type of radiation, and it is also used to treat cancer after diagnosis. However, exposure to this type of radiation can have harmful effects on pregnant women and children. It can lead to acute radiation sickness, multi-system syndromes, and genetic abnormalities at the cellular level. Practicing clinicians are making a concerted effort to minimize exposure to ionizing radiation, which is discussed further in this activity. Several regulatory bodies provide guidelines to ensure that the use of ionizing radiation is safe for both individuals and the population as a whole.

The International Commission on Radiological Protection (ICRP) is dedicated to safeguarding people and the environment from the adverse effects of ionizing radiation exposure. This safeguarding involves managing radiation doses effectively, which hinges on a comprehensive grasp of dose quantities. For more than 90 years, the system of radiological protection has evolved to align with scientific advancements in radiation exposure knowledge concurrent with the discovery of radiation imaging modalities. The primary goals are preventing harmful tissue reactions (deterministic effects) by keeping doses to organs and tissues below certain thresholds and managing the likelihood of stochastic effects.[17] The system relies on 3 dose quantities: absorbed, equivalent, and effective. Absorbed dose is the fundamental measure that sets the limits for tissue reaction prevention. Effective dose combines equivalent doses to protect against stochastic effects. The ICRP now considers absorbed dose the most suitable measure for limiting tissue reaction doses, distinguishing them from limits for stochastic effects, which are set in effective dose.[17] Clinicians should strive to decrease ionizing radiation exposure to themselves and their patients, particularly those at risk. One way to decide whether or not a test is needed is to ask oneself, "Will this extra imaging test change the outcome or treatment for the patient?" If yes, the test may be indicated, but radiation-minimizing strategies described above should be employed. If the answer is no, the imaging test is unnecessary.[16]

Clinicians should strive to decrease ionizing radiation exposure to themselves and their patients, particularly those at risk. One way to decide whether or not a test is needed is to ask oneself, "Will this extra imaging test change the outcome or treatment for the patient?" If yes, the test may be indicated, but radiation-minimizing strategies described above should be employed. If the answer is no, the imaging test is unnecessary.[16] With the rise of interventional radiology and the number of procedures under fluoroscopic guidance, the assessment of the attitudes of interventional radiologists toward personal radiation protection and the utilization of radiation protection devices is important. Results from a survey of 504 members of the Society of Interventional Radiology revealed that while many radiologists use radiation safety devices such as lead aprons and thyroid shields, some devices like leaded eyeglasses, ceiling-suspended shields, and rolling shields are less commonly used. Reasons for avoiding specific devices were comfort, ease of use, and availability. The study suggests further investigation into the barriers to device usage and the availability of protective tools in interventional radiology practice.[18] Protocol-based healthcare implementations, such as protocols to decrease the dose of ionizing radiation administered, are a great way to improve outcomes in patient safety and enhance team performance.[5] Current advancements in artificial intelligence, such as machine learning algorithms, enable precise dose optimization and continuous monitoring, decreasing radiation doses to patients and operators during medical procedures.[19]