Radiation and Cancer Risk

New research on the cancer risk of low-dose ionizing radiation could have disturbing implications for those who are exposed to radiation on the job – including medical professionals. In a new study in BMJ, researchers found that nuclear workers exposed to occupational levels of radiation had a cancer mortality risk that was higher than previously estimated.

The link between low-dose radiation and cancer has long been controversial. Most studies on the radiation-cancer connection are based on Japanese atomic bomb survivors, many of whom were exposed to far higher levels of radiation than most people receive over their lifetimes – even those who work with ionizing radiation. 

The question is whether that data can be extrapolated to people exposed to much lower levels of radiation, such as nuclear workers, medical professionals, or even patients. To that end, researchers in the International Nuclear Workers Study (INWORKS) have been tracking low-dose radiation exposure and its connection to mortality in nearly 310k people in France, the UK, and the US who worked in the nuclear industry from 1944 to 2016.

INWORKS researchers previously published studies showing low-dose radiation exposure to be carcinogenic, but the new findings in BMJ offer an even stronger link. For the study, researchers tracked radiation exposure based on dosimetry badges worn by the workers and then rates of cancer mortality, and calculated rates of death from solid cancer based on their exposure levels, finding: 

  • Mortality risk was higher for solid cancers, at 52% per 1 Gy of exposure
  • Individuals who received the occupational radiation limit of 20 mSv per year would have a 5.2% increased solid cancer mortality rate over five years
  • There was a linear association between low-dose radiation exposure and cancer mortality, meaning that cancer mortality risk was also found at lower levels of exposure 
  • The dose-response association seen the study was even higher than in studies of atomic bomb survivors (52% vs. 32%)

The Takeaway

Even though the INWORKS study was conducted on nuclear workers rather than medical professionals, the findings could have implications for those who might be exposed to medical radiation, such as interventional radiologists and radiologic technologists. The study will undoubtedly be examined by radiation protection organizations and government regulators; the question is whether it leads to any changes in rules on occupational radiation exposure.

Radiology in 2040

A new Radiology Journal editorial shared a radical vision for how the specialty will operate in 2040, warning that “seismic” changes will require radiologists to overhaul their roles in order to thrive, or even stay relevant.

Here’s what the authors expect:

Super Reporting – Radiology reporting will become far more automatic and dynamic, as reports embrace multimedia formats, become far more accessible and patient-friendly, and integrate into automatic follow-up systems.

Disease Focus – The growth of at-home care and the emergence of mobile and self-examination imaging technologies will force radiology workflows to become organized by diseases, rather than by patients’ “location” (ED, ICU, etc.).

Inevitable AI – “AI will not replace radiology,” but it will “profoundly affect [radiologists’] relevance and workflow” as algorithms become more comprehensive, autonomous, and accurate.

The AI Threat – AI will eliminate many current radiologist tasks, but its greatest threat to radiology would come from referring physicians using imaging AI independently. 

Multi-Diagnostics – The rise of non–imaging precision diagnostics (ie, “liquid biopsies”) and multimodal/multiomic diagnostics will reduce imaging’s role in disease detection, and lead to a more-integrated diagnostic and treatment planning process.

Future Therapy – Major advances in precision imaging, image-guided technology, and theranostics would allow radiology to increase its clinical value by owning image-related procedures.

Those are some major changes, and would require radiologists to take similarly major actions in order to thrive in 2040 and beyond:

  • Understand that image interpretation will become a commodity, and maybe “obsolete”
  • Maintain a “laser-sharp” focus on adding value across the healthcare continuum 
  • Actively embrace radiologists’ role as AI’s primary users, owners, and managers
  • “Extensively cultivate” radiology’s interventional and theranostics capabilities

The Takeaway
It’s impossible to accurately predict how medicine will evolve over the next two decades, and there’s surely plenty of readers who are growing tired of obsolescence warnings.

That said, the authors are very well-respected and each of their forecasts can be directly linked to today’s emerging trends, suggesting that radiologists who follow their advice might be more likely to “thrive” in 2040 regardless of how the future unfolds.

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