Low Dose Effects: Benefit or Harm?

Looking for solutions: vision and a call-for-attention for radiation research scientists

Purpose: The concept of benefit-risk assessment has often been propagated for clinical professionals for deciding the radiological exam for the patient. A detailed look into how to use this concept leads to several unanswered questions. The purpose of this article is to bring forth questions which have remained unanswered for several decades. These questions pertain to our inability to provide needed information to physicians for making benefit-risk assessment for deciding a frequent imaging modality like the computed tomography (CT) such as non-applicability of risk estimates to an individual patient, the concept of cumulative risk at low doses, accounting for the time gap between series of CT scans, risk variation with age, gender and disease condition. In the absence of concrete information on these, it becomes essentially benefit assessment rather than benefit-risk. The article also provides a motivation to think that there are a large number of patients getting exposed every year to radiation doses over 100 mSv of effective dose and several tens of mGy of organ doses. This may provide a very large cohort for radiation effect studies. Further, a series of ideas are presented as a vision for future studies. Conclusions: The article emphasizes the need to create a research agenda to deal with day-to-day questions faced in medical practice and provides a call-for-attention. Further, it provides some challenging ideas as outside of the box thinking points that may provide research direction for future years.