Correspondence (letter to the editor): More Intense Communication is Required

The article on radiation protection in diagnostic radiology constitutes an important scientific contribution. Details of individual dosimetric terms are explained in an exemplary fashion.

All reported risk estimates are based primarily – as mentioned in the article – on the experiences of the nuclear bombs dropped on Japan in World War II. These calculations are bound to be rough estimates as the radiation doses and types at the time were different to those used in diagnostic radiology today.

The reported tables are for orientation purposes, and it should be mentioned that a substantial variation in range exists which is mainly user dependent. The factor 400 for a thoracic computed tomography scan seems high, whereas in abdominal CT, more than 10 mSv can occur, depending on the number of the examined phases (1). Data are missing on catheter investigations (cardiac catheter, percutaneous transluminal coronary angioplasty), image guided treatments (vertebroplasty and kyphoplasty, intraoperative radiology), and modern methods (CT colography, cardiac CT, high resolution CT of the lung). The doses of all these investigations are often not known to referring doctors (2).

Many unpredictable factors exist with regard to the "attributable mortality risk" (3). The absolute numbers may be correct under the given circumstances, but they are suitable merely for comparing exposure practices in the different countries. With regard to potential deaths or malignancies due to radiography, it needs to be kept in mind that investigations using ionizing radiation are usually done on severely ill patients who are often of advanced age.

The authors emphasized the need for intensive communication between referrers and specialists – this is of crucial relevance. Radiation protection should start earlier than in the radiography department! The correct indication with set requirements and radiation-sparing investigation techniques will result in a dose reduction in the individual as well as in the population. "In radiation protection, 1 g of cerebral matter weighs more than 1 tonne of lead" (Felix Wachsmann, 1965).