Less than two months into her breast cancer treatment, Alexandra Jn-Charles was called into a new room at SUNY Downstate Medical Center, where two treating physicians, the chief medical officer and an attorney representing the hospital told her that mistakes had been made.
The skin lesions on her chest, they said, had been caused not by her illness but by the machine that was supposed to cure her. The 32-year-old had received nearly 30 radiotherapy sessions, but at this point it didn't really make sense to count them, because a programming error had caused each installment to deliver at least three times the prescribed amount of radiation.
Jn-Charles, who died two and a half years after this meeting in 2005, would eventually come to exemplify the emergence of accidental over-radiation in U.S. hospitals. The worst off have reported skin damage, inexplicable hair loss and ribs buckling beneath their chests—debilitating injuries suffered while undergoing screening or treatment for something that would otherwise kill them. A steep price for survival.
These tragedies go to the core of an issue as pressing as it is uncomfortable to think about: Have advances in technology, improved treatment methods and more comprehensive screening protocols led to systematic, excessive irradiation of patients?
The answer, according to a growing number of health experts, is yes. For example, the CT scan, which has become commonplace in response to rising cancer rates, is itself thought to increase the likelihood that a person develops cancer. The scans deliver several hundred times more radiation than an X-ray—even when guidelines and dosages are followed precisely. "What we do as physicians arguably harms people," James Ehrlich, a clinical associate professor at the University of Colorado and an adviser for Premier Micronutrient Corp., told Newsweek.
A jarring example of that came in 2010, when Walt Bogdanich published an extensive review in The New York Times that listed numerous patients whose lives had been destroyed by mistakes in hospital imaging and radiotherapy. Shortly after the article series went to press, the Food and Drug Administration began to ramp up its efforts to limit excessive exposure, eventually launching its Initiative to Reduce Unnecessary Radiation Exposure From Medical Imaging.
Along with organizations like the American College of Radiology, the FDA now supports a number of so-called dose registries that allow facilities to compare radiation dose indexes to regional and national values. To date, hundreds of facilities across the U.S. have enrolled.
But the FDA's regulatory authority is generally focused on equipment manufacturers, and compliance on the state level is never guaranteed. And even compliant facilities run the risk of over-radiating patients: A 2012 paper by the Institute of Medicine found that medical imaging is one of the leading environmental causes of breast cancer.
Two seemingly intractable issues contribute to this problem. First, radiological technicians and other imaging personnel often have little more than a cursory understanding of the way radiation interacts with the body. "The field of radiation biology is fairly complex.... We don't spend much time learning how radiation affects cells and DNA," Ehrlich explained.
Second, the current public perception of radiation is spotty at best: The average American knows what it does, but not how. So when a radiation injury appears, a patient may have a hard time connecting it back to his or her last hospital visit.
For Heike Daldrup-Link, an associate professor of radiology at the Stanford School of Medicine, the answer is a gradual move to entirely new screening methods. "The best prevention of radiation-induced side effects from radiographic scans is to replace them by radiation-free alternative imaging technologies, such as ultrasound or magnetic resonance imaging," she told Newsweek.
Daldrup-Link and her colleagues made headlines earlier this year with an MRI method that appears to spot all of the tumors with none of the radiation. Rather than radioactive tracers, the new method sends an iron oxide contrast agent through the patient's body. On scans, these nanoparticles allow accurate tumor profiling by highlighting important anatomical landmarks.
"We focused our studies on children and young adults, because these patients are more sensitive to the effects of radiation exposure," Daldrup-Link explained. "And they live long enough to encounter potential secondary cancers."
Once the technique has been fully adapted for clinical application, it could in some areas retire the full-body PET-CT scan, which currently delivers as much radiation as 700 chest X-rays.
Daldrup-Link's proposed safeguard follows in a line of technologies that seek to limit radiation exposure through shielding and other physical protection measures. But some experts believe that to solve our self-radiation problems once and for all, we must add another layer. Ehrlich, for example, is part of a group working on a product dubbed "BioShield"—a new supplement that delivers antioxidants and similar agents known to reinforce the body's own defenses against the genetic damage that excessive radiation induces. In a recent study published in the journal Radiology, the pill was shown to halve the damage of CT scan-grade radiation in human trials.
"What we were able to prove and publish was a 58 percent reduction in double-strand DNA breakage," Ehrlich explained to Newsweek. "It became the first-ever demonstration that a supplement can protect DNA from ionizing radiation."
With a biological layer against radiation, protection would not end at the hospital doors. BioShield is designed to shield users from a range of everyday factors associated with DNA damage. "The area we're trying to address is everything from cell phones to frequent fliers, airline crews, health-care workers, astronauts and those living in close proximity to disaster areas like Fukushima," Ehrlich said.
A push to limit radiation should not be understood as an attempt to end the practice altogether. Both medical imaging and radiotherapy are mainstays of global health care, and their consistent application saves lives every day. What the push should do is keep technologists' eyes open on dosages, promote safety-conscious equipment design and end the American habit of blowing $1 billion on unnecessary brain scans annually.
It may take some time before safety measures like BioShield and the new MRI technique begin to pop up across the health-care landscape. But from the perspective of public health, the real significance of these safeguards may not be their promise to protect but their capacity to educate the public about what they protect against.
Correction: An earlier version of this article said that doses in the attached graphic were measured in sieverts, they were actually measured in millisieverts.