Radiation exposure during lung cancer diagnostic work-up: how important in the wider picture?

The paper by Rintoul et al 1 has highlighted the radiation burden for patients undergoing imaging investigations for lung cancer and calculated the lifetime attributable risk of developing a further malignancy as a result of that radiation exposure. Patients who underwent curative-intent surgery or radical (chemo)radiotherapy received an average radiation dose of approximately 28 mSv in their work-up. As might be expected, those patients with more advanced disease, in whom radical treatment was not possible and underwent best supportive care, received approximately half the radiation dose (approximately 15 mSv). Using standard conversion factors, the authors have derived the lifetime risk of developing a second cancer as a consequence of the radiation exposure as approximately 1:1700 for all cancers and 1:5000 specifically for lung cancer in patients undergoing curative-intent surgery or radical (chemo)radiotherapy. It is important for the physician, radiologist and, of course, the patient to determine whether this risk is acceptable by evaluating the benefits gained from the diagnostic imaging undertaken and putting that risk into context of other causes of morbidity and mortality that the patient might suffer. Accurate staging is essential to identify those patients with resectable, potentially curable disease but equally to avoid undertaking …