ISSN : 0376-4672
Radiographs can help in the diagnosis and treatment planning, but the exposure to ionizing radiation may elevate the risk of developing cancer in a person's lifetime. The objective of this review is to briefly summarize 1) radiation risk, especially cancer risks associated with diagnostic imaging, 2) linear, non-threshold (LNT) hypothesis, 3) the risks of radiation exposure to a fetus, and 4) the campaign of Image Gently. The individual risk of radiation-related cancer from any single medical imaging procedure is extremely small and it is not likely to be cancer risk at doses lower than 100 mGy, but patients may be harmed by avoiding diagnostic imaging due to fear of radiation hazard. Dentists need to understand the radiation doses delivered by various radiographic techniques and the acceptable exposure thresholds to effectively advise the patient and to reduce the unnecessary radiation
1. Brenner DJ, Hall EJ. Computed Tomography-an increasing source of radiation exposure. N Engl J Med. 2007; 357(22): 2277-84.
2. Ron E. Cancer risks from medical radiation. Health Phys. 2003; 85(1): 47-59.
3. Nair RR, Rajan B, Akiba S, Jayalekshmi P, Nair MK, Gangadharan P, Koga T, Morishima H, Nakamura S, Sugahara T. Background radiation and cancer incidence in Kerala, India-Karanagappally cohort study. Health Phys. 2009; 96(1): 55-66.
4. Hendry JH, Simon SL, Wojcik A, Sohrabi M, Burkart W, Cardis E, Laurier D, Tirmarche M, Hayata I. Human exposure to high natural background radiation: what can it teach us about radiation risks? J Radiol Prot. 2009; 29(2A): A29-42.
5. Mettler FA, Jr., Bhargavan M, Faulkner K, Gilley DB, Gray JE, Ibbott GS, Lipoti JA, Mahesh M, McCrohan JL, Stabin MG, Thomadsen BR, Yoshizumi TT. Radiologic and nuclear medicine studies in the United States and worldwide: frequency, radiation dose, and comparison with other radiation sources--1950-2007. Radiology. 2009; 253(2): 520-31.
6 Brenner DJ. Extrapolating radiation-induced cancer risks from low doses to very low doses. Health Phys. 2009; 97(5): 505-9.
7. Preston DL, Ron E, Tokuoka S, Funamoto S, Nishi N, Soda M, Mabuchi K, Kodama K. Solid cancer incidence in atomic bomb survivors: 1958-1998. Radiat Res. 2007; 168(1): 1-64.
8. Balter S, Hopewell JW, Miller DL, Wagner LK, Zelefsky MJ. Fluoroscopically guided interventional procedures: a review of radiation effects on patients' skin and hair. Radiology. 2010; 254(2):326-41.
9 The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP. 2007; 37(2-4): 1-332.
10. Ainsbury EA, Bouffler SD, Dorr W, Graw J, Muirhead CR, Edwards AA, Cooper J. Radiation cataractogenesis: a review of recent studies. Radiat Res. 2009; 172(1): 1-9.
11 Epstein JB, Wong FL, Stevenson-Moore P. Osteoradionecrosis: clinical experience and a proposal for classification. J Oral Maxillofac Surg. 1987; 45(2): 104-10.
12 White SC, Mallya SM. Update on the biological effects of ionizing radiation, relative dose factors and radiation hygiene. Aust Dent J. 2012; 57 Suppl 1: 2-8.
13. Ratnapalan S, Bentur Y, Koren G. "Doctor, will that x-ray harm my unborn child?". CMAJ. 2008;179(12): 1293-6.
14. Linet MS, Slovis TL, Miller DL, Kleinerman R, Lee C, Rajaraman P, Berrington de Gonzalez A. Cancer risks associated with external radiation from diagnostic imaging procedures. CA Cancer J Clin. 2012; 62(2): 75-100.
15. Preston DL, Kusumi S, Tomonaga M, Izumi S, Ron E, Kuramoto A, Kamada N, Dohy H, Matsuo T, Matsui T, et al. Cancer incidence in atomic bomb survivors. Part III. Leukemia, lymphoma and multiple myeloma, 1950-1987. Radiat Res. 1994;137(2 Suppl): S68-97.
16. Preston DL, Cullings H, Suyama A, Funamoto S, Nishi N, Soda M, Mabuchi K, Kodama K, Kasagi F, Shore RE. Solid cancer incidence in atomic bomb survivors exposed in utero or as young children. J Natl Cancer Inst. 2008; 100(6): 428-36.
17. Verdun FR, Bochud F, Gundinchet F, Aroua A, Schnyder P, Meuli R. Quality initiatives* radiation risk: what you should know to tell your patient. Radiographics. 2008; 28(7): 1807-16.
18. Brenner DJ, Doll R, Goodhead DT, Hall EJ, Land CE, Little JB, Lubin JH, Preston DL, Preston RJ, Puskin JS, Ron E, Sachs RK, Samet JM, Setlow RB, Zaider M. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci U S A. 2003;100(24): 13761-6.
19. Huang L, Kim PM, Nickoloff JA, Morgan WF. Targeted and nontargeted effects of low-dose ionizing radiation on delayed genomic instability in human cells. Cancer Res. 2007; 67(3): 1099-104.
20. Valentin J. Low-dose extrapolation of radiationrelated cancer risk. Ann ICRP. 2005; 35(4): 1-140.
21. Council NR. Health effects of exposure to low levels of ionizing radiation: BEIR V. Washington, DC:National Academy Press. 1990.
22. Preston RJ. Update on linear non-threshold doseresponse model and implications for diagnostic radiology procedures. Health Phys. 2008; 95(5):541-6.
23. Robertson A, Allen J, Laney R, Curnow A. The cellular and molecular carcinogenic effects of radon exposure: a review. Int J Mol Sci. 2013; 14(7):14024-63.
24. Calabrese EJ, Baldwin LA. Hormesis: the doseresponse revolution. Annu Rev Pharmacol Toxicol. 2003; 43: 175-97.
25. Conference of Radiation Control Program Directors. Nationwide Evaluation of X-Ray Trends (NEXT):Tabulation and Graphical Summary of 2000 Survey of Computed Tomography. Frankfort, KY:Conference of Radiation Control Program Directors, Inc.; 2007:154.
26. 대한영상치의학교수협의회. 영상치의학. 제5판. 서울: 나래출판사; 2015
27. Furlow B. Radiation protection in pediatric imaging. Radiol Technol. 2011; 82(5): 421-39.
28. National Research Council. Committee to Assess Health Risks from Exposure to Low Level of Ionizing Radiation. Health risks from exposure to low levels of ionizing radiation: BEIR VII Phase 2. Washington, DC: National Academies Press; 2006
29. International Commission on Radiological P. Pregnancy and medical radiation. Ann ICRP. 2000;30(1): iii-viii, 1-43.
30. Brent RL. Developmental Risks of Radiological Procedures Utilizing Ionizing Radiation During Pregnancy. In: Radiation Protection in Medicine:Contemporary Issues Proceedings of the Thirty-Fifth Annual Meeting of the National Council on Radiation Protection and Measurements. Arlington:NCRP; 1999.
31. Lidskog R. Scientised citizens and democratised science. Re-assessing the expert-lay divide. Journal of Risk Research. 2008; 11: 69-86.
32. Rabinovich A, Morton TA. Unquestioned answers or unanswered questions: beliefs about science guide responses to uncertainty in climate change risk communication. Risk Anal. 2012; 32(6): 992-1002.
33. White SC, Scarfe WC, Schulze RK, Lurie AG, Douglass JM, Farman AG, Law CS, Levin MD, Sauer RA, Valachovic RW, Zeller GG, Goske MJ. The Image Gently in Dentistry campaign:promotion of responsible use of maxillofacial radiology in dentistry for children. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014; 118(3): 257-61.
34. Memon A, Godward S, Williams D, Siddique I, Al-Saleh K. Dental x-rays and the risk of thyroid cancer: a case-control study. Acta Oncol. 2010;49(4): 447-53.
35. National Health and Medical Research Council. Code of practice for radiation protection in dentistry. Canberra: Australian Government Publishing Service.
36. National Radiological Protection Board. Guidelines on radiology standards for primary dental care. London: National Radiological Protection Board N.
37. 이세민, 김영욱. 과학 커뮤니케이션 담론 변화에따른 참여자 간 상호지향성 연구: 원자력 위험커뮤니케이션에 대한 일반인과 전문가의 인식 비교. 한국언론학부. 2012; 56: 31-57.
38. 김창규. 대학생들의 방사선에 대한 인식도. 한국융합학회논문지. 2012; 3(11): 27-42.
