Mammograms, CT scans, X-rays: Assessing the risk of all that radiation


An X-ray for knee pain. A CT scan for a head injury. Mammograms every other year, starting at age 50. Over a typical lifetime of radiation exposure from medical tests, a person can start to wonder: How much is too much?

There’s no formula for answering that, experts say, in part because the health effects of radiation don’t add up in a linear way. And while massive doses of radiation are known to be harmful, the small doses used in routine tests are usually safe, especially compared with other health-care choices people make without thinking twice.

“Radiation does have some risk,” says Russ Ritenour, a medical physicist at the Medical University of South Carolina in Charleston. “But it is important for medicine. And in most cases, the risk is quite small compared to the risk of taking too much Advil over your life and other things like that.”

Ionizing radiation – the type that can damage cells – is a daily fact of life even for people who never go to the doctor. Rocks and soil contain radioactive materials, which also appear in our food, our bones and the air we breathe. Cosmic rays barrage us with radiation from space, with higher doses at altitude and on airplanes.

Overall, a person in the United States gets an annual average of about 3 millisieverts (mSv) of background radiation. (Millisieverts are units that measure radiation absorbed by our bodies.)

Added exposure, totaling another 3 mSV each year for the average American, comes from such man-made sources as power plants that run on coal and nuclear fuel, and consumer products including TVs and computer screens. But most of the extra radiation we get comes from X-rays and CT scans, Ritenour says.

Most routine diagnostic tests emit extremely small amounts of radiation. A patient will get about 0.001 mSv from an arm X-ray, 0.01 mSv from a from a panoramic dental X-ray, 0.1 mSv from a chest X-ray and 0.4 mSv from a mammogram, according to Harvard Medical School. (Those estimates vary somewhat, depending on the source and on the specific device used, the size of the patient and other factors.)

CT scans, which take multiple X-rays to create cross-sectional images, deliver higher doses: 7 mSv for a chest CT, and 12 mSV for a full-body scan, according to the National Cancer Institute. Studies have found doses of 25 mSv or more from a PET/CT, an imaging test that requires ingesting a radioactive substance.

With the increasing availability and affordability of imaging technologies, people are getting more tests than they used to. Today, Americans receive more than 85 million CT scans each year, compared with 3 million per year in the 1980s.

Many of those tests may be excessive, argue some researchers, who have been trying to quantify the risks of our increasing use of ionizing radiation in medical imaging. A 2009 study by scientists at the National Cancer Institute estimated that 2 percent – or about 29,000 – of the 1.7 million cancers diagnosed in the United States in 2007 were caused by CT scans. In a 2004 study, researchers estimated that a 45-year-old who planned to get 30 annual full-body CT exams would have a nearly 2 percent lifetime risk of dying of cancer. Other studies are underway to clarify risks, including in children.

But evaluating an individual’s chances of experiencing a bad outcome from any given test or a combination of tests is tricky. Some of the most definitive data on radiation’s health effects come from long-term studies of tens of thousands of people who survived the atomic bombings of Hiroshima and Nagasaki in 1945. Sudden exposure to 1,000 mSv, those studies have found, increased the risk of getting cancer by 42 percent and increased the risk of dying of cancer by 5 percent.

Risks of secondary cancers also rise with the high doses of radiation used in some cancer treatment – a trade-off that often makes sense because doing nothing would be even riskier.

Evidence is murkier about health consequences from lower doses. The Food and Drug Administration estimates that 10 mSv of radiation, an amount typical for a CT of the abdomen, increases lifetime cancer risk by 1 in 2,000. But that calculation assumes that risks are proportional to dose, which has not been proved. Below 10 mSv, there is not enough good data to draw clear conclusions.

There is also no absolute number of scans that constitute a tipping point for health, Ritenour says, in part because our bodies have repair mechanisms that can fix cells damaged by radiation. So while every scan adds to the chances that a problem will occur, radiation doesn’t build up in the body. And damage doesn’t accumulate like water poured into a glass. Theoretically, he adds, 10 mammograms in one day would be riskier than one mammogram a year for 10 years.

“All you can really say is that there’s very little chance a problem can happen” at low doses, says Ritenour, who often consults with patients who have questions about radiation. “It is very unsatisfying in a way. You can’t say, ‘You will definitely have no problems.’ ”

Although health risks from most imaging tests are extremely small, fear can be hard for people to rationalize away. There is a one-in-a-million chance of getting cancer from a chest X-ray, Ritenour says, the same tiny chance of getting cancer from toxins in peanut butter.

Making decisions about diagnostic tests ultimately requires comparing their potential benefits with their potential harms. That balance can be easy to measure if someone has a broken leg or a bullet fragment lodged in their body. But decisions become more nuanced for tests such as mammograms, which catch breast cancers in some women but also produce false alarms that cause unnecessary anxiety and follow-up testing that entails even more radiation. Given the trade-offs, the U.S. Preventive Services Task Force offers evidenced-based advice about many screening tests, and those guidelines can be helpful starting points for conversations with your doctor.

Online calculators can also offer food for thought. When I entered my location, estimated miles traveled by airplane and other information into a tool maintained by the Nuclear Regulatory Commission , I learned that I absorb an estimated 318 millirems, or 3.18 mSv, of radiation each year. Each millirem, according to this government agency, equates to a 1.2-minute reduction in life span, the same accrued from eating 10 extra calories (assuming I’m overweight) or crossing the street three times. In other words, I am likely to die 4 1/2 hours sooner than I would if I could avoid radiation altogether.

While some researchers work to better understand and communicate the risks of radiation, others are refining technologies and procedures, adds Louis Wagner, a diagnostic medical physicist at McGovern Medical School at the University of Texas Health Science Center at Houston. And the field has come a long way.

For example, after studies found an elevated risk of breast cancer among women who had received X-rays for childhood scoliosis, experts say, many health centers switched from taking images from the front of the body to taking images from behind to reduce the cancer risk.

Technicians have made mistakes, such as using higher doses of radiation than needed during scans, and some mistakes have led to expensive legal cases, Wagner says. But those cases are rare. And most machines are now equipped with safety features to avoid overexposure.

“The profession has sought to make use of radiation very, very beneficial to patients with minimal and, I believe, unrecognizable risks,” Wagner says. “I want patients to know the medical profession is avidly pursuing better ways to use radiation to increase the benefits-to-risks ratio. I think good progress is being made.”

Uber, Lyft and the Urgency of Saving Money on Ambulances

‘Don’t reflexively call an ambulance,’ a Harvard researcher says. In many cases, a cheaper way makes sense.

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An ambulance ride of just a few miles can cost thousands of dollars, and a lot of it may not be covered by insurance. With ride-hailing services like Uber or Lyft far cheaper and now available within minutes in many areas, would using one instead be a good idea?

Perhaps surprisingly, the answer in many cases is yes.

The high cost of an ambulance isn’t really for the ride. It comes with emergency medical staff and equipment, and those can be very important, of course, even lifesaving.

But they are not things you always need, although you (and your insurer) pay for them with every trip.

“Don’t reflexively call an ambulance,” said Anupam Jena, a physician and researcher with the Harvard Medical School. “Ambulances are for emergencies. If you’re not having one, it’s reasonable to consider another form of transportation.”


Pathologists shortage ‘delaying cancer diagnosis’

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Patients are facing delays in diagnosis because of severe shortages among pathology staff, according to a report seen by the BBC.

A survey by the Royal College of Pathologists found only 3% of the NHS histopathology departments that responded had enough staff.

Histopathologists are doctors and scientists who diagnose and study diseases such as cancer.

Hundreds more pathologists are now working in the NHS, health chiefs said.

‘Staffing gaps’

The new report by the Royal College of Pathologists says that demand for pathology services has grown significantly in recent years, but staffing has not increased at the same rate.

It carried out a workforce survey of histopathology departments throughout the UK in 2017.

Of the 158 departments, 103 responded.

Only 3% said they had enough staff to meet current clinical demand.

And 45% of departments had to outsource work while half of departments were forced to use locums.

“The cost of staff shortages across histopathology departments is high for both patients and for our health services.

“For patients, it means worrying delays in diagnosis and treatment,” said Prof Jo Martin, president of the Royal College of Pathologists.

“We estimate the cost of locums and outsourcing work is £27m each year across the UK health service, money that could be better invested in staff and new diagnostic equipment” she added.


Hidden From View: The Astonishingly High Administrative Costs of U.S. Health Care

It takes only a glance at a hospital bill or at the myriad choices you may have for health care coverage to get a sense of the bewildering complexity of health care financing in the United States. That complexity doesn’t just exact a cognitive cost. It also comes with administrative costs that are largely hidden from view but that we all pay.

Because they’re not directly related to patient care, we rarely think about administrative costs. They’re high.

A widely cited study published in The New England Journal of Medicine used data from 1999 to estimate that about 30 percent of American health care expenditures were the result of administration, about twice what it is in Canada. If the figures hold today, they mean that out of the average of about $19,000 that U.S. workers and their employers pay for family coverage each year, $5,700 goes toward administrative costs.

Such costs aren’t all bad. Some are tied up in things we may want, such as creating a quality improvement program. Others are for things we may dislike — for example, figuring out which of our claims to accept or reject or sending us bills. Others are just necessary, like processing payments; hiring and managing doctors and other employees; or maintaining information systems.

That New England Journal of Medicine study is still the only one on administrative costs that encompasses the entire health system. Many other more recent studies examine important portions of it, however. The story remains the same: Like the overall cost of the U.S. health system, its administrative cost alone is No. 1 in the world.


Using data from 2010 and 2011, one study, published in Health Affairs, compared hospital administrative costs in the United States with those in seven other places: Canada, England, Scotland, Wales, France, Germany and the Netherlands.

At just over 25 percent of total spending on hospital care (or 1.4 percent of total United States economic output), American hospital administrative costs exceed those of all the other places. The Netherlands was second in hospital administrative costs: almost 20 percent of hospital spending and 0.8 percent of that country’s G.D.P.

At the low end were Canada and Scotland, which both spend about 12 percent of hospital expenditures on administration, or about half a percent of G.D.P.

Hospitals are not the only source of high administrative spending in the United States. Physician practices also devote a large proportion of revenue to administration. By one estimate, for every 10 physicians providing care, almost seven additional people are engaged in billing-related activities.

It is no surprise then that a majority of American doctors say that generating bills and collecting payments is a major problem. Canadian practices spend only 27 percent of what U.S. ones do on dealing with payers like Medicare or private insurers.

Another study in Health Affairs surveyed physicians and physician practice administrators about billing tasks. It found that doctors spend about three hours per week dealing with billing-related matters. For each doctor, a further 19 hours per week are spent by medical support workers. And 36 hours per week of administrators’ time is consumed in this way. Added together, this time costs an additional $68,000 per year per physician (in 2006). Because these are administrative costs, that’s above and beyond the cost associated with direct provision of medical care.

In JAMA, scholars from Harvard and Duke examined the billing-related costs in an academic medical center. Their study essentially followed bills through the system to see how much time different types of medical workers spent in generating and processing them.

At the low end, such activities accounted for only 3 percent of revenue for surgical procedures, perhaps because surgery is itself so expensive. At the high end, 25 percent of emergency department visit revenue went toward billing costs. Primary care visits were in the middle, with billing functions accounting for 15 percent of revenue, or about $100,000 per year per primary care provider.

“The extraordinary costs we see are not because of administrative slack or because health care leaders don’t try to economize,” said Kevin Schulman, a co-author of the study and a professor of medicine at Duke. “The high administrative costs are functions of the system’s complexity.”

Costs related to billing appear to be growing. A literature review by Elsa Pearson, a policy analyst with the Boston University School of Public Health, found that in 2009 they accounted for about 14 percent of total health expenditures. By 2012, the figure was closer to 17 percent.

One obvious source of complexity of the American health system is its multiplicity of payers. A typical hospital has to contend not just with several public health programs, like Medicare and Medicaid, but also with many private insurers, each with its own set of procedures and forms (whether electronic or paper) for billing and collecting payment. By one estimate, 80 percent of the billing-related costs in the United States are because of contending with this added complexity.

Read More:

Why Your Brain Tricks You Into Doing Less Important Tasks Yet again, your brain is working against you, and it’s because of a phenomenon called the urgency effect.

Here’s a list of things I did before starting this newsletter: I filled out the documents to renew my passport; clipped my cat’s nails; bought some household items; responded to a few Instagram DMs; and ate a snack because I was hungry.

Sound familiar?

Some of those tasks were relatively urgent — I need to get my passport in order soon, and those Instagram DMs were weighing on me. But none of those tasks were as important as writing this newsletter. I know I needed to get this done, but the call of those minor-yet-urgent tasks was too strong.


To all of my procrastinators out there, I offer an explanation: Your brain is working against you, and it’s because of a phenomenon called the urgency effect.Our brains tend to prioritize immediate satisfaction over long-term rewards (you probably remember this from the famous marshmallow experiment). But a study from February found that subjects were more likely to perform smaller-but-urgent tasks that had a deadline than they were to perform more important tasks without one. This was true even if the outcome of the smaller task was objectively worse than that of the larger one.“Normatively speaking,” the researchers wrote, “people may choose to perform urgent tasks with short completion windows, instead of important tasks with larger outcomes, because important tasks are more difficult and further away from goal completion, urgent tasks involve more immediate and certain payoffs, or people want to finish the urgent tasks first and then work on important tasks later.”

In other words: Even if we know a larger, less-urgent task is vastly more consequential, we will instinctively choose to do a smaller, urgent task anyway. Yet again, thanks for nothing, brain.

So what are we to do? To answer that, let’s talk about boxes — specifically, one developed by our 34th president, Dwight D. Eisenhower.

Picture a 2×2 square with four boxes. At the top of the square are two labels: Urgent and non-urgent. On the left are two other labels: Importantand not important.On any given day, try to put every task you have to do into one of those four boxes. You’ll quickly see that the things tied to approaching deadlines are quite often not the most important things you have on your plate. Accordingly, schedule time to finish them later or, if possible, delegate them.

Similarly, it’s very likely you’ll wind up with tasks that don’t have a deadline and aren’t important. Immediately and aggressively remove them from your to-do list.

Two crucial bits I’ll leave you with:

The Senate’s Unaffordable Care Act

aidspicIt would be a big mistake to call the legislation Senate Republicans released on Thursday a health care bill. It is, plain and simple, a plan to cut taxes for the wealthy by destroying critical federal programs that help provide health care to tens of millions of people.

The Senate majority leader, Mitch McConnell, and other Republicans have pitched the bill as a fix for the Affordable Care Act, or Obamacare. But their true ambition is not to reform Obamacare, which, whatever its shortcomings, has given 20 million Americans access to health insurance. If passed in its current form, the Senate bill would greatly weaken Medicaid, the federal-state program that provides insurance to nearly 69 million people, more than any other government or private program. It would do this by gradually but inexorably shifting more of the financial burden of Medicaid to states, in effect, forcing them to cover fewer people and to provide fewer services. Over all, the Senate would reduce federal spending by about $1 trillion over 10 years and use almost that much to cut taxes for rich families and health care companies.

In the days ahead, while the Congressional Budget Office totes up the bill’s cost, and before a floor vote, some Republicans, President Trump included, might be tempted to see the Senate bill as an improvement over the draconian House measure passed in May that would take insurance away from 23 million people. Mr. Trump previously expressed the hope that the Senate version would be less brutal. It isn’t. True, Mr. McConnell and his colleagues have made a few superficial improvements; the rollback of Obamacare’s intended expansion of Medicaid would proceed more slowly than under the House’s timetable. But the long-term damage might be worse. That is because the Senate bill would cap federal spending on Medicaid on a per-person basis. Currently, federal spending varies from year to year based on demand for medical services and the cost of care. Starting in 2025, the cap would be allowed to increase at the rate of inflation in the economy. But the overall inflation rate has typically been much lower than the inflation rate for medical services; in 2016, the overall inflation rate was 1.3 percent, whereas medical costs increased by 3.8 percent. Over time, this would means states will get a lot less money than they do under current law. The inevitable shrinkage in Medicaid will be particularly devastating to older Americans. Contrary to what many people think, the program does not just benefit the poor. Many middle-class seniors depend on it after they have exhausted their savings. Medicaid pays for two-thirds of the people in nursing homes. The disabled and parents who have children with learning disabilities also rely on Medicaid. The program covers nearly half of all births in the country. And in recent years, it has played a very important role in dealing with the opioid epidemic, especially in states like Kentucky, Massachusetts, Maryland, Ohio and West Virginia. Medicaid pays between 35 percent and 50 percent of the cost of medication-assisted addiction treatment, according to two professors, one from Harvard and one from New York University.

Like its House counterpart, the Senate bill would also hurt millions of non-Medicaid beneficiaries of Obamacare, those who buy insurance on federal and state marketplaces. It would greatly reduce federal subsidies that help low-income and middle-income families buy health coverage, while allowing insurers to increase deductibles, forcing people to pay more for medical services. It would let states waive rules that now require insurers to cover essential health services like maternity care, cancer treatment and mental health care, which is likely to happen because this will be the only way that states can lower premiums. In sum, it will make health insurance more expensive and less useful, to the great misfortune of the poor, elderly and sick.

Mr. McConnell seems determined to steamroll this travesty through the Senate before July 4, despite complaints by conservatives and moderates. Expect him and his colleagues to try to buy support of wavering lawmakers by offering sweeteners like a few billion dollars for addiction treatment and some extra cash for states with high medical costs. Republican senators like Susan Collins of Maine, Lisa Murkowski of Alaska, Shelley Moore Capito of West Virginia, Rob Portman of Ohio and Dean Heller of Nevada ought not to fall for these cheap gimmicks. Instead, they should vote no on a bill that will take a devastating toll on millions of Americans and that no amount of tinkering around the edges can make better.

News Headlines 02.28.13

Health law’s rules help hospitals cut patient readmission rate 
The law includes both penalties and incentives for better coordinating care for patients after they head home. 
( by N.C. Aizenman , The Washington Post) 

ICE release of illegal immigrants sparks political firestorm in Arizona 
Politicized controversy surrounds release of illegal immigrants from federal custody. 
( by Pamela Constable , The Washington Post) 
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House hearing looks at limits on government travel. Spending drops, but so could needed collaboration. 
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Millionaire’s Mars mission: To inspire the children (and to beat China there) 
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Prudence Bushnell on being a diplomat 
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Montgomery police canvass for information on fatal crash 
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Large families crowd D.C. shelters 
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( by Annie Gowen , The Washington Post) 
6 teens indicted on murder charges in Woodley Park Metro stabbing 
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Alexandria police officer shot and wounded in Old Town 
Police said the officer is in serious condition. 
( by Allison Klein and Michael Alison Chandler , The Washington Post)
Metro’s deputy GM leaving 
In coming weeks, David Kubicek, who oversees rail operations, will be one of two high-level departures. 
( by Dana Hedgpeth , The Washington Post) 
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House to vote on Violence Against Women Act measures 
Republican leaders are prepared to allow a vote on a version favored by Democrats, pointing to GOP division. 
( by Rosalind S. Helderman , The Washington Post) 

In the Loop: A multilingual secretary 

Secretary of State John Kerry speaks French to the French, German to the Germans, and on it goes… 
(, The Washington Post) 

Michael A. Brown tries to rebound from loss of D.C. Council seat 
Michael A. Brown says he has been cleared by a federal investigation into missing campaign funds. 
( by Tim Craig , The Washington Post) 
Sequester spin gets ahead of reality 
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( by Karen Tumulty and Lyndsey Layton , The Washington Post) 
Authorities say U-Md. shooter admitted self for treatment 
Governor’s gun-control bill would not have stopped subsequent gun purchases. 
( by Aaron C. Davis and Matt Zapotosky , The Washington Post) 
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Jimmy Kimmel and Morrissey feud over ‘Duck Dynasty’ 
The singer canceled an appearance on the late-night show. 
(, The Washington Post) 
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Newspapers face death threats over requests for public records on gun owners. 
( by Paul Farhi , The Washington Post) 
100 years later, activists will march in tradition of Inez Milholland 
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( by Lonnae O’Neal Parker , The Washington Post) 
Hot-bar leftovers: To trash or not to trash? 
Supermarket chains take different approaches to the food the remains on their hot bars. 
( by Tim Carman , The Washington Post) 
Carolyn Hax: Husband is walking the line between caring and badgering 
He says that he cares about her health, but she says that he makes her feel like crud. 
(, The Washington Post) 

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Survey finds gap in Internet access between rich, poor students 
Vast majority of teachers rely on social media and other digital resources, Pew study says. 
( by Cecilia Kang , The Washington Post) 
Supreme Court defines SEC time limits for pursuing civil cases 
Court says the clock starts ticking when the violation takes place, not when it’s discovered. 
( by Dina ElBoghdady , The Washington Post) 
Senate confirms Lew as Treasury secretary 
Jack Lew gets Senate green light in a 71-26 vote just as economy faces potentially severe budget cuts. 
( by Jia Lynn Yang , The Washington Post) 
JPMorgan layoffs reflect some hope 
Many of the employees the nation’s largest bank is letting go were hired to deal with mortgages in default. 
( by Danielle Douglas , The Washington Post) 
conomic crisis ‘balkanized’ global finance 
Study documents continued collapse in global finance, pushing world system back by decades. 
( by Howard Schneider , The Washington Post) 

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Terrapins suffer a damaging loss 
U-Md. falls to 1-6 on the road in the ACC and may need a deep run in the conference tournament to impress the NCAA selection committee. 
( by Alex Prewitt , The Washington Post) 
Vikings advance to 4A West final 
Whitman tops Walter Johnson, 49-42, to set up a region final matchup with Gaithersburg on Friday night. 
( by Roman Stubbs , The Washington Post) 
Capitals bullied, trounced by Flyers 
Starting goaltender Braden Holtby is chased in the second period after allowing four goals on 18 shots and Washington provides hardly any punch in a loss to Philadelphia. 
( by Katie Carrera , The Washington Post) 
Porter’s better half vaults Hoyas 
Otto Porter Jr. scores 21 of his 22 points after halftime, including the game-winner with 9.5 seconds to go in double overtime, as 7th-ranked Georgetown secures a 10th straight victory. 
( by Liz Clarke , The Washington Post) 
Jaguars dump Bowie to advance to region final 
De’Janae Boykin finishes with 18 points and 14 rebounds as No. 18 C.H. Flowers drops No. 17 Bowie to reach the Maryland 4A South final. 
( by Eric Detweiler , The Washington Post) 

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Survey finds gap in Internet access between rich, poor students 
Vast majority of teachers rely on social media and other digital resources, Pew study says. 
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Set up network security standards for the BYOD era now 
Tips for protecting your business in a bring-your-own-device world. 
( by Steve King | , 

Samsung launches its own wallet app 
Like Apple’s Passbook, this mobile payment service gives users a digital place for their coupons and tickets. 
( by Hayley Tsukayama , The Washington Post) 
What to expect from the Apple shareholders meeting 
Apple likely won’t be discussing a controversial proposal that landed the company in court. 
( by Hayley Tsukayama , The Washington Post) 
Why First Solar’s new world record for solar cell efficiency is important 
First Solar announced on Tuesday that it’s managed to create a record 18.7 percent solar cell, up from the 17.3 percent cell it touted in July 2011. Here’s why this is a big deal. 
( by Ucilia Wang | ,

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After pope’s farewell message, the main event begins: The conclave 
Attention quickly shifts to conclave — and the important matter of timing. 
( by Jason Horowitz , The Washington Post) 
Envoys agree to hold more nuclear talks amid positive signals from Iran 
Iran hails possible “turning point” as negotiations with bloc of six world powers yield modest progress. 
( by Joby Warrick and Jason Rezaian , The Washington Post) 
Kerry: U.S. must help counter aid to Syria opposition from extremists 
The U.S. is preparing a package of broader financial and practical support for the Syrian rebels. 
( by Anne Gearan , The Washington Post) 
Japanese warn against Chinese smog 
Residents will be urged to stay indoors if the level of toxic smog from China gets too high. 
( by Michiyo Nakamoto | Financial Times , The Washington Post) 
Hagel pledges straight talk, loyalty to troops on first day at Pentagon 
The new defense secretary praises the military and says the agency will cope with the looming budget cuts. 
( by Craig Whitlock , The Washington Post) 
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Ending dysfunction central 
Republicans need to act responsibly and replace the sequester. 
(, The Washington Post) 
Golden goose eggs 
After 100 years, the Federal Reserve’s record on preventing recessions is stuck on zero. 
(, The Washington Post) 
The China challenge 
The U.S. has no choice but to work with China and all its insecurities. 
(, The Washington Post) 
How much time are we really losing in traffic? 
(, The Washington Post) 

The only way to cut the budget? 
(, The Washington Post) 

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Web Hostess Live: The latest from the Web 
Web Hostess Monica Hesse sifts the Internet so you don’t have to, searching for meaning, manners and the next great meme. 
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