How Much Radiation Exposure Occurs with a CT Scan? X-ray? Sunlight?

A common concern now is how much radiation exposure occurs with common radiological testing such as x-rays and CT scans, especially given the small increased risk of cancer with accumulated exposure over years.

Of note, ultrasounds and MRI scans do not emit radiation. MRI scans use magnets while ultrasounds use sound waves in order to obtain imaging information.

So, here's a chart comparing such tests with common environmental radiation exposure such as sunlight. Information taken from www.X-RayRisk.com:

Radiation	Amount
Sunlight (high-altitude city)	6 mSv per year
Sunlight (sea-level city)	3.1 mSv per year
Frequent Flyer	1 - 6.7 mSv
Single Airflight coast-to-coast	0.01 - 0.03 mSv
Smoke 20 cigarettes per day	53 mSv
CT Chest	7 mSv
CT Head	2 mSv
Nuclear Stress Test (Technicium)	9.4 mSv
Nuclear Stress Test (Thallium)	40.7 mSv
Barium Swallow	5 mSv
Mammogram	0.4 mSv
Chest X-ray	0.1 mSv
Dental X-ray (Bitewing)	0.02 mSv

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Congressman Putney with Vocal Cord Cancer

Media has reported that Congressman Lacey Putney, chairman of the powerful Appropriations Committee in the House of Delegates, has early stage vocal cord cancer.

He is currently undergoing radiation therapy which has a high chance of cure with relatively minimal side effects along with voice preservation.

My suspicion is that he is suffering from squamous cell carcinoma which is the most common type of vocal cord cancer. Though radiation therapy is a common form of treatment for this type of early stage cancer, surgical excision without the need for radiation is also possible. No chemotherapy is necessary for early stage vocal cord cancer.

Below is a picture of an early stage right vocal cord squamous cell carcinoma.

Compare to normal:

Source:
Putney undergoing treatment for throat cancer. WSLS10 8/15/12

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Levon Helm, Singer/Drummer for The Band, Dies of Throat Cancer

Levon Helm, legendary singer and drummer for The Band, died of throat cancer at age 71 on April 19, 2012.

It is unclear exactly what happened over this past month, but media reports state that he was diagnosed with vocal cord cancer in 1998 and underwent 28 sessions of radiation treatment at the Memorial Sloan Kettering Cancer Center. His cancer was almost certainly due to his 3 packs per day smoking and though he quit with his initial cancer diagnosis, cancer being what it is, it can always come back.

No mention of surgery or chemotherapy since than.

Given this little bit of information and the fact that he did have an albeit raspy voice to the point that he was still able to sing 1 month prior to his death on March 19, 2012, I suspect he had an aggressive recurrence of his vocal cord cancer.

Shown below is what a normal vocal cord looks like along with one that has cancer.

Typically with vocal cord cancer, radiation therapy alone is curative and allows for voice preservation. In fact, if no cancer is seen 5 years after treatment which in Mr. Helm's case would have been in 2003, one could state "cured" from this type of cancer.

So it is strange indeed that his vocal cord cancer would come back with a vengeance to the point it killed him 14 years later, though not impossible, especially if he started smoking again as well as drinking alcohol which exacerbates smoking's cancer-causing potential.

Furthermore, it is rare that vocal cord cancer alone would kill a person as there are salvage treatments in event the cancer does comes back as apparently it did for Mr. Helm.

If the vocal cord cancer comes back, it could grow in size to the point it would cut off the ability to breath. The growth could be quite dramatic taking a breathing/talking person to being unable to breath or talk in a matter of weeks.

With an aggressive vocal cord cancer recurrence, radiation therapy really is no longer an option if previously already done. Chemotherapy can be tried but with a localized aggressive cancer recurrence, surgery is really the only option... the COMPLETE removal of the entire voice-box.

This complete voice-box removal is known as total laryngectomy. It would leave the person completely unable to talk in a natural manner. It would also leave the person with a permanent hole in the neck as the only way to breath.

It just may be that Mr. Helm was offered this option, but given his life as a professional singer, it was perhaps too draconian an option for him to conceive of. As any singer can tell you, their voice is their life. Without their voice, their life might as well be over.

Of course, he may have developed a "new" cancer somewhere else in his throat... the supraglottis located immediately above the vocal cords or the pharynx which surrounds the vocal cords.

Unfortunately, the treatment options would have been still pretty much the same.

Source:
Levon Helm's Life After Cancer. CBS 2/11/09

Levon Helm Throat Cancer: Legendary 'The Band' Musician Dies At 71. HuffingtonPost 4/18/12

Levon Helm, Drummer and Singer of the Band, Dead at 71. RollingStone 4/19/12

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Dental X-rays Linked to Brain Tumors

In a study spanning over decades, researchers have found an association between dental x-rays and increased risk of a non-malignant type of brain tumor called meningioma.

Of the four types of dental x-rays, only the full-mouth series was associated with this increased risk. More specifically, the risk was elevated with the aggregate number of full-mouth series in 10-year periods from approximately 15–40 years before diagnosis, with significant elevations in the 10-year periods beginning 22–30 years before diagnosis. The risks in these analyses were even greater when only women were considered.

One needs to be aware that radiation exposure from full-mouth series was much greater in the past than it is now and as such, this risk may be nominal (though not zero) with current dental x-ray technology.

However, it also should be a reminder that x-rays should not be routinely performed unless there is a very good reason to obtain especially in children who are more susceptible to radiation injury... and that applies to not only x-rays, but any kind of testing involving ionizing radiation including CT scans.

Some x-rays should NEVER be performed including sinus x-rays for sinus problems given a nearly 50% error rate in diagnosing the presence OR absence of sinus problems.

X-rays for nasal fractures is not recommended given x-rays rarely change how such fractures are managed.

Soft-tissue lateral x-rays to look for large adenoids should also be discouraged as nasal endoscopy can provide similar if not better information without any radiation exposure.

To know what the cancer risk is with different types of x-rays, check out this website!

Source:
Dental X-rays and the risk of intracranial meningioma. Cancer. Volume 100, Issue 5, pages 1026–1034, 1 March 2004

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Celebrity Chef Grant Achatz With Stage 4 Tongue Cancer

Chicago news recently published a story about their very own celebrity chef Grant Achatz who suffered from Stage 4B squamous cell carcinoma of the tongue.

Grant Achatz, chef and co-owner of Alinea/Next/Aviary, approached multiple physicians throughout the country who essentially told him the oral cancer was terminal. In the end, he underwent treatment at University of Chicago successfully, though he certainly is not out of the woods yet.

There are several approaches in the treatment of tongue cancer, especially one as advanced as Mr. Achatz's, each with its own advantages and disadvantages.

In one approach is surgery first to remove all visible disease followed by radiation and chemotherapy to get rid of microscopic tumor cells. Surgery is huge... it entails removal of most of the tongue, involved jawbone, and removal of lymph nodes in the neck (neck dissection). Given how much tissue is removed, reconstruction of the defect is typically performed using bone, skin, and muscle typically taken from the arm (radial forearm free flap). Given how massive the surgery is, a tracheostomy as well as stomach feeding tube is placed. Hospitalization is typically 1-2 weeks long.

An alternative approach is surgery second. Radiation and chemotherapy is done first to shrink the tumor. Once this course is completed, surgery is performed to remove residual disease. The amount of surgery depends on the degree of residual cancer that is left. This course of action is what Mr. Achatz chose to pursue.

Regardless of what step is pursued, there are lots of side effects from cancer treatment including:

• loss/alteration in taste and smell
• dry mouth
• difficulty with swallowing
• stiff neck
• poor teeth (often they get removed prior to cancer treatment)
• leathery skin

Unfortunately, cancer being cancer, risk of recurrence is VERY high especially for stage 4 tongue cancer no matter how well the initial response appears to be. Regularly monitoring over the next 5 years is absolutely essential starting with an exam every 2-3 months for the first two years as that's when the risk of cancer recurrence is highest.

Source:

Celebrated chef gives back. WGN 3/22/12

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