One of my favorite movies is Ferris Buehler’s Day Off, and one of my favorite scenes is at the Art Institute of Chicago. Beginning with a close-up of a bunch of dots of paint, the camera zooms out to show, first, a low-resolution face and, eventually, a painting (“Sunday Afternoon on the Island of La Grande Jatte,” by Georges Seurat, for those of you who always wondered – it still amazes me how quickly you can find this sort of stuff out through Google). This is not a bad visual analogy for many things, but I’d like to think about it in terms of risk reduction. Are we so focused on radiation safety and radiological risk reduction that we have lost sight of the larger picture? In other words – are we concentrating on a dot and thinking it is the entire picture?
What brings this to mind right now are the continuing focus on Fukushima’s radiological impact and the cost to clean it up (and in the process paying scant attention to the thousands of dead and tens of thousands who lost their homes). Also relevant are a few consulting projects I’ve worked on, and some recent articles about the extraordinary measures people are taking to avoid even the slightest dose of radiation. For example, would you believe that a dentist in the UK was sued for taking panoramic x-rays of some of his patients? Nobody claimed to have been injured, but some patients were concerned about being put at needless risk. A few years ago the issue of irradiated gemstones – which have trivially small amounts of induced radioactivity – were an item of regulatory concern, forcing many to ask if there is any reason to think that irradiated gemstones should really be competing for our attention with far more potent radiation sources such as irradiators, nuclear reactors, and orphaned sources. Then there is the slew of articles discussing radiation dose to patients (including emergency room patients) from medical x-rays, and much more.
Now, I am not proposing that this attention is bad, and I am certainly not proposing that we drop the concept that we should try to keep radiation exposure as low as reasonably achievable (a regulatory concept called “ALARA”). But I am proposing that we might try to expand the ALARA concept beyond the strictly radiological and try to think about what is reasonable when we consider all of the risks that are faced by an individual or by society.
Let’s take medical x-rays for example. If I go to the doctor with a headache, I’m not sure that an x-ray is really called for – and almost certainly not a CT or fluoroscopy. If my doctor sent me for one of these exams, I’d be interested in his explaining his reasoning to me. On the other hand, when I showed up at the emergency room with severe abdominal pains I had no objections to the radiation dose from the abdominal CT used to determine whether or not I needed surgery. I felt the same way when my young son required x-rays to try to find out why he was having problems breathing. Whatever risks a medical x-ray procedure may cause are not clinically significant at the time of the procedure; they may become clinically significant years or decades later, but only if the dose was high enough to initiate a cancer. When faced with a gravely ill or seriously injured patient, shouldn’t the physician’s focus be the immediate well-being of the patient? Proceeding on a course of action without appropriate information is risky. And these risks are immediate, not longer-term. The bottom line is that not taking an x-ray also carries with it a risk – the risk of not having needed diagnostic information. If this latter risk exceeds the risk from the radiation, then the physician should order the radiological procedure.
We can make similar comments about other aspects of radiation exposure. It may make radiological sense to spend money cleaning up mildly contaminated sites. But does it make sense for a society in which 1% of the population dies in traffic accidents to spend a lot of money in areas in which there is very little real risk reduction? How can we justify spending money in areas that have little or no impact on public health, especially when that money is diverted from other areas that can have a real impact? And when we consider that traffic accidents, childhood malnutrition and disease, shootings, and so forth affect both young and old, whereas cancer is primarily a risk to those of us who are older, it makes even less sense to be focusing excessively on radiological risks. I am reminded of an oncologist I met in Cambodia who told me that, at that time, they only needed one radiation oncology clinic for the entire country – because so few Cambodians lived long enough to get cancer. It made me realize that we in the developed world are fortunate that we live long enough to have the luxury of worrying about cancer. It also made me realize that it makes sense to give everyone the opportunity to live long enough to develop cancer (or heart disease; no reason to play favorites) – by putting our risk reduction efforts into areas that kill young and old alike. And this may mean reducing our emphasis on reducing radiological risks when the money spent can accomplish far more risk reduction in other areas.
Certainly we have to protect radiation workers and the population as a whole from the potentially adverse effects of radiation – the radiation safety profession and the regulations they follow serve a valuable purpose in doing this. And we have an obligation to make sure that we do not abuse the environment unduly. But let’s also remember that, after all of our best efforts, after all of the money that we spend, after all of the time that we devote to risk reduction, the sum of all of the risks in our lives remains 100% – reducing one risk necessarily increases all other risks because we are all going to die of something someday (I don’t want to sound overly somber, but there is no hiding from this fact). That being the case, shouldn’t we focus on the big picture– making sure that the largest number of people have the greatest opportunity to live into old age? As members of society, shouldn’t this be our goal – to spend our society’s resources to the maximum benefit of everyone? Yes – radiation safety and radiological dose reduction is a part of this picture. But let’s remember that it is only one small part of a much larger picture – and that we cannot let our devotion to a single dot of paint overshadow our responsibility to the whole.
Dr Y is a certified health physicist, trained in nuclear power plant design and operations, with experience in nuclear power, environmental science, and planning for radiological and nuclear emergencies. He has 30 years of experience in the areas of nuclear and radiation safety.