JACR: Pros & cons of iPhone rad dose, cancer risk tracking app

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A recent article published in the April edition of the Journal of the American College of Radiology discussed a Radiation Passport, an iPhone and iPod Touch application that tracks radiation dose and estimates associated cancer risks.

Mark Otto Baerlocher, MD, of the department of medical imaging at the University of Toronto in Ontario, and colleagues wrote: “[A]s a result of the increasing amount of scrutiny and general lack of radiation risk awareness, the application Radiation Passport for the Apple iPhone and iPod Touch was developed and made available on the Apple iTunes/App store."

The application is intended for use by both healthcare providers (radiologists, referring physicians, dentists, chiropodists, nurses, technologists and others who deal with radiologic exams and procedures) and patients, which sparks a debate of whether or not the tool should be made available to patients.

“The perceived risk is that patients may then refuse to undergo recommended examination solely on the basis of the estimated risk,” the researchers wrote.

Noting that the Radiation Passport can be used in two ways: By the patient to estimate the cancer risks associated with given radiologic exams their healthcare providers request that they undergo and to track or keep a record or passport of their lifetime radiation exposures, Baerlocher and colleagues said that the application allows patients to determine the estimated cancer (total and fatal) risks associated with the radiation from individual examinations or from their lifetime cumulative exposure.

Caregivers, on the other hand, can use the tool for their own education when considering different types of radiologic exams to request. An individual exam type (modality or body area), patient gender, and patient age are entered into the application and the estimated effective dose and associated cancer risk are returned to the user. The physician can also use the application for help in answering patient questions regarding radiation risks from specific exams.

The calculations used by the application are generated from the National Research Council's Report on the Health Effects of Ionizing Radiation and incorporate the effect of age on cancer risk for each exam entered individually, explained Baerlocher and colleagues.

In writing that there is “cause for concern” in regard to radiation dose, Baerlocher and colleagues said that “a sizable number of radiologic examinations are ordered by referring physicians are otherwise not medically indicated. This, coupled with a lack of radiation risk awareness among physicians (both radiologists and referring physicians) indicates that potentially a significant number of patients are receiving unnecessary radiation and, as a result, are at increased risk for developing cancers.”

In noting the aforementioned concern regarding the availability of the tool for patients as well as physicians, the authors said: “[P]atients need to know all relevant pieces of information to make informed, ‘empowered’ decisions… If a patient wishes to refuse an examination ordered by a physician because of perceived radiation risks, it is the physician's responsibility to explain the potential benefit side of the risk-benefit equation.”

Another concern raised by this application is the room for dispute regarding the radiation estimates, for which Baerlocher and colleagues offered: “We would argue that they are the best estimates available and therefore the estimates we must take into account.”

Nothing that the goal of the tool is to provide further education and increased awareness of radiation risks, the researchers said that they will now be seeking feedback on the application, in order to learn the impact of the tool and potential room for improvement.

“It is a much better alternative for patients to be provided with an objective tool such as Radiation Passport with which to assess their radiation exposure and secondary cancer risk than to judge on the basis of sometimes sensational and only partly true information spread throughout the media,” the article concluded.