Exposure to diagnostic ionizing radiation in sports medicine: Assessing and monitoring the risk

Objective: To understand the estimation of both the effective dose and the risk estimate associated with diagnostic ionizing radiation in sports medicine and to appreciate strategies by which this radiation exposure may be minimized. Design: Observational study. Setting: Sports medicine practice. Patients: A theoretical patient, athlete X (male, aged 20-29 years, 80 kg), was used to illustrate how the effective dose and the corresponding risk estimate are calculated for various common sports medicine investigations. Doses and risk estimates for female and pediatric athletes also are discussed. Main Outcome Measures: The effective dose and corresponding risk estimate associated with common sports medicine investigations. Results: Computed tomography and radiographic examinations of the extremities have significantly lower effective doses than investigations about the trunk region. Bone scanning and computed tomography have a significantly higher effective dose than radiography. The risk estimates associated with the low doses used in diagnostic ionizing radiation procedures are extrapolated from epidemiologic studies on exposures to high doses of radiation, and several uncertainties exist in this estimation. Notwithstanding this, the responsible clinician should be aware of both the effective doses and the risk estimates that are associated with the more common investigations. The principles of justification and optimization for these investigations will help guide clinicians to reduce radiation exposure without compromising the management of their patients. Conclusions: Certain investigations have a greater effective dose and risk estimate than others. Elite athletes may potentially undergo numerous investigations in their career. An athlete radiation record may be useful to better manage this exposure.