Economic Considerations for Radiation Protection in Medical Settings—Is It Time for a New Paradigm?

Abstract

The full ALARA principle includes “as low as reasonably achievable” taking social and economic factors into consideration. The International Commission on Radiological Protection advises a conventional cost benefit approach (e.g., cost per monetized averted stochastic effects or years of life saved) to consider economic factors. Given small incremental radiation dose reductions to patients, workers, or the public that may be realized in medical settings and the correspondingly small changes to theoretical stochastic effects, a conventional cost benefit approach is less than ideal. This is illustrated in the case studies presented in this paper. Alternate approaches, such as cost per unit of radiation dose averted (e.g., $/μSv averted), cancer induction/fatality probabilistic thresholds, or thresholds relative to natural background radiation may be alternate options. However, the decision regarding what is a “safe” level of radiation and what are reasonable costs to make it “safer” are driven by societal values and may vary from jurisdiction to jurisdiction.