Reforming the debate around radiation risk.

The back-and-forth debate on radiation risk, in the recent years, has unscientifically drifted away from proportionality and become increasingly antagonistic. A handful of authors have used exaggerated claims which are corroborated by their own previous work and presented using heated and superlative language. With unwarranted certainty, many have also referenced studies which report inconclusive findings and given undue weight to the results of laboratory animal and cellular studies, regardless of their exact positions on radiation risk. The passion and subjective interpretation with which the debate is now presented detracts from rational, scientific evaluation. A reform of the debate is needed to reach grounded consensus in the community and, if appropriate, begin the process of amending the legislation to reflect it. In this article we have analysed key research on the topic and discussed the fundamental limitations of science in providing satisfactory answers to our questions.

Does quantification have a role to play in the future of bone SPECT?

Routinely, there is a visual basis to nuclear medicine reporting: a reporter subjectively places a patient's condition into one of multiple discrete classes based on what they see. The addition of a quantitative result, such as a standardised uptake value (SUV), would provide a numerical insight into the nature of uptake, delivering greater objectivity, and perhaps improved patient management.For bone scintigraphy in particular quantification could increase the accuracy of diagnosis by helping to differentiate normal from abnormal uptake. Access to quantitative data might also enhance our ability to characterise lesions, stratify and monitor patients' conditions, and perform reliable dosimetry for radionuclide therapies. But is there enough evidence to suggest that we, as a community, should be making more effort to implement quantitative bone SPECT in routine clinical practice?We carried out multiple queries through the PubMed search engine to facilitate a cross-sectional review of the current status of bone SPECT quantification. Highly cited papers were assessed in more focus to scrutinise their conclusions.An increasing number of authors are reporting findings in terms of metrics such as SUVmax. Although interest in the field in general remains high, the rate of clinical implementation of quantitative bone SPECT remains slow and there is a significant amount of validation required before we get carried away.