It is estimated that more than 3 billion medical and dental radiologic studies are performed each year around the world . In most of the cases, the images are used for only one purpose: to assess the health status of the patient on whom the study is being performed. In the case of a patient who presents with cough and fever, a chest radiograph is obtained to assess for pneumonia; a patient who has pain after a fall receives wrist radiographs; and a patient with symptoms and signs of appendicitis undergoes an abdomen/pelvis computed tomography (CT) examination. In nearly all such cases, the images are interpreted and then archived, usually never to be seen again.
In some cases, this pattern of image utilization entails a substantial degree of waste. Specifically, we are missing out on huge opportunities to reuse such an image for educational purposes. To be sure, in many teaching programs, such images are captured for the education of medical students, residents, and other health professionals. For example, we use particularly illustrative clinical images to help learners to recognize pneumonias, fractures, and appendicitis. But, there is another largely unrecognized educational purpose to which radiologic images can be put—public health education. Specifically, radiologic images can be used to discourage health behaviors that lead to disease and injury.
Major threats to the health of Americans include cancer, heart disease, stroke, trauma, and a host of conditions associated with substance abuse, including alcoholism, prescription drug abuse, and the use of illicit substances. In each of these cases, personal conduct plays a substantial role in determining risk. Patients who avoid smoking, maintain appropriate weight, exercise, keep blood pressure under control, drive safely and use seat belts, avoid overindulgence with alcohol, and avoid the use of controlled substances can substantially lower their risk of a variety of diseases and injuries that lead to premature disability and death.
By providing real-life illustrations of the sorts of harms that can befall people who engage in hazardous behaviors, radiologists can help to discourage such patterns of conduct. For example, comparing CT images of the lungs of nonsmokers and long-term smokers, including patients with diseases such as lung cancer, can help to convince patients to give up smoking or never to adopt the habit in the first place. Likewise, skeletal radiographs of motorists who were ejected from their vehicles during collisions because they were not wearing safety belts can help convince people of the importance of always buckling up when traveling by car.
We can bombard people with statistics, show them innumerable tables and graphs, and quote public health advocates until we are blue in the face, but as radiologists know well, sometimes a picture can be worth a thousand words. We believe this to be the case no less in public health education than in clinical medicine; specifically, we believe that well-selected radiologic images can help general public better appreciate the magnitude of certain health risks. We are not suggesting that radiologic images should supplant other educational approaches but only that they represent an important and underutilized educational resource.
To illustrate the role radiologic images can play in public health education, we focus on their use in educating middle-school and high-school students about the risks associated with substance abuse. This is a major public health problem. For example, a 2012 National Institute on Drug Abuse survey found that 69% of 12th graders report having tried alcohol, 24% report having had five or more drinks in one occasion in just the last 2 weeks, 17% report smoking at least one cigarette in the past 30 days, 49% report using illicit drugs in their lifetime, and 39% having done so in the past year .
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Figure 1
A 15-year-old male involved in a motor vehicle collision, after consumption of alcohol, with femur, humerus, and wrist fractures.
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Figure 2
A 27-year-old male involved in an assault, while intoxicated, with a left inferior orbital blowout fracture.
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Figure 3
A 56-year-old female with a 24-year history of consuming one pint of alcohol per day, now presenting with ascites and hepatocellular carcinoma.
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Figure 4
A 53-year-old female with a 30 pack–year history of smoking with loss of the second digit secondary to thromboangiitis obliterans.
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Figure 5
A 50-year-old female with a history of smoking and loss of right lower extremity secondary to thromboangiitis obliterans.
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Figure 6
A 39-year-old female with a 20 pack–year history of smoking, now presenting with lung cancer and multiple brain metastases.
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Figure 7
A 45-year-old male with hemorrhagic stroke after cocaine use.
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Figure 8
A 20-year-old male with multiple ischemic strokes after methamphetamine use.
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Figure 9
A 23-year-old female with a retained needle from intravenous drug abuse.
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Figure 10
A 30-year-old male with a history of polysubstance abuse, who attempted to self-harm after ingestion of bath salts.
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References
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2. Johnston L.D., O’Malley P.M., Bachman J.G., et. al.: Monitoring the future national survey results on drug use, 1975-2012. Volume I: Secondary school students.2013.Institute for Social Research, The University of MichiganAnn Arbor, MI
3. Dusenbury L., Falco M.: Eleven components of effective drug abuse prevention curricula. J Sch Health 1995; 65: pp. 420-425.
4. Bouchery E.E., Harwood H.J., Sacks J.J., et. al.: Economic costs of excessive alcohol consumption in the US, 2006. Am J Prev Med 2011; 41: pp. 516-524.
5. U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau: Child Health USA 2012.2013.U.S. Department of Health and Human ServicesRockville, MD