**2. The magnitude of the "silent" problem**

Difficult to identify at the time of the initial exposure, radiation injury tends to present in a delayed fashion. Radiation injury also tends to be low on a typical differential diagnosis list as most cases tend to involve unintentional (and unrecognized) exposure. As demonstrated by our three vignettes, the uncommon occurrence of harmful medical radiation exposure (HMRE) can originate as a result of various types of PS error; both of omission and of commission [21]. In addition, radiation-related PS issues can result from lack of adequate oversight at both institutional level (e.g., absent safety procedures) and governmental level (e.g., lack of applicable laws, regulations, or enforcement) [9, 22, 23].

Complexities associated with HMRE prompted an important discussion regarding the nature and the content of the informed consent process, specifically as it relates to medical radiation exposure [24]. The true gravity of such considerations is exemplified by the known association between cumulative radiation exposure and the incremental risk of malignancy following repeated CT imaging episodes [25]. Moreover, compared to the adult population, the overall risk is significantly greater for pediatric patients [26].
