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Radiation Dose from Adult and Pediatric Multidetector Computed Tomography (Medical Radiology / Diagnostic Imaging)

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The use of computed tomography (CT) has seen enormous growth over the past decade. In the US, approximately 63 million examinations were performed in 2005 (Niagara Health Quality Coalition 2004) compared to 35 million in 2000. The increased number of clinical applications (e.g., in emergency and trauma, paediatric, cardiac, and vascular disorders) made possible by the fast scanning capabilities of multidetector CT (MDCT) will drive even greater growth.

CT is already the main cause of radiation dose to the US population (Wiest et al. 2002; Mettler et al. 2000), and this will surely increase as the number of examinations per patient increases. This is a serious concern with which the radiology community is now confronted. The signifi cant uncertainty associated with radiation risk estimates, long delays between exposure and cancer manifestation, and the fact that carcinogenesis is proved by statistical inference rather than by direct observation tend to reduce the perceived urgency to reduce radiation dose delivered by CT. However, the radiology community needs to be made aware that the small but acceptable risk–benefi t decisions made at the individual patient level are amplifi ed by the huge number of CT procedures performed each year. In a recent report on the biological effects of ionizing radiation (Beir 2005), the overall probability of death due to a solid tumor induced by a single 10-mGy CT examination is estimated to be approximately 0.00041. This apparently very low risk – multiplied by the 63 million CT examinations performed each year – suggests in fact that 25,420 fatal cancers are induced by CT every year.

This calculation, however, has a number of major fl aws. The most important fl aw is the fact that the risk factors were derived for generally healthy individuals in the population of Japanese A-bomb survivors, whereas patients who undergo CT are usually older and have a lower life expectancy than those in the general population. Moreover, the health benefi t of CT-derived diagnostic information is immediate, whereas the risk of induced cancer is decades away. Nevertheless, this mathematical calculation was meant to underscore the importance of restraint in the use of MDCT.

Given these fi gures, what are radiologists supposed to do? Should they refuse to perform CT examinations on the patients referred to them? Conservative estimates of the benefi t-to-risk ratios for CT are 100:1 and even higher. This discussion does suggest, however, that CT should not be performed for dubious or trivial clinical indications. Appropriateness criteria need to be vigilantly applied for all patients referred for a CT examination. Appropriate medical training in radiation risk management would be helpful in reducing the number of inappropriate requests for CT examinations. Academic radiologists should push for this training and organize dedicated lectures in medical schools. In training hospitals, CT examinations requested by young residents should be approved by senior physicians.
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