(1)
Department of Radiology, UMDNJ-New Jersey Medical School, Newark, NJ, USA
Abstract
I do not need to tell you that the last 15 years have seen a revolution in how patients undergo diagnostic workups. That change had already begun about 35 years ago with the phenomenal growth of radiology, including the advent of ultrasound, CT, MR, nuclear medicine and interventional radiology. And from 1995 to 2009 these has been a precipitous rise in CT utilization occasioned by fantastic advances in that technique [1]. Growth has leveled off and declined a little but more than 60 million CT exams are done each year in the U.S.A. This period of growth has caused not merely an increase in the number of cases but, in fact, a transformation, actually a metamorphosis, about how patients are evaluated. For many diseases diagnosis has been ceded to the radiologist. That change is not merely a modification of medical practice but a sociological transformation that has been accepted by the public as well as by other medical practitioners. Are there implications in this increasing reliance on CT that perhaps are not salutary? I am not only talking about economic issues but actually also issues of the induction of pathology.
I do not need to tell you that the last 15 years have seen a revolution in how patients undergo diagnostic workups. That change had already begun about 35 years ago with the phenomenal growth of radiology, including the advent of ultrasound, CT, MR, nuclear medicine and interventional radiology. And from 1995 to 2009 these has been a precipitous rise in CT utilization occasioned by fantastic advances in that technique [1]. Growth has leveled off and declined a little, but more than 60 million CT exams are done each year in the U.S.A. This period of growth has caused not merely an increase in the number of cases but, in fact, a transformation, actually a metamorphosis, about how patients are evaluated. For many diseases diagnosis has been ceded to the radiologist. That change is not merely a modification of medical practice but a sociological transformation that has been accepted by the public as well as by other medical practitioners. Are there implications in this increasing reliance on CT that perhaps are not salutary? I am not only talking about economic issues but actually also issues of the induction of pathology.
In 1980 two million CTs were done nationally. Today on average nearly one in four American will have a CT exam every year. Some will have less or none but others will have them more frequently than annually. Not only has CT utilization increased, but the protocol of CT examinations has also changed. We now do much faster studies, which enable us to do more regions per exam, more slices per region, more doses per slice, and more studies of children. The National Academy of Sciences recent report has stated that there really is no threshold below which radiation causes no damage. Now that may still be debated, but when we do a study of the chest and abdomen with CT slices as close together as 1 mm, we are imparting a radiation dose much higher than any low threshold. For the purpose of this talk we need not get into specific dose numbers, but the point is that the doses we are giving for one CT and then repetitive CTs approach a level where we must give consideration to the fact that perhaps what we are doing has some ill effect as well as some good.
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