Are we doing more harm than good?

摘要

With the increasing availability of CT, in terms of more equipment and faster scanning times, the number of opportunities to utilize CT has increased dramatically. Clinicians have rightly demanded the highest quality imaging in the expectation of increased diagnostic yield and therefore better patient outcomes. It is only in relatively recent years that clinicians have become aware of the potential pitfalls of this ever-increasing radiation dose [1]. Those involved in radiation protection have pointed this out for a much longer period of time, emphasizing the contribution that CT makes to population dose as well as individual patient risk. The major risk of cancer induction has been discussed recently, particularly in children [2]. Such risks have, to some extent, been rebuffed by enthusiasts who point out that, for patients in their later years, this risk is obviously restricted. The realization within paediatric radiology came rather earlier and with greater force [3, 4] and, indeed, even reached the popular press in the US in quite a dramatic way. Despite this, numbers of CT examinations continue to rise and, with the greater use of multislice CT, could be predicted to rise even further. J.autin et al in their Commentary (see this issue) [5] bring this very much into focus in relation to serial CT scans for monitoring pulmonary nodules. They point out that most nodules are not malignant and that CT of the entire chest using standard protocols is not necessary. They even challenge the premise that deaths from lung cancer are being reduced by this strategy.