[ RadSafe ] American College of Radiology respond to NEJM article on CT scans

John Jacobus crispy_bird at yahoo.com
Sat Dec 1 16:58:48 CST 2007


ACR Responds to NEJM Article on Radiation Risk
Associated With CT Scans

The American College of Radiology (ACR) is concerned
that certain conclusions and comparisons made in the
study, “Computed Tomography — An Increasing Source of
Radiation Exposure,” published in the Nov. 29 issue of
the New England Journal of Medicine, may be
inappropriate and cause patients to mistakenly avoid
getting life-saving medical imaging care. 

The study claims that up to 2 percent of all cancers
in the United States may be caused by radiation
received from CT scans. Yet, the study authors admit
that there are currently no published studies directly
linking CT scans (even multiple CT scans) to cancer. 

The study also equates radiation exposure and effects
experienced by many atomic bomb survivors in Japan to
present day patients who receive computed tomography
(CT) scans. Most CT exams are performed in a
controlled setting. They result in limited radiation
exposure to a small portion of the body. Atomic bomb
survivors experienced instantaneous radiation exposure
to the whole body. Also, CT exams expose patients
solely to X-rays. Atomic blast survivors were exposed
to X-rays, particulate radiations, neutrons, and other
radioactive materials. The known biological effects
are very different for these two scenarios. 

“Patients need accurate information on which to base
their health care decisions. They may be terribly
confused and unduly distressed by some of the
statements in this study,” said Arl Van Moore Jr.,
M.D., FACR, chair of the ACR Board of Chancellors. 

There is little doubt in the medical community that CT
scans help save lives. Advancing technology has
increasingly allowed imaging exams to replace more
invasive techniques, but has also resulted in
increased radiation exposure for Americans. 

The College urges patients and providers to visit the
“Radiology Safety” section of the ACR Web site as well
as the “Radiation Safety” section of
www.radiologyinfo.org, the patient information site
co-managed by the ACR and the Radiological Society of
North America (RSNA), for more information regarding
radiation exposure from medical imaging exams.  

Patients should also keep a record of their X-ray
history and before undergoing a scan, should ask their

Why do I need this exam? 
How will having this exam improve my health care? 
Are there alternatives that do not use radiation which
are equally as good (e.g.. MRI, ultrasound, etc.) 
Is this facility ACR accredited? (ensures that
physician and staff meet education and training
standards and that equipment is surveyed regularly by
medical physicist to ensure that it is functioning

“The College has long held that no medical test,
particularly those utilizing ionizing radiation,
should be performed unless the medical benefits
clearly outweigh any risk associated with the exam.
For example, the ACR has long opposed full body CT
scans for asymptomatic patients, one of the exams that
the NEJM article authors put forth as a driver of
future CT growth,” said ACR Chair Moore. We also
support the ‘as low as reasonably achievable’ (ALARA)
concept which urges providers to use the minimum level
of radiation needed in such exams to achieve the
necessary results.

The ACR has led the effort to eliminate unnecessary
radiation dose in imaging for decades. Historic ACR
actions to monitor and reduce radiation dose include: 

ACR Appropriateness Criteria (1993) which help
radiologists and referring physicians prescribe the
most appropriate imaging exam for more than 200
clinical conditions (can help patients avoid
unnecessary exposure to scans utilizing radiation when
others such as MRI and ultrasound, which do not use
radiation, may be better for that particular

Accreditation of facilities which offer X-ray
technologies (including dose assessments) 
Mammography (1987) 
Stereotactic Breast Biopsy (1996) 
CT (2002)

Practice Guidelines and Technical Standards (1990)
which layout the acceptable protocols for performing
imaging exams (including CT).

ACR activities to lower radiation dose were recently
summarized in the ACR Whitepaper on Radiation Dose in
Medicine published in May 2007. In the paper, the ACR
Blue Ribbon Panel on Radiation Dose also outlined 33
specific action items to help reduce radiation dose.
Below are items already in motion: 

Creation of a Dose Registry (2008) including CT dose
and the ability to establish bench marks.

Working with other medical specialties on radiation
dose awareness. An example of this is the upcoming
“Consensus Conference on Imaging Safety and Quality
for Children in the Emergency Setting” scheduled for
Feb. 2008 (cosponsored by the Society for Pediatric

The ACR will continue to work with congress,
government agencies, other medical specialties, and
public and private payers to improve quality and
reduce unnecessary radiation exposure for patients.

"Courage is what it takes to stand up and speak, Courage is also what it takes to sit down and listen." -- Sir Winston Churchill

-- John
John Jacobus, MS
Certified Health Physicist
e-mail:  crispy_bird at yahoo.com

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