NEJM Article Questions Safety of Medical Imaging Procedures

August 27, 2009 · Written by ·

nejm1An Original Article in the August 27, 2009 issue of the New England Journal of Medicine raises concerns that imaging procedures, such as CT scans, that expose patients to low-dose ionizing radiation may be increasing their risk for cancer.

Fazel et al of Emory University obtained utilization data from just under 1 million nonelderly adults between January 1, 2005 and December 31, 2007 in five areas in the U.S. Using this data, the authors estimated the cumulative effective doses of radiation from imaging procedures and calculated population-based rates of exposure. Annual effective doses were defined as low, moderate, high or very high.

The authors found that almost 70 percent of those studied were exposed to radiation by at least one imaging procedure. Almost 20 percent received at least moderate (>3 to 20 mSv) annual doses and about 2 percent had high (>20 to 50 mSv) annual doses of radiation from diagnostic tests. The authors concluded that imaging procedures are “an important source of ionizing radiation in the United States and can result in high cumulative effective doses of radiation.”

Approximately 75% of the cumulative effective dose was due to computed tomographic (CT) and nuclear imaging. The imaging procedures with the largest doses were: myocardial perfusion imaging, abdominal CT, pelvic CT, chest CT, and diagnostic cardiac catheterization.

Dr. Michael Lauer of the National Heart, Lung and Blood Institute wrote the Perspective accompanying the article. “CT scans produce beautiful pictures, but they generate a huge amount of radiation compared with a standard X-ray,” Lauer notes.

The number of CT scans has quadrupled since 1992, but the article does not address whether medical imaging is over-prescribed or overused.

The American College of Radiology was quick to address and rebuff any concerns raised by the recent NEJM article. Read the ACR response here.

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