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Editorial |
Royal Liverpool Children's Hospital, Alder Hey, Eaton Road, Liverpool L12 2AP, UK
Correspondence: D W Pilling, Royal Liverpool Children's Hospital, Alder Hey, Eaton Road, Liverpool L12 2AP, UK. E-mail: david.pilling{at}rlc.nhs.uk
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. Lautin 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. It is to be hoped that this Commentary is a sufficient wake-up call to all of those involved not only in chest CT for pulmonary nodules but also in abdominal and pelvic CT in order that they tailor their examinations to the clinical question rather than take a rather blunderbuss approach to diagnosis in the hope of picking up some incidental abnormality (which may or may not relevant). If all involved in this area considered the potential for radiation-induced deaths from cancer, then perhaps this would in some way counter the argument of potential litigation if the examination is not done.
As the authors say, our first duty as doctors is to do no harm. Perhaps our duty as radiologists is to point out to our enthusiastic clinical colleagues with greater emphasis the potential harm they may be causing.
Received for publication January 18, 2008. Accepted for publication January 18, 2008.
References
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