CT radiation dose reduction: can we do harm by doing good?

Cohen, Mervyn D.

doi:10.1007/s00247-011-2315-9

Cited by 21 publications

(14 citation statements)

References 13 publications

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“…In this way, benchmarking will remain an important and valuable tool to incentivize further dose-reduction efforts. However, as institutions engage in more aggressive dose reduction practices, there is a risk of appreciably poorer image quality and reduced diagnostic value [27-28]. In these situations, it is critical to consider the differential benefit received by individual patient populations.…”

Section: Discussionmentioning

confidence: 99%

Prioritizing Examination-Centered Over Patient-Centered Dose Reduction: A Hazard of Institutional “Benchmarking”

Eisenberg¹,

Gilmore²,

Kalra³

et al. 2014

American Journal of Roentgenology

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Purpose To evaluate whether examination-specific radiation dose metrics reliably measure an institution's success in reducing cancer risks. Materials and Methods We projected health benefits from dose-reduction programs in a hypothetical institution that sought to decrease exposures from abdominopelvic CT. Using modeling techniques to project radiation-induced cancer risks, and tertiary center data to inform the institution's abdominopelvic CT age distribution, we compared: a program in which effective doses were reduced equally (from 10 to 7-mSv) across all scans; to programs in which dose reduction was age-dependent. For each program, we projected lethal cancers averted, life expectancy gained, and average institutional dose achieved. Markov Chain Monte Carlo methods were used to estimate uncertainty in projections. Results The analysis’ age distribution drew from 20,979 CT scans; 39% were from patients ≥65-years-old. To illustrate trends yielded, if all patients in the hypothetical institution received 7-mSv (instead of 10-mSv) scans, we projected the maximum number of lethal cancers averted to be 7/100,000 patients, and maximum life expectancy gained to be 0.26 days per patient, when averaged over the institution's population. When restricting dose reduction (from 10 to 7-mSv) to patients <65-years-old, benefits were slightly lower (5/100,000 patients, 0.22 days gained); however, the average institutional dose was substantially higher (8.2-mSv). While dose reduction in ≥65-year-old patients accounted for only 16% of possible institutional life expectancy gains, this patient group contributed disproportionately (39%) to the institution's average dose. Conclusion Institutional examination-specific dose metrics can be misleading, because the least benefited patients may contribute disproportionately towards “improved” averages.

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Section: Discussionmentioning

confidence: 99%

Prioritizing Examination-Centered Over Patient-Centered Dose Reduction: A Hazard of Institutional “Benchmarking”

Eisenberg¹,

Gilmore²,

Kalra³

et al. 2014

American Journal of Roentgenology

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“…These include imaging avoidance, nondiagnostic image quality, and use of alternative imaging procedures, such as a longer-duration MRI study, requiring risk-incurring sedation for young children (6)(7)(8). The risks of misdiagnoses from inadequate dose could be much higher than the cancer risks that the LNTH falsely predicts and that are putatively avoided by ALARAbased dose-reduction strategies (9).…”

Section: Evaluation Of the Presented Evidencementioning

confidence: 99%

“…Unwarranted fear of low-dose radiation leads to the misguided doctrine of "prudence" in dosing-ALARA (as low as reasonably achievable)-that, by often diminishing image quality, increasingly produces suboptimal and even nondiagnostic CT scans (9,10). Thus, today, 70 y after Muller's Nobel speech, another non sequitur advances, this time within the field of radiologic imaging.…”

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confidence: 99%

Subjecting Radiologic Imaging to the Linear No-Threshold Hypothesis: A Non Sequitur of Non-Trivial Proportion

Siegel¹,

Pennington²,

2016

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Radiologic imaging is claimed to carry an iatrogenic risk of cancer, based on an uninformed commitment to the 70-y-old linear nothreshold hypothesis (LNTH). Credible evidence of imaging-related low-dose (,100 mGy) carcinogenic risk is nonexistent; it is a hypothetical risk derived from the demonstrably false LNTH. On the contrary, low-dose radiation does not cause, but more likely helps prevent, cancer. The LNTH and its offspring, ALARA (as low as reasonably achievable), are fatally flawed, focusing only on molecular damage while ignoring protective, organismal biologic responses. Although some grant the absence of low-dose harm, they nevertheless advocate the "prudence" of dose optimization (i.e., using ALARA doses); but this is a radiophobia-centered, not scientific, approach. Medical imaging studies achieve a diagnostic purpose and should be governed by the highest science-based principles and policies. The LNTH is an invalidated hypothesis, and its use, in the form of ALARA dosing, is responsible for misguided concerns promoting radiophobia, leading to actual risks far greater than the hypothetical carcinogenic risk purportedly avoided. Further, the myriad benefits of imaging are ignored. The present work calls for ending the radiophobia caused by those asserting the need for dose optimization in imaging: the low-dose radiation of medical imaging has no documented pathway to harm, whereas the LNTH and ALARA most assuredly do.

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“…CT scans could be performed with non-diagnostic dose levels [53,[55][56][57]. Ultimately, the diagnostic quality of any CT study is a subjective individual radiologist's decision [58].…”

Section: Patientsmentioning

confidence: 99%