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Alastair 02-10-2005 05:34 AM

There is an article in Medscape today, warning of the dangers of radiation from CT scans. MRI scans which are not radioactive have been preferred by most doctors recently.

It's quite an alarming article but I feel worthy of being read by all of us.

Try this link here
http://www.medscape.com/viewarticle/496297?src=mp

Best,
Alastair http://adrsupport.org/groupee_common...icon_smile.gif

Harrison 02-10-2005 07:33 PM

Sir A, if it's not too much trouble, could you give us your brief summary of the key points? Many people can not access the article, or do not know how.

Thx for your help and thinking of the community at large!

(On other hand...if the article is going to scare us, I dunno if we want to see it!)

http://adrsupport.org/groupee_common...s/icon_eek.gif

Alastair 02-11-2005 06:17 AM

I would encourage all members, especially our American members to join Medscape orthopaedic section. I have not put the full article down here because of copyright law.


From Medscape Radiology

Radiation Risk From CT Scans: A Call for Patient-Focused Imaging
Posted 01/26/2005

Richard C. Semelka, MD

MRI is an imaging modality that is considerably safer than CT on the basis of a number of factors, of which radiation exposure is perhaps the most serious. In addition, MRI may actually be much more accurate in describing disease. Although MRI is recognized to be superior to CT in a number of organ systems, a recent pivotal article also has shown that screening MRI of the entire body may be as accurate or more accurate than individual "gold-standard" diagnostic investigations of individual organ systems.[2] The accuracy of modern MRI to evaluate the full range of organ systems should cause reevaluation of how different imaging investigations should be used to ensure the welfare of patients and optimize their care.

It is beyond question that radiation delivered by x-ray-based imaging modalities has deleterious health effects.[3-7] The problem is that an exact quantification of these harmful effects is difficult to ascertain -- which explains why physicians in general have not been overly concerned about the radiation related to CT investigation. One prior study, however, described the increased risk of breast cancer in patients who are women who received serial spine x-rays for the investigation of scoliosis,[5] and another study described the increased incidence of leukemia in patients who underwent serial radiographic examination during childhood.[8] One of the most recent of these articles[4] estimates that, per year, diagnostic x-ray use in the United States causes .9% of the cumulative risk of cancer to age 75 in men and women, equivalent to 5695 cases. The US Food and Drug Administration (FDA) estimates that a CT examination with an effective dose of 10 millisieverts (mSv), for example, 1 CT examination of the abdomen, may be associated with an increase in the possibility of fatal cancer of approximately 1 chance in 2000 (http://www.fda.gov/cdrh/ct/risks.html).

This statistic becomes even more alarming if one considers the potential public health problem, when one contemplates that 60 million CT scans are performed per year in the United States.[9] The pediatric population represents an especially vulnerable group of patients at increased risk for cancer development secondary to low-level ionizing radiation. Recent studies show that 600,000 abdominal and head CT examinations annually in children under the age of 15 years could result in 500 deaths from cancer attribute to CT radiation.[10] These estimates are terrifying and particularly tragic if safe, alternative radiology modalities are available.

Balancing Risks and Benefits
It has been more than 50 years since physicians had direct physical evidence of the dangers of radiation exposure,[11,12] which is older than the career experience of even the most senior practicing physicians. The understandable excitement that current practicing radiologists experience with the increased imaging capability of modern multidetector CT is therefore not tempered with the direct experience of the harmful effects of excessive radiation exposure. Techniques that employ modern multidetector CT technology, multiphase contrast-enhanced CT of the liver or kidneys, and CT urography are generally performed with the intention of acquiring sufficient data to provide maximal image quality and diagnostic information, but often without enough attention paid to limiting radiation exposure. Attention has been directed in a number of reports to diminish the amount of radiation delivered by CT studies in settings, such as pediatric CT studies or lung screening studies.[13] At the same time, it is clear that often radiation settings are not adjusted to lower levels for pediatric patients and small adults.[14]

The Case for MRI: Especially in Children
In my opinion, an even better approach is to avoid radiation altogether by performing MRI. As mentioned previously, consideration is not often placed as to whether another technique may provide equivalent diagnostic information with no radiation risk. The fact that modern CT equipment provides highly collimated beams and adjustable milliamperes may serve to even further lower the level of concern of radiologists and referring physicians to the dangers of radiation, and create the sense that CT is risk-free. Serial CT examinations of patients with various long-standing disorders or chronic disease are especially worrisome.


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