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Irogers{at}ajroffice.org
As you may recall, an article by Brenner et al. [1] appeared in the February 2001 issue of the AJR concerning the possibility that the increased use of CT was placing children at higher risk of developing cancer. This article was accompanied by two other articles: one, a report by Paterson et al. [2], who showed that, in many cases, children undergoing CT were indeed examined with adult exposure factors; and a separate article by Donnelly et al. [3], who described how to adjust CT exposure factors for pediatric patients.
The media, ever on the lookout for exploitable, newsworthy features, took note of the AJR articles and selected the topic of radiation dose from CT and the resultant increased risk of childhood cancer as their cause du jour. As a result, the articles received considerable publicity and raised a public clamor. However, as with almost any cause du jour, the resultant clamor was short-lived.
The lapse of public concern for this subject notwithstanding, there is clear evidence that radiologists and their physicist colleagues have not forgotten. I present as evidence the fact that the AJR has received since February 2001 several submissions on the subject of dose reduction in CT, more than we had received prior to February 2001. Many of these submissions are now being reviewed and others have been accepted and are headed toward publication.
Indeed, in this issue, Prasad et al. [4] describe the image quality of chest CT scans obtained with a standard radiation exposure dose compared with the quality of images obtained with a 50%-reduced dose. These researchers present welcome evidence that when it comes to radiation exposure dose, we might well be able to do with less. These investigators found that, even with a 50% reduction in exposure dose, the resultant image quality of chest CT was surprisingly satisfactory. In their report, Prasad et al. confirm the work of Ravenel et al. [5] and Mayo et al. [6] published previously in the AJR.
And our interest in lowering radiation exposure doses from CT has even gotten the attention of equipment manufacturers. A well-attended seminar at the recent annual meeting of the American Roentgen Ray Society in Atlanta entitled Radiation Dose Reduction in CT featured presentations by several prominent radiologists as well as representatives from General Electric, Siemens, and Philips Medical Systems. The manufacturers' representatives all maintained that their companies had gotten the message and were committed to reducing the radiation exposure dose during CT. All described various methods by which their companies intended to achieve this end.
At the seminar, Stanley Fox of General Electric rendered the most telling statement, confessing that the recent clamor surrounding radiation dose from CT had "put exposure dose on the front burner in terms of marketing CT units." "Marketing," of course, is a euphemistic reference to sales. What Mr. Fox was saying was that if manufacturers want to sell CT units, the manufacturers have to do something about the radiation exposure dose—manufacturers realize that they can make money if they lower the radiation exposure dose. Now, that's the way to get their attention—that's the American way!
Confession is good for the soul. It is definitely good for the souls who perform CT to learn that manufacturers now recognize that they themselves must confront the issue of radiation exposure to patients from CT. When it comes to exposure dose in CT, everyone involved now appears to be on the same page: lower is better.
Having said that, we radiologists and our physicist colleagues must recognize that we are not blameless in regard to radiation exposure doses in CT. In all honesty, we would have to confess that most of us, with the exception of some pediatric radiologists, had not given CT exposure doses much thought. (Admittedly, the European radiology community was way ahead of us here.) We were lulled into thinking that our past efforts had made the use of X rays as safe as they could possibly be—and besides that, the diagnostic information provided by CT is invaluable and, in many ways, unique, and definitely worth whatever radiation dose is required.
It takes quite a commotion to arouse people from a collective torpor such as the radiology profession found itself in with regard to exposure doses in CT. Brenner et al. [1] furnished the explosion required to arouse the profession from its collective lethargy when pronouncing that exposure doses used for CT in children could lead to an increased incidence of cancer.
In retrospect, it all seems so obvious. What were we thinking? How could we allow such a thing to happen? Where's the scapegoat? Who's to blame? No one and everyone; there is enough blame to go around.
But now let us direct our attention to seeing that the radiation exposure dose from CT is reduced—reduced through the collective efforts of radiologists, physicists, and equipment manufacturers.
For now, the investigation of radiation exposure dose from CT is far from over. How low can we go? How much more can radiation exposure doses be lowered? Let's find out. Get together with physicists. Develop a research plan. Work on it. We here at the AJR will be happy to publish the results of your labors.
References
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