Interim Recommendations to Limit Radiation Exposure from CT Scans

I wrote an article roughly one year ago addressing the use of CT scans to image the brains of children who suffered mild head trauma. In the article (link here) I argued the CT scans of the brain are overused in children who show no evidence of concussion on physical exam and thus are at a very low risk for complications like bleeding or coma. The point of the article was to warn parents of the potential risks involved in CT scanning, especially in children. Children have a long life ahead of them and as a result are more likely to experience side effects from x-ray radiation that are adults. The article suggested that CT scans only be used on cases where physical exam findings demonstrate neurologic signs that would indicate a possible bleed, bruise, or contusion in the brain.

Recently, two findings have brought to light the dangers of CT scanning the side-effects that can be suffered from elevated doses of x-ray radiation. The first of these findings was published in an article in the Archives of Internal Medicine in December of 2009. The article (link here) indicated that roughly 29,000 cancers will result from the CT scans performed in 2007 alone. In other words, one year worth of CT scans in the United States is enough to produce 29,000 new cancers in the future. Fifteen percent of those cancers will result from scans performed in children under the age of 18 and fully 2/3 will occur in women.

The next finding comes from a long-term investigation made by the FDA into 206 cases of radiation poisoning that occurred over an 18-month period in patients who underwent perfusion brain imaging via CT scan at Cedar-Sinai Hospital in Los Angeles (link here). These patients suffered scalp burns and hair loss and are at extremely high risk of developing head and neck cancer as a result.

While the findings of the FDA are limited to the Cedar-Sinai Hospital in this case, patients are at risk of radiation over-exposure due to poor practice and over-utilization of CT scanning in many locations. CT scanners use x-ray technology to obtain images of the internal organs and certain physiological processes. This is an extremely useful tool to physicians and patients alike, but it is not a benign process. In developed countries, doctors have become overly reliant on imaging technology to help them weed out both difficult and mundane diagnoses. At the same time, patients are almost demanding an X-ray, CT, or MRI every time they visit the doctor and feel cheated if they are not scanned. Medical imaging, especially that which uses x-ray radiation (X-ray and CT), is not without risk. As patient you depend on the machine to operate correctly and the personal to perform their jobs thoroughly and carefully. The point is not that one should not undergo CT scanning or receive and X-ray, but that one should weigh the risks and benefits carefully, especially in the case of young children. Many diagnoses can be reached without imaging. Every exposure is a potential risk and one that should not be taken lightly.

RESOURCES

Gonzalez AB, et. al. Projected Cancer Risks from Computed Tomographic Scans Performed in the United States in 2007. Arch Intern Med. 2009;169(22):2071-2077

http://archinte.ama-assn.org/cgi/content/full/169/22/2071?home

FDA Makes Interim Recommendations to Address Concern of Excess Radiation Exposure during CT Perfusion Imagaing. Dec. 7, 2009. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm193190.htm