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Benefits Versus Risks of Computed Tomography: Tipping the Balance

Schoepf, U. Joseph MD, FAHA* †

Journal of Thoracic Imaging: May 2010 - Volume 25 - Issue 2 - p 97
doi: 10.1097/RTI.0b013e3181e0f8fc
Editor's Section

*Department of Radiology and Radiological Science; and †Division of Cardiology

Department of Medicine, Medical University of South Carolina, Charleston, SC

Dr Schoepf is a consultant for and receives research support from Bayer-Schering, Bracco, General Electric, Medrad, and Siemens.

Reprints: U. Joseph Schoepf, MD, FAHA, Department of Medicine, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive, MSC 226, Charleston, SC 29425 (e-mail:

People losing their hair after computed tomography (CT) brain perfusion scans. A child receiving more than 100 neck CT scans due to a technologist's error. Doomsday predictions of thousands of cancer deaths from radiation during medical imaging. For the casual observer, our profession must cast a rather Frankenstein-esque picture right now; these may seem like inopportune times for the publication of a special Journal of Thoracic Imaging (JTI) symposium on advances in CT, which many see as the main culprit of rising radiation exposure.

Understandably, our patients and our colleagues in the greater field of medicine are startled and scared by the prominent broadcasting of such news in the lay and professional media. Explaining the benefits and risks of medical imaging to my patients and my referring physicians is increasingly becoming a considerable part of my job. Mostly, I rather appreciate and welcome this aspect, as it gives me the opportunity to interact more with my patients, thus raising the profile and public awareness of our profession's invaluable contributions to patient care.

What can we do to stem the tide of biased and undifferentiated reporting on radiation risks from medical imaging, which holds the danger of undermining the very foundations of our profession? It would be desirable to demonstrate that there is no risk involved with the levels of radiation applied at medical imaging. Unfortunately, considering the natural incidence of cancer, this hypothesis is equally as impossible to substantiate as the opposing claim that radiation from medical imaging increases cancer risk.

However, there are 2 things that we can and must aim for: first, we need to rectify the distorted public perception of what we do. Currently, the discussion is unilaterally dominated by sensationalist radiation fear-mongering, which almost completely drowns out the recognition of the overwhelming benefits that noninvasive imaging provides to our patients and to healthcare as a whole on a daily basis. Vigorously highlighting and broadcasting these benefits vis-a-vis the public and our peers must become our first order of business. Compared with other medical specialties, radiology has, unfortunately, been slow to adopt the ever-more important principles of evidence-based medicine. Preoccupied by our fascination with our own technical prowess, we somehow forgot the need to unequivocally demonstrate improved outcomes and cost-effectiveness with the use of advanced imaging techniques, which makes our field needlessly vulnerable to attacks from partisan quarters. Focusing and realigning our research according to the tenets of evidence-based medicine is an absolute necessity for ensuring our continued relevance. Second, and this may be the easiest part, because of the uncertainties concerning the biologic effects of radiation from imaging, we must convincingly demonstrate our ability to change and drastically lower the radiation exposure involved with our techniques.

This current JTI symposium is a beautiful testimony to the ingenuity and poise of our field for furthering the cause of improving our patients' care. Experts from around the globe provide the most cutting-edge insights into the latest advancements in imaging techniques for battling thoracic disease with the least amount of radiation. Yes, we can continue our conquest of ever-newer territories to add to the realm of noninvasive imaging and we can do so while dispelling concerns over our use of radiation at the same time.

Our gratitude goes out to all the contributing authors and the editorial team, who did such an exquisite job to make this symposium issue the milestone that it has become for charting the future course of thoracic imaging. Our special thanks also to the Siemens Computed Tomography Division for their generous support, which greatly facilitated the production of this special symposium.

Along with Dr Phil Boiselle and the entire editorial team at JTI, it is my privilege to dedicate this symposium issue in memory of Dr Jud Gurney, a renowned chest radiologist, educator, and scholar. I would also like to bring to your attention an “In Memoriam” article on the following page that is authored by his longtime friend and colleague, Dr Gerry Abbott.

© 2010 Lippincott Williams & Wilkins, Inc.