Imaging Pearls ❯ Radiation Dose ❯ ACR and Radiation Dose Issues
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- CONCLUSIONS AND RELEVANCE This study found that at current utilization and radiation dose levels, CT examinations in 2023 were projected to result in approximately 103 000 future cancers over the course of the lifetime of exposed patients. If current practices persist, CT-associated cancer could eventually account for 5% of all new cancer diagnoses annually.
Projected Lifetime Cancer Risks From Current Computed Tomography Imaging
Rebecca Smith-Bindman et al.
JAMA Intern Med. doi:10.1001/jamainternmed.2025.0505 - Question How many future cancers could result from radiation exposure from annual computed tomography (CT) examinations in the United States?
Findings In this risk model, the 93 million CT examinations performed in 62 million patients in 2023 were projected to result in approximately 103,000 future cancers. Although the per-examination cancer risk was higher in children, higher CT utilization among adults accounted for the majority of the projected cancers.
Meaning These findings suggest that if current radiation dosing and utilization practices continue, CT-associated cancers could eventually account for 5% of all new cancer diagnoses annually.
Projected Lifetime Cancer Risks From Current Computed Tomography Imaging
Rebecca Smith-Bindman et al.
JAMA Intern Med. doi:10.1001/jamainternmed.2025.0505 - “This study has several strengths, including detailed data on CT utilization and associated radiation dose, detailed calculation of risks with uncertainty limits, and sensitivity analyses that provide a range of estimates under widely varying assumptions. There are several limitations: first, the BEIR VII risk estimated model parameters are based primarily on the Japanese survivor outcomes, and questions remain about the transfer of radiation risks from the mid-20th century Japanese population to the current US population.”
Projected Lifetime Cancer Risks From Current Computed Tomography Imaging
Rebecca Smith-Bindman et al.
JAMA Intern Med. doi:10.1001/jamainternmed.2025.0505 - “Second, our risk calculations factored in average life expectancies, and the degree to which patients who undergo CT have shorter life expectancy due to underlying illness may overestimate future cancer risk. However, we excluded on average 10.6% of CTs that were likely performed during the last year of life, given these patients are not at risk of a radiation-induced cancer. A recent analysis found that 9.6% of patients who undergo CT died within 1 year, similar to our estimate. Third, while the CT categorization algorithm was 90% accurate compared with expert review, some examinations in the registry may have been miscategorized; however, this is unlikely to significantly impact our results.”
Projected Lifetime Cancer Risks From Current Computed Tomography Imaging
Rebecca Smith-Bindman et al.
JAMA Intern Med. doi:10.1001/jamainternmed.2025.0505 - “In this study, approximately 5% of annual cancer diagnoses or 100000 cancers were projected to result from CT utilization in 2023. Despite public attention to the potential adverse effects, CT use has grown significantly in the United States since 2009. In 2023, 93 million CT examinations were performed in the United States, in 2007, the number was 68.7 million—a 35% increase incompletely explained by population growth.38 Justification of use and optimization of dose, including consideration of the need for multiphase examinations, are the tenets of CT imaging and must be applied uncompromisingly to mitigate potential harm.”
Projected Lifetime Cancer Risks From Current Computed Tomography Imaging
Rebecca Smith-Bindman et al.
JAMA Intern Med. doi:10.1001/jamainternmed.2025.0505 - Use of computed tomography was once relatively rare. In the 1980s, approximately 3 million CT scans were performed annually.2 The marked growth of computed tomography— about 30-fold over 40 years—reflects its diagnostic value. CT scanning is accurate, quick, well-tolerated, and relatively inexpensive. Its success as an imaging modality is also what makes it so challenging to constrain. CT has become essential to the diagnostic process for many serious conditions, from trauma to cancer. Emergency departments and hospitals have come to rely on prompt and accurate diagnosis for efficient patient flow and management. Patients likewise expect timely and accurate diagnoses. CT is now inextricably woven into the fabric of modern medicine.
Balancing Computed Tomography's Benefits With Radiation Risks.
Richman IB, Katz MH.
JAMA Intern Med. 2025 Apr 14. doi: 10.1001/jamainternmed.2025.0514. Epub ahead of print. PMID: 40227674. - How, then, might we balance the benefits of CT with its risks? As with all complex problems, there will be no simple solution. First, despite our reliance on CT, physician behavior is still malleable, and specific interventions designed to Reducing low-yield CT use has been effective. For example, Incorporating diagnostic algorithms at the point of care can reduce CT use among low-risk patients, A process that can be facilitated with artificial intelligence and informatics. Offering alternative imaging modalities that do not use ionizing radiation, including ultrasound and magnetic resonance Imaging can also be useful—a strategy that has been particularly successful in pediatrics, where computed tomography use is rare.
Balancing Computed Tomography's Benefits With Radiation Risks.
Richman IB, Katz MH.
JAMA Intern Med. 2025 Apr 14. doi: 10.1001/jamainternmed.2025.0514. Epub ahead of print. PMID: 40227674. - Third, reducing radiation dose, such as with digitization, and reducing variation in radiation technique and dose with standardization and training across imaging centers can mitigate risk. Lastly, educating clinicians about avoiding low-value testing and, in circumstances where alternatives are readily available, involving patients in the decision to do a CT scan may help shift culture and practice.
Balancing Computed Tomography's Benefits With Radiation Risks.
Richman IB, Katz MH.
JAMA Intern Med. 2025 Apr 14. doi: 10.1001/jamainternmed.2025.0514. Epub ahead of print. PMID: 40227674.
- What can you do in your practice today
-Tube current selection is now controlled by automatic tube current modulation systems that automatically adjust tube output to a desired operator selected image noise level. This alone can reduce dose by up to 77%
-Tube voltage selection can substantially decrease dose when going from 140 to 120, or from 120 to 100 mAs (4th power). You may need to increase mAs to maintain quality in these cases. Lower tube voltage will often lower the volume of contrast needed especially in CTA studies - The ACR recommendations addressed all parties
- Referring physician- educate about radiation exposure
- Radiologists- increase resident training in regards to dose, develop radiation dose modules as part of MOC, make CT protocols more available, encourge group to develop safety teams
- Technologists- increased in service training, require each site have at least 1 tech with advanced registry in CT
- Patients- work with patient advocacy groups to provide the facts
- Medical physicists- more training of non-radiologists who use radiation and of retraining radiologists
- Vendors- work with NEMA to ensure ALARA is followed, develop standardized ways to measure and display dose
- Regulatory agencies- work closely with FDA and NRC to combine efforts, encourage more regulations on use of radiation but do it uniformly - The ACR recommendations addressed all parties
- Referring physician
- Radiologists
- Technologists
- Patients
- Medical physicists
- Vendors
- Regulatory agencies " In a 2009 paper, Fazel et al showed that myocardial perfusion imaging alone contributed to >22% of the total effective dose from medical imaging studies, while CT of the abdomen, pelvis, and chest accounted for nearly 38%."
ACR White Paper on Radiation Dose in Medicine: Three Years Later
Amis Jr ES, Butler PF
J Am Coll Radiol 2010;7:865-870"Since the publication of the white paper, 30 of the 37 recommendations have been completed or are in progress."
ACR White Paper on Radiation Dose in Medicine: Three Years Later
Amis Jr ES, Butler PF
J Am Coll Radiol 2010;7:865-870"The ACR, an advocate for radiation safety since its inception in 1924, convened the ACR Blue Ribbon Panel on Radiation Dose in Medicine in 2006 and issued 37 recommendations for the College to address these issues. This report updates the status of these recommendations."
ACR White Paper on Radiation Dose in Medicine: Three Years Later
Amis Jr ES, Butler PF
J Am Coll Radiol 2010;7:865-870- "Although data derived from the atomic bomb survivors in Japan and other events suggest that the expanding use of imaging modalities using ionizing radiation may eventually result in an increased incidence of cancer in the exposed population, this problem can likely be minimized by preventing the inappropriate use of such imaging and by optimizing studies that are performed to obtain the best image quality with the lowest radiation dose."
American College of Radiology White Paper on radiation Dose in Medicine
Amis ES et al.
J Am Coll Radiol 2007;4:272-284 - "this problem can likely be minimized by preventing the inappropriate use of such imaging and by optimizing studies that are performed to obtain the best image quality with the lowest radiation dose."
American College of Radiology White Paper on radiation Dose in Medicine
Amis ES et al.
J Am Coll Radiol 2007;4:272-284