4.7 Review

Imaging strategies to reduce the risk of radiation in CT studies, including selective substitution with MRI

Journal

JOURNAL OF MAGNETIC RESONANCE IMAGING
Volume 25, Issue 5, Pages 900-909

Publisher

WILEY
DOI: 10.1002/jmri.20895

Keywords

computed tomography; ionizing radiation; cancer risks; MRI; patient safety

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Computed tomography (CT) is one of the largest contributors to man-made radiation doses in medical populations. CT currently accounts for over 60 million examinations in the United States, and its use continues to grow rapidly. The principal concern regarding radiation exposure is that the subject may develop malignancies. For this systematic review we searched journal publications in MEDLINE (1966-2006) using the terms CT, ionizing radiation, cancer risks, MRI, and patient safety. We also searched major reports issued from governmental U.S. and world health-related agencies. Many studies have shown that organ doses associated with routine diagnostic CT scans are similar to the low-dose range of radiation received by atomic-bomb survivors. The FDA estimates that a CT examination with an effective dose of 10 mSv may be associated with an increased chance of developing fatal cancer for approximately one patient in 2000, whereas the BEIR VII lifetime risk model predicts that with the same low-dose radiation, approximately one individual in 1000 will develop cancer. There are uncertainties in the current radiation risk estimates, especially at the lower dose levels encountered in CT. To address what should be done to ensure patient safety, in this review we discuss the as low as reasonably achievable (ALARA) principle, and the use of MRI as an alternative to CT.

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