In the first part of this decade, the volume of diagnostic x-ray procedures in the United States increased by one third and the number of medical facilities providing such services increased by almost 40%. Within the larger number, the volume of computed tomography (CT) procedures increased from 3 million per year in 1980 to 60 million in 2005. The number of nuclear medicine examinations came to 20 million and rising.
Along with these increases came comparable growth in the amount of money spent to pay for them and the amount of radiation absorbed by patients and, in some cases, physicians and technologists. The total medical radiation dose for Americans now is almost as large as the dose from background radiation. To put this another way, since the discovery of x-rays and the beginning of their medical uses, the population dose has about doubled over 110 years.
In the past few years, we have seen an increasing expression of concern about global warming from the consumption of hydrocarbons. The ozone hole grew as a result of certain chemical overuses. Should we include ionizing radiation exposure as another threat to civilization? Background radiation is not a threat. When we contemplate nuclear weapons, that is a threat. But what about other uses? And, if so, what should be done about the harm from radiation exposures?
Even the most scornful critics will admit that the contributions of diagnostic x-ray techniques are vital to modern medicine. Where does this put the cost benefit ratio? Can we get the benefits while reducing the risks?
In April, the National Council on Radiation Protection and Measurements devoted its annual meeting program to medical radiation uses and their hazards. A month later, an American College of Radiology blue ribbon committee published a white paper identifying areas of concern and suggestions as to remedial actions. The pages of most radiology journals in recent years have contained papers about radiation problems caused by the growing use of multislice, multidetector helical CT scanners and by the use of fluoroscopy in image-guided procedures.
In effect, the century-old effort to make x-ray procedures safer and to reduce exposures has spun off in the other direction. Are Americans receiving too many x-ray procedures? Which of those procedures are safe and effective? There are still arguments about the optimal age at which women should begin periodic screening mammograms. Several current major studies contest the value of CT examinations for early lung cancer detection. A few years ago, we experienced a spate of freestanding imaging centers offering whole-body CT scans to the worried well and wealthy.
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