COMMENTARY

Rita Redberg on Excess Use of Radiation Imaging Tests

Rita F. Redberg, MD

Disclosures

February 20, 2014

In This Article

Younger Patients and Cumulative Exposure

In pediatrics, it's especially important to think carefully about the use of imaging tests. We have more and more CT scanners, we have really good imaging, and we have gotten used to using imaging when we're evaluating patients. But the risks of radiation are greatest in younger people, and recent data suggest that our use of CT scans in particular in people aged 20-35 years and even in the pediatric age group has increased significantly.

Certainly, there will be cases where a CT scan is necessary, but we have to really think very carefully about risks and benefits, because there is a much higher lifetime risk for cancer when we use CT scans in younger people. In addition, we have to assess whether we have a truly informed consent process with parents of pediatrics patients.

In the same issue of Archives of Internal Medicine as the article that I mentioned previously on reduced imaging exposure, there was an article by Amy Berrington de González and colleagues from the National Cancer Institute estimating cancer risks from CT scans.[3] Their base year at that time was 2007, and they estimated that there would be 30,000 additional cases of cancer from the CT scans in 2007 alone, resulting in 15,000 excess deaths. After that article was published in Archives of Internal Medicine, we got a lot of emails. (Editor's note: Dr. Redberg is the editor of JAMA Internal Medicine, formerly Archives of Internal Medicine.)

I wrote an editorial in that issue,[4] and the emails that were the most touching came from parents of children who had recently had one or multiple CT scans for various kinds of stomach pains, as I remember, but there were lots of different instances. These parents, of course, were racked with worry and guilt, and we reassured them that the radiation exposure from one test is only a small amount. But I think what we need to remember as a profession is that these tests add up. We need to be sure that we can feel good that for the tests we order, the benefits do outweigh the risks, particularly in children.

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