Dr. U. Joseph Schoepf, professor of radiology and medicine at the Medical University of South Carolina, refutes the latest reports in the December 14/28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals, on cancer risks from CT scans.

The health-care reform debate is heating up on the Hill and the hordes brawling for the redistribution of our increasingly limited health-care funds are coming out again. They are armed with pocket calculators and 50-year old data on atomic bomb survivors. They claim “known risks of radiation” and that “the large doses of radiation from [CT] scans will translate, statistically, into additional cancers” creating a “public health time bomb”. Such statements are intended to create fear, but their line of logic breaks down due to the simple fact that a connection between radiation from medical imaging and cancer has never been established. On the contrary, while the numbers of medical imaging procedures are clearly on the rise, the mortality rates from cancer are dramatically dwindling in step. According to a recent analysis by the National Bureau of Economic Research (Lichtenberg 2009), life expectancy increased more rapidly in states where the fraction of advanced diagnostic imaging procedures increased more rapidly. Such observations are conveniently ignored in this and related publications.

However, there are aspects to the current debate on radiation exposure that should give us pause. The individual assessment of the risk benefit ratio for each patient when considering an imaging study and the commitment to reduce radiation as much as possible are long held core principles of our profession as a whole and of the American College of Radiology in particular. Over-utilization of medical imaging unfortunately does occur; however, it is well recognized that this is not driven by radiologists, but by other medical specialties who perform imaging in their offices. There is indeed a need for greater transparency and involvement of the patient in the decision process that leads up to an imaging study. However, this should not be pursued with the ulterior motive of scaring patients out of an indicated imaging test by raising the specter of radiation risk, but rather by explaining the expected benefits and discussing the current uncertainties surrounding radiation from medical imaging.