Clinical Scorecard: Evaluating the Advantages and Risks of Computed Tomography: Insights from the EuroSafe Imaging Initiative of the European Society of Radiology
At a Glance
Category
Detail
Condition
Use of Computed Tomography (CT) imaging and associated ionizing radiation exposure
Key Mechanisms
CT imaging exposes patients to ionizing radiation which can increase cancer risk, particularly leukemia and brain tumors in children
Target Population
Patients undergoing CT scans, with particular attention to children and adults
Care Setting
Radiology departments and clinical settings where CT imaging is performed
Key Highlights
CT scans performed in 2023 in the U.S. are projected to cause about 103,000 future cancers, approximately 5% of all new cancer diagnoses annually.
Children exposed to CT scans have a small but statistically significant increased risk of leukemia and brain tumors; estimated 1–2 radiation-attributable cancers per 10,000 children scanned.
Adherence to radiation protection principles—justification and optimization—is critical to minimize unnecessary exposure and associated cancer risk.
Guideline-Based Recommendations
Diagnosis
Ensure every CT scan has a clear clinical indication based on benefit-risk analysis.
Consider alternative imaging modalities without ionizing radiation (e.g., ultrasound, MRI) especially in pediatric cases.
Management
Apply ALARA (As Low As Reasonably Achievable) principle to optimize scan protocols and minimize radiation dose.
Use modern CT technologies such as automated exposure control and iterative reconstruction to reduce dose without compromising diagnostic accuracy.
Radiologists should review and question scan requests that appear unjustified or excessively frequent.
Monitoring & Follow-up
Continuously update and audit CT protocols to incorporate latest dose-saving techniques.
Monitor justification rates and appropriateness of CT examinations to reduce variability and overuse.
Risks
Recognize that even though individual risk per scan is very low, cumulative population exposure can contribute to measurable cancer burden.
Communicate risks transparently but balanced to avoid undue patient alarm and maintain trust.
Be aware of potential media misinterpretation that may exaggerate CT-associated cancer risks.
Patient & Prescribing Data
Children and adults undergoing CT imaging
While absolute cancer risk from a single CT scan is very small, millions of scans contribute to population risk; thus, scans should only be performed when clinically justified and optimized for lowest dose.
Clinical Best Practices
Strictly adhere to justification criteria before ordering CT scans.
Prefer non-ionizing imaging alternatives when appropriate, especially in pediatric patients.
Implement and maintain dose optimization protocols using current CT technology.
Foster multidisciplinary collaboration between radiologists and referring physicians to ensure appropriate imaging use.
Communicate radiation risks to patients clearly, emphasizing low individual risk and safety measures in place.
