Below is an abstract and key points of the article “Understanding, justifying, and optimizing radiation exposure for CT imaging in nephrourology”, signed by Andrea Ferrero, Naoki Takahashi, Terri J. Vrtiska, Amy E. Krambeck, John C. Lieske & Cynthia H. McCollough. Check out:

Abstract

It is estimated that between 4 and 5 million CT scans are performed in the US each year to investigate nephrourological diseases such as urinary stones and kidney masses. Despite the clinical benefits of computed tomography imaging, concerns remain about the potential risks associated with exposure to ionizing radiation. To assess the potential risk of harmful biological effects of exposure related to ionizing radiation, it is essential to understand the mechanisms by which they occur, considering tissue damage and repair.

Although radiation level and cancer risk follow a linear association at high doses, no strong relationship is apparent at doses below 100 mSv, the same as commonly used in diagnostic imaging. In addition, the small theoretical increase in cancer risk should be considered in the context of the clinical benefit derived from a clinically indicated CT scan and the likelihood of cancer in the general population.

Eliminating unnecessary images is the most important method for reducing image-related radiation; however, the technical aspects of medically justified images should also be optimized so that the necessary diagnostic information is retained, minimizing the radiation dose.

Despite extensive work, concrete evidence is lacking demonstrating a markedly increased risk of neoplasia associated with radiation doses below ~ 100 mSv; However, concerns about ionizing radiation in medical imaging remain and may affect patient care. Overall, the principles of justification and optimization should remain the basis for clinical decision making regarding the use of ionizing radiation in medicine.

Key points

• CT scans are commonly performed in nephrourology, for indications including suspected stones and renal masses.

• Concerns have been raised regarding the potential harmful effects of exposure to radiation associated with CT scans; however, the dose associated with CT is <~100mSv and no harmful effects have been shown at these low doses.

• Even taking the very low potential risk of malignancy into account, such a risk must be considered in the context of the clinical benefit of performing the scan, and elimination of unnecessary CT examinations is the first step towards managing risk.

• Optimization of the scanning technique is essential, so that the necessary clinical information can be gathered with minimization of the radiation dose.

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