I am writing in response to your editorial and article in the August 2006 issue regarding radiation dose concerns ("Soaring CT use may prompt need for long-term dose monitoring," page 5, and "Meetings present strategies for lowering dose loads," page 19). The use of MRI as a replacement for many CT indications would also prove beneficial. In particular, with more rapid body imaging, MR can replace CT of the abdomen and pelvis in regard to the solid organs and hollow viscera. In Europe, for example, imaging of inflammatory bowel disease has recently been outlined in the literature.
The root cause of excessive initial imaging and reimaging needs to be addressed as well. Referring clinicians are being held hostage to medicolegal concerns when ordering endless "rule-out studies." Radiologists often subsequently find an "incidentaloma" that is unlikely to be of clinical significance but is followed with CT surveillance as our litigious society demands.
Finally, the excessive imaging that is necessitated by frivolous lawsuits may lead to a new wave of future class-action claims replacing those related to asbestos and silicone breast implants. I would not be surprised a decade from now to hear the following in a late-night commercial: "Have you ever had a CAT scan? Do you have cancer? Call 1-800-DOCTORSUE. You may be entitled to a large cash settlement from the equipment manufacturers, hospitals, imaging centers, and radiologists who knowingly exposed you to radiation despite the National Toxicology Program classifying x-rays as a known human carcinogen in 2005."
I am pessimistic that lobbying for true tort reform will be effective while the three branches of government are populated by a large number of lawyers. In the meantime, we need to develop national standards to inform our patients about ALARA and educate our referring physicians on American College of Radiology appropriateness criteria.
-Paul S. Needelman M.D.
Great Neck, NY