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Radiology faces inconvenient truth of inappropriate use of MSCT


It dawned on me as I listened to former Vice President Al Gore accept the Nobel Peace Prize that radiology is dealing with its own inconvenient truth.

It dawned on me as I listened to former Vice President Al Gore accept the Nobel Peace Prize that radiology is dealing with its own inconvenient truth.

Global warming and radiation-related cancers from CT are similar. Both result from the use of technologies that simultaneously help and threaten life. The internal combustion engine, petroleum, and coal led to economic prosperity while releasing carbon dioxide responsible for global warming. Multislice CT increases the diagnostic power of medical imaging, while its inappropriate application sets the stage for a possible radiation-induced cancer crisis.

The political and industrial forces with vested interests in perpetuating the status quo are powerful in both areas, but the relative strength of the arguments favoring action to combat global warming and CT-related radiation exposure differ. With prodding by Al Gore, nearly everyone now agrees that evidence pointing to global warming is incontrovertible. Attention has shifted toward strengthening the consensus on how to conduct the fight. For MSCT, radiologists agree that utilization is growing rapidly and that inappropriate use occurs frequently, but they disagree about the degree to which these trends will ultimately affect cancer incidence and mortality.

Yet the perspective expressed by Gore in his acceptance speech applies to both situations.

"Make no mistake, the next generation will ask us one of two questions," he said. "Either they will ask. 'What were you thinking; why didn't you act?' Or they will ask instead, 'How did you find the moral courage to rise and successfully resolve the crisis that so many said was impossible to solve?'"

Radiologists should ask themselves these questions whenever they are asked to perform a CT scan that they know will not benefit their patient. Will you refuse to unnecessarily expose patients to ionizing radiation in these situations, or will you do the procedure anyway? The fate of the planet may not change because of your decisions, but the courage of your conviction could save lives.

Mr. Brice is senior editor of Diagnostic Imaging.

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