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Education And Debate

Sustainability of medical imaging

BMJ 2004; 328 doi: (Published 04 March 2004) Cite this as: BMJ 2004;328:578
  1. Eugenio Picano, senior medical researcher (
  1. Consiglio Nazionale delle Ricerche, Institute of Clinical Physiology, Via Moruzzi 1, 56124 Pisa, Italy
  • Accepted 20 January 2004

Doctors and patients should be more aware of the long term risks of radiological investigations

Contemporary medicine relies heavily on radiological and mediconuclear investigations and procedures. However, the often essential information derived from such investigations is obtained at a risk that few doctors are fully aware of. Increased awareness among both doctors and patients would help reduce the number of inappropriate examinations and the avoidable biological burden on current and future generations. In this article, I outline the effect of ionising testing in our society, review the possible detrimental public health effect based on current estimates of risk, and discuss simple ways of achieving a more cautious approach.

Exposure to medical radiation

Use of radiation for medical examinations and tests is the largest manmade source of radiation exposure. The biological effect of radiation dose received is expressed in milliSievert (mSv). According to the latest estimation of the United Nations, an average of 2.4 mSv/year comes from natural sources.1 The medical sources of radiation were about one fifth of the natural radiation in 1987,2 close to half in 1993,3 and almost 100% of natural radiation in 1997 in most affluent countries (fig 1).4 In 1997, the German Federal Office for Radiation Protection reported 136 million x ray examinations and 4 million nuclear medicine diagnostic tests, resulting in a mean effective dose of 2.15 mSv per person per year.4

Fig 1

Medical and natural sources of radiation

Embedded Image

3 Dimensional reconstruction of child's head from computed tomography data


The use of procedures with a high load of radiation continues to grow steadily.5 The medical sources of radiation in industrialised countries may therefore soon be greater than natural sources. Ivan Illich wrote in 1976 (at the …

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