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BMJ 2007; 335 doi: (Published 06 December 2007) Cite this as: BMJ 2007;335:1178

Computed tomography could be a risk to public health

Computed tomography (CT) generates ionising radiation, so each scan carries a small but detectable increase in the lifetime risk of cancer. For most people, the diagnostic benefit of a scan outweighs the risk, but at least two experts are getting worried about the effects on the US population of a sharp rise in the use of computed tomography for diagnosis and screening. They estimate that 1-2% of all cancers in the US are attributable to radiation from CT scans.

Children are particularly vulnerable. They are more radiosensitive than adults and have more remaining years of life in which to develop cancer. In the US, 6-11% of scans are performed in children, often to diagnose or rule out appendicitis. Ultrasound might be a better option, say the experts. Other questionable uses of CT, particularly multiple scans, include the investigation of seizures, chronic headaches, or blunt trauma. Using CT defensively is even harder to justify, but not uncommon.

Anecdotal evidence indicates that up to a third of CT scans could be replaced by other diagnostic tests, or not done at all, say the experts. If that is true, about 20 million adults and more than a million children in the US are irradiated unnecessarily each year.

High trauma fractures can be associated with osteoporosis

If an older woman broke her wrist falling from a standing height or less she would be investigated for osteoporosis. If the same woman broke her wrist in a car crash she wouldn’t because the received wisdom is that “high trauma” fractures are not linked to bone mineral density. Researchers from the US recently put this wisdom to the test and found it to be wrong. Analysis of data from two large cohorts showed a clear, independent, and statistically significant association between low bone mineral …

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