In the realm of modern medicine, the balance between the benefits and risks of diagnostic imaging, particularly CT scans, has become a pressing concern. While these scans can be lifesaving diagnostic tools, there is increasing evidence suggesting that their overuse may expose patients to unnecessary radiation, potentially elevating their risk of developing cancer.

The overwhelming reliance on high-tech imaging stems, in part, from a deep-seated fear—fear of missing critical diagnoses. As one physician candidly reflects, the medical imperative often seems to lean towards comprehensive testing rather than judicious application. This approach has resulted in significant increases in CT scan utilisation; statistics reveal that in the UK alone, over seven million CT scans are performed annually. The implications are profound when considering that each scan utilises ionising radiation, which can damage DNA cells and contribute to mutation over time.

In the US, a recent study published in JAMA Internal Medicine estimated that the 93 million CT scans performed in 2023 could lead to over 100,000 new cancer cases, accounting for around 5% of new cancer diagnoses. Although this data pertains to the US, its relevance to UK practice is heightened by similar trends in scanning rates and technologies. Notably, abdominal and chest scans have been identified as particularly high-risk procedures.

Growing evidence supports the assertion that the risk is even more pronounced in younger patients. A comprehensive analysis involving nearly one million individuals who underwent CT scans before age 22 revealed a concerning association between exposure to radiation from these scans and heightened risk of blood cancers. Remarkably, the risk of developing such malignancies increased significantly with varying radiation doses, suggesting that even a single CT scan could result in an increased risk of developing a serious condition.

This growing body of research highlights the need for a reevaluation of established protocols surrounding the utilisation of CT scans, especially in paediatric care. Experts recommend that physicians rigorously assess the necessity of a CT scan before proceeding and consider alternative diagnostic methods when feasible. This is especially true in cases of suspected head trauma, where studies indicate a link between radiation exposure from CT imaging and subsequent brain cancer, indicating a potential case of ‘doing harm’ under the guise of thoroughness.

Comments from medical professionals underscore the importance of engaging patients in dialogues about potential risks associated with imaging. One physician recounted making decisions on whether to proceed with scans during a night shift, opting against unnecessary radiation exposure for two patients who presented with low-risk conditions. These crucial choices illuminate the moral and ethical dimensions faced by practitioners, who must weigh immediate diagnostic benefits against long-term health outcomes.

While the case for breast screening via mammography has been mentioned as a critical preventive measure that can save lives despite some risk, the consensus is clear: a cultural shift is necessary within the medical community. More thoughtful consideration of scan requisitions is paramount. As highlighted by recent studies, a significant proportion of patients may be subjected to cancer-inducing radiation without any clear clinical justification. The path forward demands not just vigilance but also an evolving perspective on patient care—one that prioritises informed consent and holistic assessments.

In the quest for effective healthcare, the message is clear: every CT scan must not only be justified but also managed with the utmost prudence, ensuring that the primacy of "do no harm" is not merely a principle, but a practice ingrained in the fabric of medical decision-making.

Reference Map

  1. Paragraphs 1, 2, 3, 4, 5, 6, 7: 1, 3, 4, 5
  2. Paragraph 2, 5: 2, 7
  3. Paragraph 5, 6: 6
  4. Paragraph 3, 7, 8: 3, 4, 5

Source: Noah Wire Services