In defense of body CT

Department of Radiology, Mayo Clinic, 200 First St. SW, East-2 Mayo Bldg., Rochester, MN 55905, USA.
American Journal of Roentgenology (Impact Factor: 2.74). 08/2009; 193(1):28-39. DOI: 10.2214/AJR.09.2754
Source: PubMed

ABSTRACT OBJECTIVE: Rapid technical developments and an expanding list of applications that have supplanted less accurate or more invasive diagnostic tests have led to a dramatic increase in the use of body CT in medical practice since its introduction in 1975. Our purpose here is to discuss medical justification of the small potential risk associated with the ionizing radiation used in CT and to provide perspectives on practice-specific decisions that can maximize overall patient benefit. In addition, we review available dose management and optimization techniques. CONCLUSION: Dose reduction strategies described in this article must be well understood and properly used, but also require broad-based practice strategies that extend beyond the CT scanner console and default, generic manufacturer settings. In the final analysis, physicians must request the imaging examination that best addresses the specific medical question without allowing worries about radiation to dissuade them or their patients from obtaining needed CT examinations. Ongoing efforts to ensure that CT examinations are both medically justified and optimally performed must continue, and education must be provided to the medical community and general public that put both the potential risks--and benefits--of CT examinations into proper perspective.

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    • "Vertebral trabecular BMD is significantly correlated with vertebral fracture [10]. Worldwide, the number of subjects undergoing thoracic and abdominal CT examinations has increased dramatically over the last two decades [8] [12]. In an age-and sex-stratified population sample of 541 women and 490 men aged 17 to 88 years, we examined the relationship between vertebral trabecular volumetric BMD (vBMD) and age [13]. "
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    International Journal of Endocrinology 03/2013; 2013(4):213234. DOI:10.1155/2013/213234 · 1.52 Impact Factor
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    • "Worldwide, many tens of thousands of thoracic and abdominal CT examinations are performed daily on clinical patients [16]. Several recent studies have shown how it is possible to obtain meaningful QCT BMD data from patients undergoing thoracoabdominal CT examinations for other clinical reasons without the use of a calibration phantom. "
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    ABSTRACT: Recent advances in computed tomographic (CT) scanning technique such as automated tube current modulation (ATCM), optimized x-ray tube voltage, and better use of iterative image reconstruction have allowed maintenance of good CT image quality with reduced radiation dose. ATCM varies the tube current during scanning to account for differences in patient attenuation, ensuring a more homogeneous image quality, although selection of the appropriate image quality parameter is essential for achieving optimal dose reduction. Reducing the x-ray tube voltage is best suited for evaluating iodinated structures, since the effective energy of the x-ray beam will be closer to the k-edge of iodine, resulting in a higher attenuation for the iodine. The optimal kilovoltage for a CT study should be chosen on the basis of imaging task and patient habitus. The aim of iterative image reconstruction is to identify factors that contribute to noise on CT images with use of statistical models of noise (statistical iterative reconstruction) and selective removal of noise to improve image quality. The degree of noise suppression achieved with statistical iterative reconstruction can be customized to minimize the effect of altered image quality on CT images. Unlike with statistical iterative reconstruction, model-based iterative reconstruction algorithms model both the statistical noise and the physical acquisition process, allowing CT to be performed with further reduction in radiation dose without an increase in image noise or loss of spatial resolution. Understanding these recently developed scanning techniques is essential for optimization of imaging protocols designed to achieve the desired image quality with a reduced dose. © RSNA, 2014.
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