The advent of computed tomography (CT) has revolutionized diagnosticradiology. Since the inception of CT in the 1970s, its use hasincreased rapidly. It is estimated that more than 62 millionCT scans per year are currently obtained in the United States,including at least 4 million for children.1
By its nature, CT involves larger radiation doses than the morecommon, conventional x-ray imaging procedures (Table 1). Webriefly review the nature of CT scanning and its main clinicalapplications, both in symptomatic patients and, in a more recentdevelopment, in the screening of asymptomatic patients. We focuson the increasing number of CT scans being obtained, the associatedradiation doses, and the consequent cancer risks in adults andparticularly in children. Although the risks for any one personare not large, the increasing exposure to radiation in the populationmay be a public health issue in the future.
Table 1. Typical Organ Radiation Doses from Various Radiologic Studies.
CT and Its Use
The basic principles of axial and helical (also known as spiral)CT scanning are illustrated in Figure 1. CT has transformedmuch of medical imaging by providing three-dimensional viewsof the organ or body region of interest.
A motorized table moves the patient through the CT imaging system. At the same time, a source of x-rays rotates within the circular opening, and a set of x-ray detectors rotates in synchrony on the far side of the patient. The x-ray source produces a narrow, fan-shaped beam, with widths ranging from 1 to 20 mm. In axial CT, which is commonly used for head scans, the table is stationary during a rotation, after which it is moved along for the next slice. In helical CT, which is commonly used for body scans, the table moves continuously as the x-ray source and detectors rotate, producing a spiral or helical scan. The illustration shows a single row of detectors, but current machines typically have multiple rows of detectors operating side by side, so that many slices (currently up to 64) can be imaged simultaneously, reducing the overall scanning time. All the data are processed by computer to produce a series of image slices representing a three-dimensional view of the target organ or body region.
The use of CT has increased rapidly, both in the United Statesand elsewhere, notably in Japan; according to a survey conductedin 1996,2 the number of CT scanners per 1 million populationwas 26 in the United States and 64 in Japan. It is estimatedthat more than 62 million CT scans are currently obtained eachyear in the United States, as compared with about 3 millionin 1980 (Figure 2).3 This sharp increase has been driven largelyby advances in CT technology that make it extremely user-friendly,for both the patient and the physician.
Figure 2. Estimated Number of CT Scans Performed Annually in the United States.
The most recent estimate of 62 million CT scans in 2006 is from an IMV CT Market Summary Report.3
Common Types of CT Scans
CT use can be categorized according to the population of patients(adult or pediatric) and the purpose of imaging (diagnosis insymptomatic patients or screening of asymptomatic patients).CT-based diagnosis in adults is the largest of these categories.(About half of diagnostic CT examinations in adults are scansof the body, and about one third are scans of the head, withabout 75% obtained in a hospital setting and 25% in a single-specialtypractice setting.1) The largest increases in CT use, however,have been in the categories of pediatric diagnosis4,5 and adultscreening,6,7,8,9,10,11,12,13 and these trends can be expectedto continue for the next few years.
The growth of CT use in children has been driven primarily bythe decrease in the time needed to perform a scan — nowless than 1 second — largely eliminating the need foranesthesia to prevent the child from moving during image acquisition.4The major growth area in CT use for children has been presurgicaldiagnosis of appendicitis, for which CT appears to be both accurateand cost-effective — though arguably no more so than ultrasonographyin most cases.14 Estimates of the proportion of CT studies thatare currently performed in children range between 6% and 11%.1,15
A large part of the projected increase in CT scanning for adultswill probably come from new CT-based screening programs forasymptomatic patients. The four areas attracting the most interestare CT colonography (virtual colonoscopy6,7), CT lung screeningfor current and former smokers,8,9,10 CT cardiac screening,10and CT whole-body screening.12,13
Radiation Doses from CT Scans
Quantitative Measures
Various measures are used to describe the radiation dose deliveredby CT scanning, the most relevant being absorbed dose, effectivedose, and CT dose index (or CTDI).
The absorbed dose is the energy absorbed per unit of mass andis measured in grays (Gy). One gray equals 1 joule of radiationenergy absorbed per kilogram. The organ dose (or the distributionof dose in the organ) will largely determine the level of riskto that organ from the radiation. The effective dose, expressedin sieverts (Sv), is used for dose distributions that are nothomogeneous (which is always the case with CT); it is designedto be proportional to a generic estimate of the overall harmto the patient caused by the radiation exposure. The effectivedose allows for a rough comparison between different CT scenariosbut provides only an approximate estimate of the true risk.For risk estimation, the organ dose is the preferred quantity.
Organ doses can be calculated or measured in anthropomorphicphantoms.16 Historically, CT doses have generally been (andstill are) measured for a single slice in standard cylindricalacrylic phantoms17; the resulting quantity, the CT dose index,although useful for quality control, is not directly relatedto the organ dose or risk.18
Typical Organ Doses
Organ doses from CT scanning are considerably larger than thosefrom corresponding conventional radiography (Table 1). For example,a conventional anterior–posterior abdominal x-ray examinationresults in a dose to the stomach of approximately 0.25 mGy,which is at least 50 times smaller than the corresponding stomachdose from an abdominal CT scan.
Representative calculated organ doses for frequently used machinesettings1 are shown in Figure 3A and 3B for a single CT scanof the head and of the abdomen, the two most common types ofCT scan. The number of scans in a given study is, of course,an important factor in determining the dose. For example, Mettleret al.15 reported that in virtually all patients undergoingCT of the abdomen or pelvis, more than one scan was obtainedon the same day; among all patients undergoing CT, the authorsreported that at least three scans were obtained in 30% of patients,more than five scans in 7%, and nine or more scans in 4%.
Figure 3. Estimated Organ Doses and Lifetime Cancer Risks from Typical Single CT Scans of the Head and the Abdomen.
Panels A and B show estimated typical radiation doses for selected organs from a single typical CT scan of the head or the abdomen. As expected, the brain receives the largest dose during CT of the head and the digestive organs receive the largest dose during CT of the abdomen. These doses depend on a variety of factors, including the number of scans (data shown are for a single scan) and the milliamp-seconds (mAs) setting. The data shown here refer to the median mAs settings reported in the 2000 NEXT survey of CT use.1 For a given mAs setting, pediatric doses are much larger than adult doses, because a child's thinner torso provides less shielding of organs from the radiation exposure. The mAs setting can be reduced for children (but is often not reduced5,19); a reduction in the mAs setting proportionately reduces the dose and the risk. The methods used to obtain these dose estimates have been described elsewhere,20 but software that estimates organ doses for specific ages and CT settings is now generally available.21 Panels C and D show the corresponding estimated lifetime percent risk of death from cancer that is attributable to the radiation from a single CT scan; the risks (both for selected individual organs and overall) have been averaged for male and female patients. The methods used to obtain these risk estimates have been described elsewhere.20 The risks are highly dependent on age because both the doses (Panels A and B) and the risks per unit dose are age-dependent. Even though doses are higher for head scans, the risks are higher for abdominal scans because the digestive organs are more sensitive than the brain to radiation-induced cancer.
The radiation doses to particular organs from any given CT studydepend on a number of factors. The most important are the numberof scans, the tube current and scanning time in milliamp-seconds(mAs), the size of the patient, the axial scan range, the scanpitch (the degree of overlap between adjacent CT slices), thetube voltage in the kilovolt peaks (kVp), and the specific designof the scanner being used.17 Many of these factors are underthe control of the radiologist or radiology technician. Ideally,they should be tailored to the type of study being performedand to the size of the particular patient, a practice that isincreasing but is by no means universal.19 It is always thecase that the relative noise in CT images will increase as theradiation dose decreases, which means that there will alwaysbe a tradeoff between the need for low-noise images and thedesirability of using low doses of radiation.22
Biologic Effects of Low Doses of Ionizing Radiation
Mechanism of Biologic Damage
Ionizing radiation, such as x-rays, is uniquely energetic enoughto overcome the binding energy of the electrons orbiting atomsand molecules; thus, these radiations can knock electrons outof their orbits, thereby creating ions. In biologic materialexposed to x-rays, the most common scenario is the creationof hydroxyl radicals from x-ray interactions with water molecules;these radicals in turn interact with nearby DNA to cause strandbreaks or base damage. X-rays can also ionize DNA directly.Most radiation-induced damage is rapidly repaired by varioussystems within the cell, but DNA double-strand breaks are lesseasily repaired, and occasional misrepair can lead to inductionof point mutations, chromosomal translocations, and gene fusions,all of which are linked to the induction of cancer.23
Risks Associated with Low Doses of Radiation
Depending on the machine settings, the organ being studied typicallyreceives a radiation dose in the range of 15 millisieverts (mSv)(in an adult) to 30 mSv (in a neonate) for a single CT scan,with an average of two to three CT scans per study. At thesedoses, as reviewed elsewhere,24 the most likely (though small)risk is for radiation-induced carcinogenesis.
Most of the quantitative information that we have regardingthe risks of radiation-induced cancer comes from studies ofsurvivors of the atomic bombs dropped on Japan in 1945.25 Datafrom cohorts of these survivors are generally used as the basisfor predicting radiation-related risks in a population becausethe cohorts are large and have been intensively studied overa period of many decades, they were not selected for disease,all age groups are covered, and a substantial subcohort of about25,000 survivors26 received radiation doses similar to thoseof concern here — that is, less than 50 mSv. Of course,the survivors of the atomic bombs were exposed to a fairly uniformdose of radiation throughout the body, whereas CT involves highlynonuniform exposure, but there is little evidence that the risksfor a specific organ are substantially influenced by exposureof other organs to radiation.
There was a significant increase in the overall risk of cancerin the subgroup of atomic-bomb survivors who received low dosesof radiation, ranging from 5 to 150 mSv27,28,29; the mean dosein this subgroup was about 40 mSv, which approximates the relevantorgan dose from a typical CT study involving two or three scansin an adult.
Although most of the quantitative estimates of the radiation-inducedcancer risk are derived from analyses of atomic-bomb survivors,there are other supporting studies, including a recent large-scalestudy of 400,000 radiation workers in the nuclear industry30,31who were exposed to an average dose of approximately 20 mSv(a typical organ dose from a single CT scan for an adult). Asignificant association was reported between the radiation doseand mortality from cancer in this cohort (with a significantincrease in the risk of cancer among workers who received dosesbetween 5 and 150 mSv); the risks were quantitatively consistentwith those reported for atomic-bomb survivors.
The situation is even clearer for children, who are at greaterrisk than adults from a given dose of radiation (Figure 4),both because they are inherently more radiosensitive and becausethey have more remaining years of life during which a radiation-inducedcancer could develop.
Figure 4. Estimated Dependence of Lifetime Radiation-Induced Risk of Cancer on Age at Exposure for Two of the Most Common Radiogenic Cancers.
Cancer risks decrease with increasing age both because children have more years of life during which a potential cancer can be expressed (latency periods for solid tumors are typically decades) and because growing children are inherently more radiosensitive, since they have a larger proportion of dividing cells. These risk estimates, applicable to a Western population, are from a 2005 report by the National Academy of Sciences25 and are ultimately derived from studies of the survivors of the atomic bombings. The data have been averaged according to sex.
In summary, there is direct evidence from epidemiologic studiesthat the organ doses corresponding to a common CT study (twoor three scans, resulting in a dose in the range of 30 to 90mSv) result in an increased risk of cancer. The evidence isreasonably convincing for adults and very convincing for children.
Cancer Risks Associated with CT Scans
No large-scale epidemiologic studies of the cancer risks associatedwith CT scans have been reported; one such study is just beginning.32Although the results of such studies will not be available forsome years, it is possible to estimate the cancer risks associatedwith the radiation exposure from any given CT scan20 by estimatingthe organ doses involved and applying organ-specific cancerincidence or mortality data that were derived from studies ofatomic-bomb survivors. As discussed above, the organ doses fora typical CT study involving two or three scans are in the rangein which there is direct evidence of a statistically significantincrease in the risk of cancer, and the corresponding CT-relatedrisks can thus be directly assessed from epidemiologic data,without the need to extrapolate measured risks to lower doses.33
The estimated lifetime risk of death from cancer that is attributableto a single "generic" CT scan of the head or abdomen (Figure 3C and 3D)is calculated by summing the estimated organ-specific cancerrisks. These risk estimates are based on the organ doses shownin Figure 3A and 3B, which were derived for average CT machinesettings.1
Although the individual risk estimates shown in Figure 3 aresmall, the concern about the risks from CT is related to therapid increase in its use — small individual risks appliedto an increasingly large population may create a public healthissue some years in the future. On the basis of such risk estimatesand data on CT use from 1991 through 1996, it has been estimatedthat about 0.4% of all cancers in the United States may be attributableto the radiation from CT studies.2,34 By adjusting this estimatefor current CT use (Figure 2), this estimate might now be inthe range of 1.5 to 2.0%.
Conclusions
The widespread use of CT represents probably the single mostimportant advance in diagnostic radiology. However, as comparedwith plain-film radiography, CT involves much higher doses ofradiation, resulting in a marked increase in radiation exposurein the population.
The increase in CT use and in the CT-derived radiation dosein the population is occurring just as our understanding ofthe carcinogenic potential of low doses of x-ray radiation hasimproved substantially, particularly for children. This improvedconfidence in our understanding of the lifetime cancer risksfrom low doses of ionizing radiation has come about largelybecause of the length of follow-up of the atomic-bomb survivors— now more than 50 years — and because of the consistencyof the risk estimates with those from other large-scale epidemiologicstudies. These considerations suggest that the estimated risksassociated with CT are not hypothetical — that is, theyare not based on models or major extrapolations in dose. Rather,they are based directly on measured excess radiation-relatedcancer rates among adults and children who in the past wereexposed to the same range of organ doses as those deliveredduring CT studies.
In light of these considerations, and despite the fact thatmost diagnostic CT scans are associated with very favorableratios of benefit to risk, there is a strong case to be madethat too many CT studies are being performed in the United States.35,36There is a considerable literature questioning the use of CT,or the use of multiple CT scans, in a variety of contexts, includingmanagement of blunt trauma,37,38,39,40 seizures,41 and chronicheadaches,42 and particularly questioning its use as a primarydiagnostic tool for acute appendicitis in children.14 But beyondthese clinical issues, a problem arises when CT scans are requestedin the practice of defensive medicine, or when a CT scan, justifiedin itself, is repeated as the patient passes through the medicalsystem, often simply because of a lack of communication. Tellingly,a straw poll35 of pediatric radiologists suggested that perhapsone third of CT studies could be replaced by alternative approachesor not performed at all.
Part of the issue is that physicians often view CT studies inthe same light as other radiologic procedures, even though radiationdoses are typically much higher with CT than with other radiologicprocedures. In a recent survey of radiologists and emergency-roomphysicians,43 about 75% of the entire group significantly underestimatedthe radiation dose from a CT scan, and 53% of radiologists and91% of emergency-room physicians did not believe that CT scansincreased the lifetime risk of cancer. In the light of thesefindings, the pamphlet "Radiation Risks and Pediatric ComputedTomography (CT): A Guide for Health Care Providers,"44 whichwas recently circulated among the medical community by the NationalCancer Institute and the Society for Pediatric Radiology, ismost welcome.
There are three ways to reduce the overall radiation dose fromCT in the population. The first is to reduce the CT-relateddose in individual patients. The automatic exposure-controloption45 on the latest generation of scanners is helping toaddress this concern. The second is to replace CT use, whenpractical, with other options, such as ultrasonography and magneticresonance imaging (MRI). We have already mentioned the issueof CT versus ultrasonography for the diagnosis of appendicitis.14Although the cost of MRI is decreasing, making it more competitivewith CT, there are not many common imaging scenarios in whichMRI can simply replace CT, although this substitution has beensuggested for the imaging of liver disease.46
The third and most effective way to reduce the population dosefrom CT is simply to decrease the number of CT studies thatare prescribed. From an individual standpoint, when a CT scanis justified by medical need, the associated risk is small relativeto the diagnostic information obtained. However, if it is truethat about one third of all CT scans are not justified by medicalneed, and it appears to be likely,35 perhaps 20 million adultsand, crucially, more than 1 million children per year in theUnited States are being irradiated unnecessarily.
Supported by grants from the National Cancer Institute (R01CA088974,to Dr. Brenner), the National Institute of Allergy and InfectiousDiseases (U19AI67773, to Dr. Brenner), and the Department ofEnergy Low Dose Radiation Research Program (DE-FG-03ER63441and DE-FG-03ER63629, to Dr. Hall).
No potential conflict of interest relevant to this article wasreported.
Source Information
From the Center for Radiological Research, Columbia University Medical Center, New York.
Address reprint requests to Dr. Brenner at the Center for Radiological Research, Columbia University Medical Center, 630 W. 168th St., New York, NY 10032, or at djb3{at}columbia.edu.
References
What's NEXT? Nationwide Evaluation of X-ray Trends: 2000 computed tomography. (CRCPD publication no. NEXT_2000CT-T.) Conference of Radiation Control Program Directors, Department of Health and Human Services, 2006. (Accessed November 5, 2007, at http://www.crcpd.org/Pubs/NextTrifolds/NEXT2000CT_T.pdf.)
Sources and effects of ionizing radiation: United Nations Scientific Committee on the Effects of Atomic Radiation: UNSCEAR 2000 report to the General Assembly. New York: United Nations, 2000.
IMV 2006 CT Market Summary Report. Des Plains, IL: IMV Medical Information Division, 2006.
Linton OW, Mettler FA Jr. National conference on dose reduction in CT, with an emphasis on pediatric patients. AJR Am J Roentgenol 2003;181:321-329. [Free Full Text]
Heiken JP, Peterson CM, Menias CO. Virtual colonoscopy for colorectal cancer screening: current status. Cancer Imaging 2005;5:S133-S139. [CrossRef][Medline]
Brenner DJ, Georgsson MA. Mass screening with CT colonography: should the radiation exposure be of concern? Gastroenterology 2005;129:328-337. [CrossRef][Web of Science][Medline]
Henschke CI, Yankelevitz DF, Libby DM, Pasmantier MW, Smith JP, Miettinen OS. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med 2006;355:1763-1771. [Free Full Text]
Bach PB, Jett JR, Pastorino U, Tockman MS, Swensen SJ, Begg CB. Computed tomography screening and lung cancer outcomes. JAMA 2007;297:953-961. [Free Full Text]
Brenner DJ. Radiation risks potentially associated with low-dose CT screening of adult smokers for lung cancer. Radiology 2004;231:440-445. [Free Full Text]
Naghavi M, Falk E, Hecht HS, et al. From vulnerable plaque to vulnerable patient -- Part III: executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report. Am J Cardiol 2006;98:2H-15H. [Web of Science][Medline]
Brenner DJ, Elliston CD. Estimated radiation risks potentially associated with full-body CT screening. Radiology 2004;232:735-738. [Free Full Text]
Beinfeld MT, Wittenberg E, Gazelle GS. Cost-effectiveness of whole-body CT screening. Radiology 2005;234:415-422. [Free Full Text]
Stephen AE, Segev DL, Ryan DP, et al. The diagnosis of acute appendicitis in a pediatric population: to CT or not to CT. J Pediatr Surg 2003;38:367-371. [CrossRef][Web of Science][Medline]
Mettler FA Jr, Wiest PW, Locken JA, Kelsey CA. CT scanning: patterns of use and dose. J Radiol Prot 2000;20:353-359. [CrossRef][Medline]
Groves AM, Owen KE, Courtney HM, et al. 16-Detector multislice CT: dosimetry estimation by TLD measurement compared with Monte Carlo simulation. Br J Radiol 2004;77:662-665. [Free Full Text]
McNitt-Gray MF. AAPM/RSNA physics tutorial for residents -- topics in CT: radiation dose in CT. Radiographics 2002;22:1541-1553. [Free Full Text]
Brenner DJ. It is time to retire the computed tomography dose index (CTDI) for CT quality assurance and dose optimization. Med Phys 2006;33:1189-1191. [CrossRef][Web of Science][Medline]
Paterson A, Frush DP, Donnelly LF. Helical CT of the body: are settings adjusted for pediatric patients? AJR Am J Roentgenol 2001;176:297-301. [Free Full Text]
Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 2001;176:289-296. [Free Full Text]
Stamm G, Nagel HD. CT-EXPO -- a novel program for dose evaluation in CT. Rofo 2002;174:1570-1576. [Web of Science][Medline]
Martin CJ, Sutton DG, Sharp PF. Balancing patient dose and image quality. Appl Radiat Isot 1999;50:1-19. [CrossRef][Web of Science][Medline]
Mitelman F, Johansson B, Mertens FE. Mitelman database of chromosome aberrations in cancer. Cancer Genome Anatomy Project, 2007. (Accessed November 5, 2007, at http://cgap.nci.nih.gov/Chromosomes/Mitelman.)
Brenner DJ, Doll R, Goodhead DT, et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci U S A 2003;100:13761-13766. [Free Full Text]
Health risks from exposure to low levels of ionizing radiation — BEIR VII. Washington, DC: National Academies Press, 2005.
Preston DL, Pierce DA, Shimizu Y, et al. Effect of recent changes in atomic bomb survivor dosimetry on cancer mortality risk estimates. Radiat Res 2004;162:377-389. [CrossRef][Web of Science][Medline]
Preston DL, Shimizu Y, Pierce DA, Suyama A, Mabuchi K. Studies of mortality of atomic bomb survivors. Report 13: Solid cancer and noncancer disease mortality: 1950-1997. Radiat Res 2003;160:381-407. [CrossRef][Web of Science][Medline]
Pierce DA, Preston DL. Radiation-related cancer risks at low doses among atomic bomb survivors. Radiat Res 2000;154:178-186. [Web of Science][Medline]
Preston DL, Ron E, Tokuoka S, et al. Solid cancer incidence in atomic bomb survivors: 1958-1998. Radiat Res 2007;168:1-64. [CrossRef][Web of Science][Medline]
Cardis E, Vrijheid M, Blettner M, et al. The 15-country collaborative study of cancer risk among radiation workers in the nuclear industry: estimates of radiation-related cancer risks. Radiat Res 2007;167:396-416. [CrossRef][Web of Science][Medline]
Cardis E, Vrijheid M, Blettner M, et al. Risk of cancer after low doses of ionising radiation: retrospective cohort study in 15 countries. BMJ 2005;331:77-77. [Free Full Text]
Giles J. Study warns of `avoidable' risks of CT scans. Nature 2004;431:391-391. [Medline]
Brenner DJ, Elliston CD, Hall EJ, Berdon WE. Estimates of the cancer risks from pediatric CT radiation are not merely theoretical. Med Phys 2001;28:2387-2388. [CrossRef][Web of Science][Medline]
Berrington de Gonzalez A, Darby S. Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet 2004;363:345-351. [CrossRef][Web of Science][Medline]
Donnelly LF. Reducing radiation dose associated with pediatric CT by decreasing unnecessary examinations. AJR Am J Roentgenol 2005;184:655-657. [Free Full Text]
Ruess L, Sivit CJ, Eichelberger MR, Gotschall CS, Taylor GA. Blunt abdominal trauma in children: impact of CT on operative and nonoperative management. AJR Am J Roentgenol 1997;169:1011-1014. [Free Full Text]
Navarro O, Babyn PS, Pearl RH. The value of routine follow-up imaging in pediatric blunt liver trauma. Pediatr Radiol 2000;30:546-550. [CrossRef][Web of Science][Medline]
Renton J, Kincaid S, Ehrlich PF. Should helical CT scanning of the thoracic cavity replace the conventional chest x-ray as a primary assessment tool in pediatric trauma? An efficacy and cost analysis. J Pediatr Surg 2003;38:793-797. [CrossRef][Web of Science][Medline]
Kaups KL, Davis JW, Parks SN. Routinely repeated computed tomography after blunt head trauma: does it benefit patients? J Trauma 2004;56:475-480. [Web of Science][Medline]
Maytal J, Krauss JM, Novak G, Nagelberg J, Patel M. The role of brain computed tomography in evaluating children with new onset of seizures in the emergency department. Epilepsia 2000;41:950-954. [CrossRef][Web of Science][Medline]
Lewis DW, Dorbad D. The utility of neuroimaging in the evaluation of children with migraine or chronic daily headache who have normal neurological examinations. Headache 2000;40:629-632. [CrossRef][Web of Science][Medline]
Lee CI, Haims AH, Monico EP, Brink JA, Forman HP. Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology 2004;231:393-398. [Free Full Text]
McCollough CH, Bruesewitz MR, Kofler JM Jr. CT dose reduction and dose management tools: overview of available options. Radiographics 2006;26:503-512. [Free Full Text]
Semelka RC, Armao DM, Elias J Jr, Huda W. Imaging strategies to reduce the risk of radiation in CT studies, including selective substitution with MRI. J Magn Reson Imaging 2007;25:900-909. [CrossRef][Web of Science][Medline]
Computed Tomography and Radiation Exposure
Tubiana M., Nagataki S., Feinendegen L. E., Dimitroyannis D. A., Frush D. P., Goske M. J., Hernanz-Schulman M., Soyer P., Varnholt H., Brenner D. J., Hall E. J.
Extract |
Full Text |
PDF
N Engl J Med 2008;
358:850-853, Feb 21, 2008.
Correspondence
This article has been cited by other articles:
Boland, G. W. L.
(2009). From Herding Cats Toward Best Practices: Standardizing the Radiologic Work Process. Am. J. Roentgenol.
193: 1593-1595
[Abstract][Full Text]
Raelson, C. A., Kanal, K. M., Vavilala, M. S., Rivara, F. P., Kim, L. J., Stewart, B. K., Cohen, W. A.
(2009). Radiation Dose and Excess Risk of Cancer in Children Undergoing Neuroangiography. Am. J. Roentgenol.
193: 1621-1628
[Abstract][Full Text]
Stevenson, M.
(2009). Validation of the Pediatric Appendicitis Score. AAP Grand Rounds
22: 50-50
[Full Text]
Bastarrika, G., Lee, Y. S., Huda, W., Ruzsics, B., Costello, P., Schoepf, U. J.
(2009). CT of Coronary Artery Disease. Radiology
253: 317-338
[Abstract][Full Text]
Angel, E., Yaghmai, N., Jude, C. M., DeMarco, J. J., Cagnon, C. H., Goldin, J. G., McCollough, C. H., Primak, A. N., Cody, D. D., Stevens, D. M., McNitt-Gray, M. F.
(2009). Dose to Radiosensitive Organs During Routine Chest CT: Effects of Tube Current Modulation. Am. J. Roentgenol.
193: 1340-1345
[Abstract][Full Text]
Kollmannsberger, C., Moore, C., Chi, K. N., Murray, N., Daneshmand, S., Gleave, M., Hayes-Lattin, B., Nichols, C.R.
(2009). Non-risk-adapted surveillance for patients with stage I nonseminomatous testicular germ-cell tumors: diminishing treatment-related morbidity while maintaining efficacy. Ann Oncol
0: mdp473v1-mdp473
[Abstract][Full Text]
Stiell, I. G, Clement, C. M, Grimshaw, J., Brison, R. J, Rowe, B. H, Schull, M. J, Lee, J. S, Brehaut, J., McKnight, R D., Eisenhauer, M. A, Dreyer, J., Letovsky, E., Rutledge, T., MacPhail, I., Ross, S., Shah, A., Perry, J. J, Holroyd, B. R, Ip, U., Lesiuk, H., Wells, G. A
(2009). Implementation of the Canadian C-Spine Rule: prospective 12 centre cluster randomised trial. BMJ
339: b4146-b4146
[Abstract][Full Text]
Harris, M. A., Cosulich, M. T., Gillespie, M. J., Whitehead, K. K., Liu, T. I., Weinberg, P. M., Fogel, M. A.
(2009). Pre-Fontan cardiac magnetic resonance predicts post-Fontan length of stay and avoids ionizing radiation. J. Thorac. Cardiovasc. Surg.
138: 941-947
[Abstract][Full Text]
Cawood, T J, Hunt, P J, O'Shea, D, Cole, D, Soule, S
(2009). Recommended evaluation of adrenal incidentalomas is costly, has high false-positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant; time for a rethink?. Eur J Endocrinol
161: 513-527
[Abstract][Full Text]
Alessio, A. M., Kinahan, P. E., Manchanda, V., Ghioni, V., Aldape, L., Parisi, M. T.
(2009). Weight-Based, Low-Dose Pediatric Whole-Body PET/CT Protocols. JNM
50: 1570-1578
[Abstract][Full Text]
Stoker, J., van Randen, A., Lameris, W., Boermeester, M. A.
(2009). Imaging Patients with Acute Abdominal Pain. Radiology
253: 31-46
[Abstract][Full Text]
Coxson, H. O., Mayo, J., Lam, S., Santyr, G., Parraga, G., Sin, D. D.
(2009). New and Current Clinical Imaging Techniques to Study Chronic Obstructive Pulmonary Disease. Am. J. Respir. Crit. Care Med.
180: 588-597
[Abstract][Full Text]
ROXBY, P, KRON, T, FOROUDI, F, HAWORTH, A, FOX, C, MULLEN, A, CRAMB, J
(2009). Simple methods to reduce patient dose in a Varian cone beam CT system for delivery verification in pelvic radiotherapy. Br. J. Radiol.
82: 855-859
[Abstract][Full Text]
Fidler, J. L., Guimaraes, L., Einstein, D. M.
(2009). MR Imaging of the Small Bowel. RadioGraphics
29: 1811-1825
[Abstract][Full Text]
Delbeke, D., Stroobants, S., de Kerviler, E., Gisselbrecht, C., Meignan, M., Conti, P. S.
(2009). Expert Opinions on Positron Emission Tomography and Computed Tomography Imaging in Lymphoma. The Oncologist
14: 30-40
[Abstract][Full Text]
Sanchez Garcia, M., Pombar Camean, M., Lobato Busto, R., Luna Vega, V., Mosquera Sueiro, J., Otero Martinez, C., Sendon del Rio, J. R.
(2009). AUTOMATED EFFECTIVE DOSE ESTIMATION IN CT. Radiat Prot Dosimetry
0: ncp171v1-ncp171
[Abstract][Full Text]
Lieberman, D. A.
(2009). Screening for Colorectal Cancer. NEJM
361: 1179-1187
[Full Text]
Dewey, M., Zimmermann, E., Deissenrieder, F., Laule, M., Dubel, H.-P., Schlattmann, P., Knebel, F., Rutsch, W., Hamm, B.
(2009). Noninvasive Coronary Angiography by 320-Row Computed Tomography With Lower Radiation Exposure and Maintained Diagnostic Accuracy: Comparison of Results With Cardiac Catheterization in a Head-to-Head Pilot Investigation. Circulation
120: 867-875
[Abstract][Full Text]
Bonow, R. O.
(2009). Should Coronary Calcium Screening Be Used in Cardiovascular Prevention Strategies?. NEJM
361: 990-997
[Full Text]
Kannan, S., Balakrishnan, B., Muzik, O., Romero, R., Chugani, D.
(2009). Positron Emission Tomography Imaging of Neuroinflammation. J Child Neurol
24: 1190-1199
[Abstract]
Hara, A. K., Paden, R. G., Silva, A. C., Kujak, J. L., Lawder, H. J., Pavlicek, W.
(2009). Iterative Reconstruction Technique for Reducing Body Radiation Dose at CT: Feasibility Study. Am. J. Roentgenol.
193: 764-771
[Abstract][Full Text]
Fahey, F. H.
(2009). Dosimetry of Pediatric PET/CT. JNM
50: 1483-1491
[Abstract][Full Text]
Rubinshtein, R, Miller, T D, Williamson, E E, Kirsch, J, Gibbons, R J, Primak, A N, McCollough, C H, Araoz, P A
(2009). Detection of myocardial infarction by dual-source coronary computed tomography angiography using quantitated myocardial scintigraphy as the reference standard. Heart
95: 1419-1422
[Abstract][Full Text]
Lauer, M. S.
(2009). Elements of Danger -- The Case of Medical Imaging. NEJM
361: 841-843
[Full Text]
Fazel, R., Krumholz, H. M., Wang, Y., Ross, J. S., Chen, J., Ting, H. H., Shah, N. D., Nasir, K., Einstein, A. J., Nallamothu, B. K.
(2009). Exposure to Low-Dose Ionizing Radiation from Medical Imaging Procedures. NEJM
361: 849-857
[Abstract][Full Text]
Goske, M. J., Frush, D. P., Schauer, D. A.
(2009). Image GentlyTM campaign promotes radiation protection for children. Radiat Prot Dosimetry
135: 276-276
[Full Text]
Biswas, D., Bible, J. E., Bohan, M., Simpson, A. K., Whang, P. G., Grauer, J. N.
(2009). Radiation Exposure from Musculoskeletal Computerized Tomographic Scans. JBJS
91: 1882-1889
[Abstract][Full Text]
Halpern, E. J.
(2009). Triple-Rule-Out CT Angiography for Evaluation of Acute Chest Pain and Possible Acute Coronary Syndrome. Radiology
252: 332-345
[Abstract][Full Text]
Rimola, J, Rodriguez, S, Garcia-Bosch, O, Ordas, I, Ayala, E, Aceituno, M, Pellise, M, Ayuso, C, Ricart, E, Donoso, L, Panes, J
(2009). Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn's disease. Gut
58: 1113-1120
[Abstract][Full Text]
Kersbergen, K. J., de Vries, L. S., van Straaten, H. L.M., Benders, M. J.N.L., Nievelstein, R. A.J., Groenendaal, F.
(2009). Anticoagulation Therapy and Imaging in Neonates With a Unilateral Thalamic Hemorrhage Due to Cerebral Sinovenous Thrombosis. Stroke
40: 2754-2760
[Abstract][Full Text]
Schneebaum, N., Blau, H., Soferman, R., Mussaffi, H., Ben-Sira, L., Schwarz, M., Sivan, Y.
(2009). Use and Yield of Chest Computed Tomography in the Diagnostic Evaluation of Pediatric Lung Disease. Pediatrics
124: 472-479
[Abstract][Full Text]
Douglas, P. S., Taylor, A., Bild, D., Bonow, R., Greenland, P., Lauer, M., Peacock, F., Udelson, J.
(2009). Outcomes Research in Cardiovascular Imaging: Report of a Workshop Sponsored by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol Img
2: 897-907
[Abstract][Full Text]
Malone, J. F.
(2009). Radiation protection in medicine: ethical framework revisited. Radiat Prot Dosimetry
135: 71-78
[Abstract][Full Text]
Wilson, D., Weissfeld, J.
(2009). Follow-up Diagnostic Procedures in Lung Cancer Screening. Am. J. Respir. Crit. Care Med.
180: 103-103
[Full Text]
Douglas, P. S., Taylor, A., Bild, D., Bonow, R., Greenland, P., Lauer, M., Peacock, F., Udelson, J.
(2009). Outcomes Research in Cardiovascular Imaging: Report of a Workshop Sponsored by the National Heart, Lung, and Blood Institute. Circ Cardiovasc Imaging
2: 339-348
[Abstract][Full Text]
(2009). Report of a consultation on justification of patient exposures in medical imaging,. Radiat Prot Dosimetry
135: 137-144
[Abstract][Full Text]
Frush, D. P.
(2009). Radiation, CT, and Children: The Simple Answer Is ... It's Complicated. Radiology
252: 4-6
[Full Text]
McCollough, C. H., Guimaraes, L., Fletcher, J. G.
(2009). In Defense of Body CT. Am. J. Roentgenol.
193: 28-39
[Abstract][Full Text]
Wilson, S. R., Greenbaum, L. D., Goldberg, B. B.
(2009). Contrast-Enhanced Ultrasound: What Is the Evidence and What Are the Obstacles?. Am. J. Roentgenol.
193: 55-60
[Abstract][Full Text]
Seo, H., Lee, K. H., Kim, H. J., Kim, K., Kang, S.-B., Kim, S. Y., Kim, Y. H.
(2009). Diagnosis of Acute Appendicitis With Sliding Slab Ray-Sum Interpretation of Low-Dose Unenhanced CT and Standard-Dose IV Contrast-Enhanced CT Scans. Am. J. Roentgenol.
193: 96-105
[Abstract][Full Text]
Siddiki, H. A., Fidler, J. L., Fletcher, J. G., Burton, S. S., Huprich, J. E., Hough, D. M., Johnson, C. D., Bruining, D. H., Loftus, E. V. Jr., Sandborn, W. J., Pardi, D. S., Mandrekar, J. N.
(2009). Prospective Comparison of State-of-the-Art MR Enterography and CT Enterography in Small-Bowel Crohn's Disease. Am. J. Roentgenol.
193: 113-121
[Abstract][Full Text]
Lateef, T. M., Grewal, M., McClintock, W., Chamberlain, J., Kaulas, H., Nelson, K. B.
(2009). Headache in Young Children in the Emergency Department: Use of Computed Tomography. Pediatrics
124: e12-e17
[Abstract][Full Text]
Maguire, J. L., Boutis, K., Uleryk, E. M., Laupacis, A., Parkin, P. C.
(2009). Should a Head-Injured Child Receive a Head CT Scan? A Systematic Review of Clinical Prediction Rules. Pediatrics
124: e145-e154
[Abstract][Full Text]
Weustink, A. C., Mollet, N. R., Neefjes, L. A., van Straten, M., Neoh, E., Kyrzopoulos, S., Meijboom, B. W., van Mieghem, C., Cademartiri, F., de Feyter, P. J., Krestin, G. P.
(2009). Preserved Diagnostic Performance of Dual-Source CT Coronary Angiography with Reduced Radiation Exposure and Cancer Risk. Radiology
252: 53-60
[Abstract][Full Text]
Lameris, W., van Randen, A., van Es, H W., van Heesewijk, J. P M, van Ramshorst, B., Bouma, W. H, ten Hove, W., van Leeuwen, M. S, van Keulen, E. M, Dijkgraaf, M. G W, Bossuyt, P. M M, Boermeester, M. A, Stoker, J., on behalf of the OPTIMA study group,
(2009). Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ
338: b2431-b2431
[Abstract][Full Text]
Raff, G. L., Chinnaiyan, K. M., Share, D. A., Goraya, T. Y., Kazerooni, E. A., Moscucci, M., Gentry, R. E., Abidov, A., for the Advanced Cardiovascular Imaging Consortium,
(2009). Radiation Dose From Cardiac Computed Tomography Before and After Implementation of Radiation Dose-Reduction Techniques. JAMA
301: 2340-2348
[Abstract][Full Text]
Caoili, E. M., Cohan, R. H., Ellis, J. H., Dillman, J., Schipper, M. J., Francis, I. R.
(2009). Medical Decision Making Regarding Computed Tomographic Radiation Dose and Associated Risk: The Patient's Perspective. Arch Intern Med
169: 1069-1071
[Full Text]
Achenbach, S., Dilsizian, V., Kramer, C. M., Zoghbi, W. A.
(2009). The Year in Coronary Artery Disease. J Am Coll Cardiol Img
2: 774-786
[Abstract][Full Text]
Mitchell, J. M., LaGalia, R. R.
(2009). Controlling the Escalating Use of Advanced Imaging: The Role of Radiology Benefit Management Programs. Med Care Res Rev
66: 339-351
[Abstract]
Nelson, A. L., Millington, T. M., Sahani, D., Chung, R. T., Bauer, C., Hertl, M., Warshaw, A. L., Conrad, C.
(2009). Hepatic Portal Venous Gas: The ABCs of Management. Arch Surg
144: 575-581
[Abstract][Full Text]
Detterbeck, F.
(2009). The fruits of our efforts: time for a different view of lung cancer and CT screening. Thorax
64: 465-466
[Full Text]
Lichtenstein, D., Meziere, G., Seitz, J.
(2009). The Dynamic Air Bronchogram: A Lung Ultrasound Sign of Alveolar Consolidation Ruling Out Atelectasis. Chest
135: 1421-1425
[Abstract][Full Text]
Bautista, A. B., Burgos, A., Nickel, B. J., Yoon, J. J., Tilara, A. A., Amorosa, J. K.
(2009). Do Clinicians Use the American College of Radiology Appropriateness Criteria in the Management of Their Patients?. Am. J. Roentgenol.
192: 1581-1585
[Abstract][Full Text]
Joo, S.-M., Lee, K. H., Kim, Y. H., Kim, S. Y., Kim, K., Kim, K. J., Kim, B.
(2009). Detection of the Normal Appendix with Low-Dose Unenhanced CT: Use of the Sliding Slab Averaging Technique. Radiology
251: 780-787
[Abstract][Full Text]
Easton, J. D., Saver, J. L., Albers, G. W., Alberts, M. J., Chaturvedi, S., Feldmann, E., Hatsukami, T. S., Higashida, R. T., Johnston, S. C., Kidwell, C. S., Lutsep, H. L., Miller, E., Sacco, R. L.
(2009). Definition and Evaluation of Transient Ischemic Attack: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease: The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists.. Stroke
40: 2276-2293
[Abstract][Full Text]
Bulas, D. I., Goske, M. J., Applegate, K. E., Wood, B. P.
(2009). Image Gently: Why We Should Talk to Parents About CT in Children. Am. J. Roentgenol.
192: 1176-1178
[Full Text]
Sivit, C. J.
(2009). Imaging Children with Abdominal Trauma. Am. J. Roentgenol.
192: 1179-1189
[Abstract][Full Text]
Cohen, M. D.
(2009). Pediatric CT Radiation Dose: How Low Can You Go?. Am. J. Roentgenol.
192: 1292-1303
[Abstract][Full Text]
LI, X, SAMEI, E, DELONG, D M, JONES, R P, GACA, A M, HOLLINGSWORTH, C L, MAXFIELD, C M, CARRICO, C W T, FRUSH, D P
(2009). Three-dimensional simulation of lung nodules for paediatric multidetector array CT. Br. J. Radiol.
82: 401-411
[Abstract][Full Text]
Wachtel, R. E., Dexter, F., Dow, A. J.
(2009). Growth Rates in Pediatric Diagnostic Imaging and Sedation. Anesth. Analg.
108: 1616-1621
[Abstract][Full Text]
Rimola, J., Rodriguez, S., Garcia-Bosch, O., Ricart, E., Pages, M., Pellise, M., Ayuso, C., Panes, J.
(2009). Role of 3.0-T MR Colonography in the Evaluation of Inflammatory Bowel Disease1. RadioGraphics
29: 701-719
[Abstract][Full Text]
Sheehy, N., Tetrault, T. A., Zurakowski, D., Vija, A. H., Fahey, F. H., Treves, S. T.
(2009). Pediatric 99mTc-DMSA SPECT Performed by Using Iterative Reconstruction with Isotropic Resolution Recovery: Improved Image Quality and Reduced Radiopharmaceutical Activity. Radiology
251: 511-516
[Abstract][Full Text]
Golfier, S., Jost, G., Pietsch, H., Lengsfeld, P., Eckardt-Schupp, F., Schmid, E., Voth, M.
(2009). DICENTRIC CHROMOSOMES AND {gamma}-H2AX FOCI FORMATION IN LYMPHOCYTES OF HUMAN BLOOD SAMPLES EXPOSED TO A CT SCANNER: A DIRECT COMPARISON OF DOSE RESPONSE RELATIONSHIPS. Radiat Prot Dosimetry
0: ncp061v1-ncp061
[Abstract][Full Text]
Weiss, K.L., Sun, D., Weiss, J.L.
(2009). Pediatric MR Imaging with Automated Spine Survey Iterative Scan Technique (ASSIST). Am. J. Neuroradiol.
30: 821-824
[Abstract][Full Text]
Tubiana, M., Feinendegen, L. E., Yang, C., Kaminski, J. M.
(2009). The Linear No-Threshold Relationship Is Inconsistent with Radiation Biologic and Experimental Data. Radiology
251: 13-22
[Full Text]
Griffey, R. T., Sodickson, A.
(2009). Cumulative Radiation Exposure and Cancer Risk Estimates in Emergency Department Patients Undergoing Repeat or Multiple CT. Am. J. Roentgenol.
192: 887-892
[Abstract][Full Text]
Sodickson, A., Baeyens, P. F., Andriole, K. P., Prevedello, L. M., Nawfel, R. D., Hanson, R., Khorasani, R.
(2009). Recurrent CT, Cumulative Radiation Exposure, and Associated Radiation-induced Cancer Risks from CT of Adults. Radiology
251: 175-184
[Abstract][Full Text]
Sistrom, C. L., Dang, P. A., Weilburg, J. B., Dreyer, K. J., Rosenthal, D. I., Thrall, J. H.
(2009). Effect of Computerized Order Entry with Integrated Decision Support on the Growth of Outpatient Procedure Volumes: Seven-year Time Series Analysis. Radiology
251: 147-155
[Abstract][Full Text]
Huang, B., Law, M. W.-M., Khong, P.-L.
(2009). Whole-Body PET/CT Scanning: Estimation of Radiation Dose and Cancer Risk. Radiology
251: 166-174
[Abstract][Full Text]
Chua, T
(2009). The evolving role of molecular imaging for coronary artery disease: where do we stand today?. Heart Asia
2009: 1-5
[Abstract][Full Text]
Iglehart, J. K.
(2009). Health Insurers and Medical-Imaging Policy -- A Work in Progress. NEJM
360: 1030-1037
[Full Text]
Kushner, B. H., Kramer, K., Modak, S., Cheung, N.-KongV.
(2009). Sensitivity of Surveillance Studies for Detecting Asymptomatic and Unsuspected Relapse of High-Risk Neuroblastoma. JCO
27: 1041-1046
[Abstract][Full Text]
Klein, H. A.
(2009). Nuclear Medicine Radiation Risks. JNM
50: 489-489
[Full Text]
Pedrosa, I., Lafornara, M., Pandharipande, P. V., Goldsmith, J. D., Rofsky, N. M.
(2009). Pregnant Patients Suspected of Having Acute Appendicitis: Effect of MR Imaging on Negative Laparotomy Rate and Appendiceal Perforation Rate. Radiology
250: 749-757
[Abstract][Full Text]
Tack, D., Gevenois, P. A.
(2009). Body MDCT at 140 kV. Am. J. Roentgenol.
192: W139-W140
[Full Text]
MEESON, S, ALVEY, C M, GOLDING, S J
(2009). Justifying multidetector CT in abdominal sepsis: time for review?. Br. J. Radiol.
82: 190-197
[Abstract][Full Text]
Gerber, T. C., Carr, J. J., Arai, A. E., Dixon, R. L., Ferrari, V. A., Gomes, A. S., Heller, G. V., McCollough, C. H., McNitt-Gray, M. F., Mettler, F. A., Mieres, J. H., Morin, R. L., Yester, M. V.
(2009). Ionizing Radiation in Cardiac Imaging: A Science Advisory From the American Heart Association Committee on Cardiac Imaging of the Council on Clinical Cardiology and Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention. Circulation
119: 1056-1065
[Full Text]
Hausleiter, J., Meyer, T., Hermann, F., Hadamitzky, M., Krebs, M., Gerber, T. C., McCollough, C., Martinoff, S., Kastrati, A., Schomig, A., Achenbach, S.
(2009). Estimated Radiation Dose Associated With Cardiac CT Angiography. JAMA
301: 500-507
[Abstract][Full Text]
Tan, J.S.P., Tan, K.-L., Lee, J.C.L., Wan, C.-M., Leong, J.-L., Chan, L.-L.
(2009). Comparison of Eye Lens Dose on Neuroimaging Protocols between 16- and 64-Section Multidetector CT: Achieving the Lowest Possible Dose. Am. J. Neuroradiol.
30: 373-377
[Abstract][Full Text]
(2009). Medical Effects of Ionizing Radiation, 3rd ed. Am. J. Neuroradiol.
30: e30-e30
[Full Text]
Graser, A, Stieber, P, Nagel, D, Schafer, C, Horst, D, Becker, C R, Nikolaou, K, Lottes, A, Geisbusch, S, Kramer, H, Wagner, A C, Diepolder, H, Schirra, J, Roth, H J, Seidel, D, Goke, B, Reiser, M F, Kolligs, F T
(2009). Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population. Gut
58: 241-248
[Abstract][Full Text]
Goodman, L. R., Sostman, H. D., Stein, P. D., Woodard, P. K.
(2009). CT Venography: A Necessary Adjunct to CT Pulmonary Angiography or a Waste of Time, Money, and Radiation?. Radiology
250: 327-330
[Full Text]
d'Assignies, G., Couvelard, A., Bahrami, S., Vullierme, M.-P., Hammel, P., Hentic, O., Sauvanet, A., Bedossa, P., Ruszniewski, P., Vilgrain, V.
(2009). Pancreatic Endocrine Tumors: Tumor Blood Flow Assessed with Perfusion CT Reflects Angiogenesis and Correlates with Prognostic Factors. Radiology
250: 407-416
[Abstract][Full Text]
Met, R., Bipat, S., Legemate, D. A., Reekers, J. A., Koelemay, M. J. W.
(2009). Diagnostic Performance of Computed Tomography Angiography in Peripheral Arterial Disease: A Systematic Review and Meta-analysis. JAMA
301: 415-424
[Abstract][Full Text]
Baskerville, J R, Chang, J H, Viator, M, Rutledge, W, Miryala, R, Duval, K E, Nishino, T K
(2009). Dose versus diagnosis: iatrogenic radiation exposure by multidetector computerised tomography in an academic emergency department with measurement of clinically actionable results and emergently treatable findings. Emerg. Med. J.
26: 15-19
[Abstract][Full Text]
Macari, M., Lee, T., Kim, S., Jacobs, S., Megibow, A. J., Hajdu, C., Babb, J.
(2009). Is Gadolinium Necessary for MRI Follow-Up Evaluation of Cystic Lesions in the Pancreas? Preliminary Results. Am. J. Roentgenol.
192: 159-164
[Abstract][Full Text]
Funama, Y., Awai, K., Taguchi, K., Hatemura, M., Yanaga, Y., Shimamura, M., Yamashita, Y.
(2009). Cone-Beam Technique for 64-MDCT of Lung: Image Quality Comparison with Stepwise (Step-and-Shoot) Technique. Am. J. Roentgenol.
192: 273-278
[Abstract][Full Text]
Schattner, A
(2008). The unbearable lightness of diagnostic testing: time to contain inappropriate test ordering. Postgrad. Med. J.
84: 618-621
[Abstract][Full Text]
Previous
