The “Gatekeepers” of Medical Imaging

It is essential to justify every medical investigation, particularly those that involve ionizing radiation, such as computed tomography (CT) scans. As a noninvasive diagnostic tool, CT has been widely utilized in medical imaging with an overall rising trend. There is no doubt that a CT scan could provide information regarding the medical condition, which could be life-saving. However, various publications and guidelines periodically emphasize the potential risks associated with its use.[1] [2] Studies have shown that requesting clinicians often underestimate the potential radiation dose and effect.[3] Although side effects have been proven, presently, there is no conclusive data to indicate the direct carcinogenicity of medical imaging.

Certain medical conditions may require repeated imaging. When evaluating the risks versus benefits, it is crucial to consider the clarity of the information anticipated from a specific investigation alongside the potential cumulative radiation dose from the procedure. Thoughtful consideration must be given to solutions that optimize resource utilization while prioritizing safety. Limited region of interest scan, choice of parameters, in-built dose reduction software in new scanners, auto-dose optimization techniques using patient body weight and height training for radiographers, building institutional optimization teams for periodic monitoring of dose and image quality, and annual periodic dose audits are some of the recommendations to minimize the radiation and keeping the quality.

Scans may be conducted at different hospitals or imaging centers, and the process of collecting DICOM (Digital Imaging and Communications in Medicine) images each time can be laborious, yet it holds significant value. The availability of picture archiving and communication system and their portability represent meaningful advancements in today's technological landscape. Maintaining comprehensive medical records and associating them with unique identification numbers would be a wise approach.

Radiation safety is an integral component of the training curriculum for radiation workers; however, the quality of this training can vary significantly across different regions. It is essential to retain and apply the knowledge acquired, which requires active follow-up. Various medical specialties utilize ionizing radiation, such as fluoroscopy, in surgical settings, where the presence of a dedicated physicist is highly advisable. Training radiation safety officers is crucial to raise awareness of these issues. Hospital administrations play a key role in prioritizing safety and can significantly influence outcomes. Referring physicians should be informed about both the benefits and risks associated with these procedures. Collaborating with external organizations, such as hospital accreditation bodies, can also help identify any deficiencies in our practices. When patients are referred for treatment elsewhere, both the hospital and the patients should ensure they obtain copies of their medical imaging. Compliance with safety guidelines set forth by regulatory authorities necessitates the involvement of all stakeholders. Patients must receive thorough counseling regarding radiation and informed consent is vital. This would avoid apprehensions like the possibility of cancer as a harmful effect.

As radiologists, we play the crucial role of “gatekeepers” for patients undergoing imaging, ensuring imaging is justified and required even though our schedule predominantly involves interpretation and reporting images. Ultrasound and CT are now regarded as the “stethoscopes of modern medicine” especially with the remarkable advancements in CT technology over the years (multislice and helical CT scanners, low-dose CT, three-dimensional and four-dimensional CT, dual-energy CT, spectral CT, photon-counting CT, hybrid CT, cone-beam CT). A concerted effort from health care professionals, health administrators, accreditation organizations, and government entities is essential for ongoing success in this area.

Conflict of Interest

None declared.

• References

• 1 Smith-Bindman R, Chu PW, Azman Firdaus H. et al. Projected lifetime cancer risks from current computed tomography imaging. JAMA Intern Med 2025; 14: e250505
• 2 Smith-Bindman. et al. ACR Statement on JAMA CT Scan Radiation Study [Internet]. April 14, 2025. Accessed May 12, 2025 at: https://www.acr.org/News-and-Publications/Media-Center/2025/jama-ct-scan-radiation-study
• 3 Thomas KE, Parnell-Parmley JE, Haidar S. et al. Assessment of radiation dose awareness among pediatricians. Pediatr Radiol 2006; 36 (08) 823-832

Publication History

Article published online:
16 June 2025