The latest news  about CT scan abuse and the subsequent excessive radiation exposure to the public is very disturbing. A recent issue of the Archives of Internal Medicine features 2 articles describing their findings in regard to the use and possible misuse of CT x-rays. There is no point in my regurgitating the details of the two articles. The reader can study the articles without my noisy input.

What I would like to point out is that this is a case of faulty administrative control over the exposure of patients to hazardous energy. Who is the gatekeeper for access to a CT scan-  the primary care doc or a consulting radiologist? If it is the primary care doc, is he/she up to speed on the exposure/dose details? Does the primary care doc know the dose and variability in radiation exposure for a given workup? Does the dose vary with the model of CT scanner? How much resolution is really necessary, anyway? Does half the dose give half the resolution, or is there some other law relating transmitted energy to resolution?

Maybe the gatekeeper should be the radiologist. The radiologist should be able to calculate a radiation dose and speak knowledgeably about the details of the risk. But should the radiologist be in a position to second guess the primary care doc? Does anybody provide feedback to the primary care doc as to the wisdom of a given CT scan? Doesn’t sound like that would work very well.

So, who is really the gatekeeper in regard to the merits of any given CT scan given to the patient? But more importantly, how the hell can it transpire that radiation exposures are far higher than anybody apparently realized??? Radiation technology and radiation biology are mature sciences now. And presumably, radiologists are trained to pay attention to these kinds of details.

Where the HELL were the radiologists when these instances of excessive exposure were accumulating?? Isn’t that why we train them … to provide expertise in the use of ionizing radiation in medicine??  Were they busy? Did they have something else to do besides monitoring the use of radiation on actual patients?

Could it be that people in the CT business are more captivated by the industrial light and magic of imagery and special effects rather than the grubby details of dosimetry?

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