CT scans and radiation exposure 19. June 2007 William Davis (8) The NY Times ran an article called With Rise in Radiation Exposure, Experts Urge Caution on Tests at http://www.nytimes.com/2007/06/19/health/19cons.html?_r=1&adxnnl=1&oref=slogin&adxnnlx=1182254102-vQpytpx6W/Z9gvAaNPDZvA “This is an absolutely sentinel event, a wake-up call,” said Dr. Fred A. Mettler Jr., principal investigator for the study, by the National Council on Radiation Protection. “Medical exposure now dwarfs that of all other sources.”Where do CT heart scans fall?Let's first take a look at exposure measured for different sorts of tests:Typical effective radiation dose valuesComputed tomography Milliseverts (mSv)Head CT 1 – 2 mSvPelvis CT 3 – 4 mSvChest CT 5 – 7 mSvAbdomen CT 5 – 7 mSvAbdomen/pelvis CT 8 – 11 mSvCoronary CT angiography 5 – 12 mSvNon-CT Milliseverts (mSv)Hand radiograph Less than 0.1 mSvChest radiograph Less than 0.1 mSvMammogram 0.3 – 0.6 mSvBarium enema exam 3 – 6 mSvCoronary angiogram 5 – 10 mSvSestamibi myocardial perfusion (per injection) 6 – 9 mSvThallium myocardial perfusion (per injection) 26 – 35 mSvSource: Cynthia H. McCullough, Ph.D., Mayo Clinic, Rochester, MNIf you have a heart scan on an EBT device, then your exposure is 0.5-0.6 mSv, roughly the same as a mammogram or several standard chest x-rays. A heart scan on a 16- or 64-slice multidetector device, your exposure is around 1.0-2.0 mSv, about the same as 2-3 mammograms, though dose can vary with this technology depending on how it is performed (gated to the EKG, device settings, etc.)CT coronary angiography presents a different story. This is where radiation really escalates and puts the radiation exposure issue in the spotlight. As Dr. Cynthia McCullough's chart shows above, the radiation exposure with CT coronary angiograms is 5-12 mSv, the equivalent of 100 chest x-rays or 20 mammograms. Now that's a problem. The exposure is about the same for a pelvic or abdominal CT. The problem is that some centers are using CT coronary angiograms as screening procedures and even advocating their use annually. This is where the alarm needs to be sounded. These tests, as wonderful as the information and image quality can be, are not screening tests. Just like a pelvic CT, they are diagnostic tests done for legimate medical questions. They are not screening tests to be applied broadly and used year after year. Always be mindful of your radiation exposure, as the NY Times article rightly advises. However, don't be so frightened that you are kept from obtaining truly useful information from, for instance, a CT heart scan (not angiography) at a modest radiation cost. Detail on radiation exposure with CT coronary angiograms on multidetector devices can be found at Hausleiter J, Meyer T, Hadamitzyky M et al. Radiation Dose Estimates From Cardiac Multislice Computed Tomography in Daily Practice: Impact of Different Scanning Protocols on Effective Dose Estimates. Circulation 2006;113:1305-1310, one of several studies on this issue.