The hidden costs of CT bioeffects.

t C p i d p t ith the rapidly increasinguseofcomuted tomography (CT) in the clinical etting, diagnostic radiology continues o solidify its integral role in thediagnois, management, and treatment of disases. In terms of the economic gain rom the rapidly increasing utilization f CT, the future seemed all too promsingforradiologists justa fewyearsago. owever, there are hidden costs associted with the boom in CT to patients, he US health care system, and the proession of radiology that should be onitored for both economic and ethcal reasons. The cost of medical imaging, fueled ncreasingly by CT, to the US health are system now outpaces that of pharaceutical drugs, with little regulation. hile the US population is growing at rateof less than1%peryear, theuseof Tisgrowingata rateof10%peryear, ith a total of more than 60 million omputed tomographic scans perormed in 2006 [1]. Given the extraorinary boom in medical imaging, the eld of radiology has increasingly beome a target for expenditure cuts in ecent years. The Deficit Reduction ct of 2005, for instance, has already ad a huge economic impact on pracicing radiologists. Although the most obvious initial eaction from an economic standpoint or radiologists would be to allow unhecked growth of CT to make up for ost revenue, thiswouldbe shortsighted or several reasons. With increasing utiization of medical imaging, fueled eavily by CT, the increased cost buren will continue to fall on the fixed esources of third-party payers, which nclude employer-based health insurnce plans, Medicaid, and Medicare. ventually, the additional billions of ollars spent on CT and medical imagng may cause a breaking point in the urrent health care system and result in U ecreasing reimbursements for technial fees for hospitals and imaging ceners,decreasingreimbursement forproessional fees for radiologists, and ncreased insurance premiums for all atients. Although the topics of CT radiation ose and possible increased radiationelated cancer risks have been heavily ebated over the past few years in the adiology community, it is an exremely relevant topic with regard to he economics of CT. In economics, ncomplete information refers to a sitution in which a market participant acks necessary information important or decision making. Although patients nd physicians consider the potential enefits of CT without consideration f the related risks, the tendency would eforoverutilizationof thismodality in he clinical setting. Although a minority within the raiology community may disagree, curent literature suggests that effective oses from computed tomographic cans are within a range associated with statistically significant increase insolid ancer risk and cancer mortality. Sevral studieshavesupportedanincreased ifetimecancerrisk inthepediatricpoplation undergoing diagnostic comuted tomographic scans [2,3] and dults undergoing elective computed omographic screening [4]. Organizaions such as the National Institutes of ealth now categorize radiation as a nown human carcinogen [5], and the ancer rate for patients receiving a 10Sv effective dose is currently estiated at 1 in 2,000 patients [6]. It is our opinion that the radiation xposure from CT will increasingly beome a national public health issue, ith exposure from medical imaging aving increased by a factor of 5 since he 1980s [7]. In contrast to the lack of S policy on this matter, the Euros