[Prudent use of computed tomography for the improvement of patient safety]

Computed tomography (CT) is one of the most useful imaging modalities, and has an important role in guided biopsies and therapeutic procedures. The expansion of CT practice is sometimes accompanied with disregard of the fact that it is an invasive methodology, with deviations from patient safety principles. The major risk is associated with ionizing irradiation which may damage the DNA, leading to malignant transformation. There are no direct data yet as to the actual cancer risk and the current assessments are based on theoretical modeLs and extrapolations from historical records. However, it is widely accepted that although the danger for an individual patient is small, a significant number of malignant disorders would be diagnosed many years later and the threat is particularly pertinent for children. Some CT scans are performed nowadays without proper indications. The reasons include: (a) physicians working burden, and the expectations from them to attain diagnoses rapidly; (b) patients demand CT scans unaware of its hazards; (c) private imaging facilities offer "sale prices" for CT scans, even when there are no definite indications, and perform them without physicians referrals. Other issues are incidental findings in screening CTs of healthy people, which may represent a genuine medical problem, but, more often, are insignificant. Undoubtedly, CT usage will increase with the development of new technologies. This process must be accompanied by patient safety measurements, including: (a) performing a CT only according to the clinical presentation and indications; (b) towering irradiation doses and monitoring the instruments and protocols; (c) instructing physicians and informing patients about the benefits and disadvantages of CT.