Dr. Ian Amber

CT
Second Take: Notify patients of radiation risk from CT scans
Should patients scheduled for CT scans be notified of the risk of radiation-induced cancer? In this Second Take article, Dr. Ian Amber and Dr. Po-Hao Chen take the position that obtaining patient consent before performing a CT scan is a necessary task for any responsible imaging provider.
December 17, 2013
2013 07 30 12 53 25 294 Second Take Am 200
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Bar graphs show comparison of volume CT dose index (CTDIvol) (A) achievable doses (50th percentile) and (B) diagnostic reference levels (75th percentile) between 2014 (see reference 4 by Kanal et al) and 2025 (present study) for 10 common CT examination types performed without contrast (w/o) and with contrast (w/). Across all 10 adult CT examination categories, CTDIvol achievable doses and diagnostic reference levels generally decreased from 2014 to 2025, with the largest reductions for torso examinations (chest; abdomen-pelvis; and combined chest, abdomen, and pelvis), intermediate reductions for neck and cervical spine, and minimal change for head examinations.
CT
CT radiation doses have fallen sharply over past decade
The largest reductions appeared in chest examinations with contrast material, where diagnostic reference levels fell 31%.
Images in a 70-year-old asymptomatic woman with a prior excisional biopsy in the left breast yielding lobular carcinoma in situ 3 years earlier. Screening contrast-enhanced mammography (CEM) was performed, which was considered a prevalence screen as the woman had no prior breast MRI in the past 3 years and no prior CEM. (A) Low-energy (26–30 kVp) mediolateral oblique (MLO) and (B) craniocaudal (CC) views show surgical clips but no abnormality. (C) Recombined MLO and (D) CC images show an enhancing mass in the medial left breast (arrows). Biopsy revealed invasive lobular carcinoma. Size was 0.2 cm; tumor grade II/III; negative lymph nodes; and estrogen receptor–positive, progesterone receptor–positive, and human epidermal growth factor receptor 2–negative.
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Bar graphs show comparison of volume CT dose index (CTDIvol) (A) achievable doses (50th percentile) and (B) diagnostic reference levels (75th percentile) between 2014 (see reference 4 by Kanal et al) and 2025 (present study) for 10 common CT examination types performed without contrast (w/o) and with contrast (w/). Across all 10 adult CT examination categories, CTDIvol achievable doses and diagnostic reference levels generally decreased from 2014 to 2025, with the largest reductions for torso examinations (chest; abdomen-pelvis; and combined chest, abdomen, and pelvis), intermediate reductions for neck and cervical spine, and minimal change for head examinations.
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Images in a 70-year-old asymptomatic woman with a prior excisional biopsy in the left breast yielding lobular carcinoma in situ 3 years earlier. Screening contrast-enhanced mammography (CEM) was performed, which was considered a prevalence screen as the woman had no prior breast MRI in the past 3 years and no prior CEM. (A) Low-energy (26–30 kVp) mediolateral oblique (MLO) and (B) craniocaudal (CC) views show surgical clips but no abnormality. (C) Recombined MLO and (D) CC images show an enhancing mass in the medial left breast (arrows). Biopsy revealed invasive lobular carcinoma. Size was 0.2 cm; tumor grade II/III; negative lymph nodes; and estrogen receptor–positive, progesterone receptor–positive, and human epidermal growth factor receptor 2–negative.
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Maximum intensity projection of Ga-68 PSMA-11 PET/CE-CT (A), Tc-99m MIP-1404 CZT SPECT/CT (B) and Tc-99m HDP CZT SPECT/CT (C) imaging. Ga-68 PSMA-11 PET/CE-CT and Tc-99m MIP-1404 CZT SPECT/CT showing tracer uptake in lymph nodes below the iliac bifurcation and above, paraaortic and left supraclavicular, bone uptake in the right proximal femur and right scapula (arrows). Tc-99m HDP CZT SPECT/CT did not show any uptake suspicious for metastatic disease. No sclerotic lesions suspicious of metastases were detected by the CT component in any of the studies. Fusion axial imaging of Ga-68 PSMA-11 PET/CE-CT (D) and Tc-99m MIP-1404 CZT SPECT/CT (E) showing uptake in lymph nodes in the left pelvic area below the iliac bifurcation (arrows). Fusion axial imaging of Ga-68 PSMA-11 PET/CE-CT (F) and Tc-99m MIP-1404 CZT SPECT/CT (G) showing uptake in the right proximal femur, not detected by Tc-99m HDP CZT SPECT/CT (H), (arrows).
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