Istituto di Fisiologia Clinica     
Picano E. Risk of cancer from diagnostic X-rays. In: The Lancet, vol. 363 (9424) pp. 1909 - 1910. Elsevier Inc, 2004.
First, to estimate radiation exposure, the authors used the 2000 report by the United Nations Scientific Committee on the Effects of Atomic Radiation, which refers to the years 1991-96. 2 In the mid-1990s, CT scanning accounted for about 4% of procedures and about 40% of the collective dose in radiology. In large hospitals, CT scanning now accounts for about 15% of procedures and 75% of the diagnostic radiation dose received by patients. In the USA, about 10 million CT scans were done in 1993, and about 60 million in 2001. 3 Second, the practice of nuclear medicine also contributes to the risks from diagnostic medical procedures. It is true that, overall, diagnostic practice with radiopharmaceuticals remains small in comparison with the use of X-rays. However, the mean dose per procedure is more than three times larger for nuclear medicine than for medical X-rays and adds a further 10% to the average radiation exposure due to diagnostic radiology. 2 We know from statistics of the American Society of Nuclear Medicine that the total number of nuclear medicine examinations during 2002 was between 12 and 13 million, and that the number of nuclear cardiology examinations-those with the highest radiation load- more than doubled from 3 million during 1993 to 7 million in 2001. 4 A stress perfusion scintigraphy test corresponds to a dose exposure equivalent to at least 500 chest X-rays. This is another substantial and growing source of oncogenic damage and cost that should be included in the calculation of cancer risk due to diagnostic medical activity. Third, the authors discuss the risks of radiation-induced cancer. This disease represents only part of the risk posed by the medical use of radiation, which is also a major cause of infertility, progeria, low mental development, and teratogenesis. The risk of major radiation-induced damage passed onto the offspring is estimated to represent a fifth of the risk of fatal cancer. 2 In summary, the medical, biological, and economic effects of inappropriate use of medical radiation can be far deeper and broader than outlined by Berrington de Gonzáles and Darby. We, the physicians and imaging specialists, are largely unaware of these effects, and continue to prescribe a significant number of medical examinations based on ionising testing despite the European Commission's 2001 medical imaging guidelines 5 which clearly state that a non-ionising examination should always be preferred to a ionising one when the information provided is comparable. 5 There is more than enough evidence to bring the responsible use of medical radiation to the top of the political and medical agenda.
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Subject cancer

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