Balancing patients’ benefits and risks in computed tomography: a European Society of Radiology ‘EuroSafe Imaging’ viewpoint

Every physician seeks to do more good than harm. A surgeon operates with the expectation that the benefits of the operation outweigh the risks associated with the surgery, leaving the patient in a better condition than before the procedure. Radiologists provide enormous benefits for patients-identifying diseases that could not otherwise be diagnosed or staging disease severity to allow for the most appropriate treatments to be undertaken. However, like any intervention, radiological studies are associated with risks; ionizing radiation may not be as apparent as a surgical site infection to patients or even other healthcare providers, but it carries inherent and cumulative risk and portends real hazard for patients. This article explores the responsibility of radiologists to champion appropriate imaging selection through rigorous justification of studies and protocol optimization when imaging is indicated. KEY POINTS: Irradiating patients for CT imaging provides tremendous diagnostic value, but is associated with an increased risk of cancer. The risk of CT-associated malignancies should be discussed with patients in an understandable way, considering individual- and population-level hazard. Strict application of the ALARA principle allows for maximizing benefits from imaging studies while minimizing harm.