An unprecedented era with patients receiving high (≥100 msv) cumulative doses: collective actions needed

Millions of patients benefit from medical imaging every single day. However, large-scale multicenter studies published in the last 6 years have brought new result that allow extrapolation to nationwide or global levels. They have opened a new era wherein millions of patients are receiving cumulative doses in three digits of mGy of organ doses or three digits of mSv of cumulative effective dose (CED) every year. One out of 125 patients can be exposed to an effective dose ≥50 mSv from a single computed tomography (CT) exam, and 3 out of 10,000 patients undergoing CT exams could potentially receive cumulative effective doses ≥100 mSv in a single day. Recurrent imaging with CT, fluoroscopically guided interventions (FGI), and hybrid imaging modalities such as positron emission tomography/computed tomography (PET/CT) are more prevalent today than ever before. Although a major fraction of patients with such high doses is ≥60 years of age, the number of patients <60 years and with diseases that do not substantially shorten life expectancy is estimated to be nearly half a million added every year. Moreover, data from a centre that employs the best form of justification and the best form of optimisation indicate that we have reached a limiting point in providing safer imaging to many patients using currently available imaging machines and justification and optimisation tools. This leads us to an unprecedented era where collective thinking and actions are needed, and it provides a fitting opportunity for the call given by the International Commission on Radiological Protection (ICRP) to develop solutions to achieve safer imaging, a mission that necessitated the creation of ICRP in 1928.