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Rebecca Smith-Bindman, MD; Jafi Lipson, MD; Ralph Marcus, BA; Kwang-Pyo Kim, PhD; Mahadevappa Mahesh, MS, PhD; Robert Gould, ScD; Amy Berrington de González, DPhil; Diana L. Miglioretti, PhD

Arch Intern Med. 2009;169(22):2078-2086.

Background  Use of computed tomography (CT) for diagnostic evaluation has increased dramatically over the past 2 decades. Even though CT is associated with substantially higher radiation exposure than conventional radiography, typical doses are not known. We sought to estimate the radiation dose associated with common CT studies in clinical practice and quantify the potential cancer risk associated with these examinations.

Methods  We conducted a retrospective cross-sectional study describing radiation dose associated with the 11 most common types of diagnostic CT studies performed on 1119 consecutive adult patients at 4 San Francisco Bay Area institutions in California between January 1 and May 30, 2008. We estimated lifetime attributable risks of cancer by study type from these measured doses.

Results  Radiation doses varied significantly between the different types of CT studies. The overall median effective doses ranged from 2 millisieverts (mSv) for a routine head CT scan to 31 mSv for a multiphase abdomen and pelvis CT scan. Within each type of CT study, effective dose varied significantly within and across institutions, with a mean 13-fold variation between the highest and lowest dose for each study type. The estimated number of CT scans that will lead to the development of a cancer varied widely depending on the specific type of CT examination and the patient's age and sex. An estimated 1 in 270 women who underwent CT coronary angiography at age 40 years will develop cancer from that CT scan (1 in 600 men), compared with an estimated 1 in 8100 women who had a routine head CT scan at the same age (1 in 11 080 men). For 20-year-old patients, the risks were approximately doubled, and for 60-year-old patients, they were approximately 50% lower.

Conclusion  Radiation doses from commonly performed diagnostic CT examinations are higher and more variable than generally quoted, highlighting the need for greater standardization across institutions.

Author Affiliations: Departments of Radiology and Biomedical Imaging (Drs Smith-Bindman, Lipson, and Gould), Epidemiology and Biostatistics (Dr Smith-Bindman), Obstetrics, Gynecology, and Reproductive Sciences (Dr Smith-Bindman), and School of Medicine (Mr Marcus), University of California, San Francisco; Department of Nuclear Engineering, Kyung Hee University, Gyeonggi-do, Republic of Korea (Dr Kim); The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Mahesh); Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland (Dr Berrington de González); and Group Health Research Institute, Group Health Cooperative, and Department of Biostatistics, University of Washington, Seattle (Dr Miglioretti).

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