Reacción a "Study estimates risk of future cancers as a result of CT scans in the US"

According to Spanish regulations - the Royal Decree is a partial transposition of the EURATOM directive 2013/59 - all CT or CAT scans must be duly justified. This means that a physician must make a personalised decision for each patient, indicating CT scanning only if, in the patient's specific clinical situation, the expected benefit outweighs the risk associated with the radiation dose received. Therefore, if a physician indicates to a patient that a CT scan is appropriate, the patient should have it performed. In addition to being justified, the radiation dose should be optimised: it should be the minimum dose compatible with the quality of the study being adequate for its purpose. This article should not be interpreted as a guide for patients to make individual decisions based on their results, but it should make professionals, health managers and administrations reflect on how to improve the justification and optimisation tools we already have.

Moreover, the radiation dose of each CT scan performed is, in general, lower in the latest generation equipment than in older ones and, fortunately, in Spain there was a major renewal of this equipment in 2023 thanks to the INVEAT plan carried out with Next Generation EU recovery funds.

According to OECD data for 2021 (the most recent available) the number of CT scans per 1,000 people (i.e. directly comparable, as the total population of the country is not taken into account) in the USA was 1.8 times higher than in Spain (254 in the USA compared to 134 in Spain). However, the number of CT scans is also growing rapidly in Spain, being more than 25% higher in 2021 compared to 2015.

In Spain, the use of tools called dose registry and management systems is currently spreading, which, if properly used by a multidisciplinary team of professionals, including radiophysicists, radiologists and senior imaging technicians, make it possible to monitor and optimise the radiation dose received by the population due to diagnostic scans. These tools should be promoted by healthcare managers and included in broader optimisation and justification projects that include continuous training programmes for professionals and improved coordination between healthcare levels. Some autonomous communities already have them in place and others are in the process of implementing them. The National Dosimetry Centre, which belongs to the Ministry of Health, also has a national project. The Spanish Society of Medical Physics is very interested in promoting the proper implementation of these tools, which can be considered quaternary prevention tools, as we consider them essential given the increase in CT scans that is being recorded.

There is a justification audit project in the European Union, financed by EU funds and still on a pilot basis. This audit consists of checking a posteriori, for a small sample of patients, and following a well-established systematic approach, whether the imaging performed was correctly prescribed (whether the risk/benefit assessment originally carried out was adequate). In my opinion, the extension of these audits would help to promote quality and safety culture and would also contribute to patients' peace of mind.