ct scanning icrp symposium oct. 25, 2011 bethesda, mdicrp.org/docs/fred mettler ct scanning the good...
TRANSCRIPT
![Page 1: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/1.jpg)
• CT scanning
Fred Mettler
NM VAHCS
Albuquerque NM
ICRP Symposium
Oct. 25, 2011
Bethesda, MD
![Page 2: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/2.jpg)
tube
stopwatch
batteries
70,000 volts
“Don’t move for the next 10 minutes or you will be electrocuted”
Things are not as ugly as they used to be
![Page 3: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/3.jpg)
3 million 1982
![Page 4: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/4.jpg)
CT
1995 21 million
![Page 5: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/5.jpg)
CT
2007 70 million
![Page 6: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/6.jpg)
CT scans by year in US (millions)
18.3 19.521.0
22.625.1 26.3
30.6
34.9
39.6
45.4
50.1
53.9
57.6
62.0
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
No
. o
f p
roced
ure
s (
millio
ns)
Annual growth of >10% per year
U.S. population < 1%/yr CT annual growth > 10%/yr
CT scans by year in U.S. (millions)
![Page 7: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/7.jpg)
Collective annual population dose from medicine has increased over 700 percent
900,000 person-Sv
2006 1980
124,000
Person Sv x 7.25 =
These results have not been reviewed and approved by Council. Not to be disseminated or referenced
![Page 8: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/8.jpg)
Bad Regarding dose we were pretty much caught off guard
![Page 9: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/9.jpg)
Good or bad ?
Natural
2.4
CT scanning 1.5 mSv
Radiography 0.3 mSv
Nuclear medicine 0.8 mSv
All other ?? mSv
Medical ~3.0 mSv
Total ~ 5.4
Medical 0.54 mSv
Total 3.0 mSv per capita
Natural 2.4 mSv
U.S. 1980 U.S. 2006
Interventional 0.4 mSv All other
![Page 10: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/10.jpg)
Computed tomography (CT scan)
Recent advances in machine technology have led to more applications and markedly increased usage
![Page 11: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/11.jpg)
Single slice CT scanner
Single detector
x-ray tube
Patient table
Scan time ~ 10-20 minutes
Incremental motion
![Page 12: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/12.jpg)
Multislice multidetector helical CT scanner (new scanners are 1000x faster)
16-300 detectors
x-ray tube
Patient table
Constant motion
Now 300 slices/images in 0.3 second
![Page 13: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/13.jpg)
Good Uncertainty reduced for patient and physician
![Page 14: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/14.jpg)
Good Uncertainty reduced for patient and physician
CT scan”
![Page 15: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/15.jpg)
Good Appendicitis
Normal
Abnormal
![Page 16: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/16.jpg)
Good Trauma
CT scan of head, neck, chest, abdomen and pelvis
10-30 seconds
Many significant findings are seen such as brain hemorrhage, liver lacerations which are difficult or impossible to see on plain x-rays
Liver laceration
Small pneumothorax
![Page 17: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/17.jpg)
Good replacement of IVPs
Obstructing stone
Bladder
Intravenous urogram (IVP)
Requires injection of intravenous contrast
Contrast reactions in 5% of patients
30 minutes
![Page 18: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/18.jpg)
CT scan 30 seconds. No intravenous contrast
4mm stone in distal ureter
![Page 19: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/19.jpg)
Good replacement of other techniques with improved accuracy
Reduced blood flow to one lung- nonspecific
Large clot in right main pulmonary artery – clear diagnosis
![Page 20: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/20.jpg)
Bad confusion in the literature
•
Bach PB et.al. JAMA 2007
144 cancers found 44 expected
No reduction in mortality
38 deaths vs 38.8 expected
Henschke et.al. NEJM 2006 CT scanning can prevent 80% of lung cancer deaths
JAMA March 7, 2007
![Page 21: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/21.jpg)
Ugly Variation in CT scan doses among institutions and by scanner model
S. Stern, USFDA
![Page 22: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/22.jpg)
Bad Radiologist’s repetitive hedging
2005 MRI to “evaluate liver lesion”
![Page 23: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/23.jpg)
2004 Ultrasound shows characteristic hemangioma
![Page 24: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/24.jpg)
Surprise 4 prior CT studies
2002
2003
2004
2005
2004
![Page 25: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/25.jpg)
CT scan 2002
No change over any scans in prior 3 years but “cannot entirely r/o neoplasm”
![Page 26: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/26.jpg)
![Page 27: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/27.jpg)
Good Hybrid imaging
![Page 28: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/28.jpg)
Bad Self-referral financial incentives
![Page 29: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/29.jpg)
Ugly Uncertainty over Obamacare, taxes and the Federal budget
has stifled investment and planning
![Page 30: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/30.jpg)
Bad Gift certificates for screening CT scans
![Page 31: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/31.jpg)
Good Rapid accurate diagnoses especially in the ER
![Page 32: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/32.jpg)
4 liters of blood
Uterine wall
Fetus spine
foot
![Page 33: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/33.jpg)
Fetus
skull
ribs
blood
CT scan results
![Page 34: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/34.jpg)
Free blood
Kidney ripped
off aorta (no contrast in it) Splenic laceration
3 min exam and off to the OR
She and the child survived
![Page 35: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/35.jpg)
Bad Potential overuse
![Page 36: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/36.jpg)
What does “ABC” stand for
Airway
Breathing
Circulation
![Page 37: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/37.jpg)
What does “ABC” stand for
Airway
Breathing
CT
![Page 38: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/38.jpg)
Ugly
• The urologist or surgeon refuses to come see the renal stone patient until a CT is ordered
![Page 39: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/39.jpg)
Good and Bad Radiology consultation
• We don’t have time to discuss all CT scans • A typical department doing 35,000 CT scans per year = 5-6 phone calls per hour for CT alone
• Some have 24 hour availability
![Page 40: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/40.jpg)
Good Computer systems Bad Limited use
![Page 41: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/41.jpg)
Warning - Similar Names
Vano El Gato July 23, 1930 144-45-6929
Vano E July 14, 2008 144-36-8729
![Page 42: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/42.jpg)
Good Computer generated warnings
Cousins Claire July 14, 1990 144-36-8729
Age 21 6 CT scans done in last 3 months
Continue to order ??
Attention: Possible radiation issue
![Page 43: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/43.jpg)
Machine generated warnings
“ The CT protocol you have chosen has CTDI over the ACR accreditation limit !!”
![Page 44: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/44.jpg)
Bad Inadequate knowledge of dose and risk
What does a dose of 13 mSv and a DLP of 500 really mean ????
Radiology resident
![Page 45: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/45.jpg)
Bad There probably is a cancer risk from CT
1.0
1.1
1.2
1.3
1.4
100 200 300 400
Relative risk
1 CT scan sequence
3-phase CT liver scan
4-5% of CT scan patients
Organ dose (mSv) A-bomb data show a statistically significant increase at > 150 mSv
50
![Page 46: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/46.jpg)
Good and Bad Age dependence of risk from a CT scan
D. Brenner
Head CT
![Page 47: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/47.jpg)
Good Some groups noticed the issues in the late 1990’s
2000
![Page 48: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/48.jpg)
Bad It really took media attention to accelerate changes
![Page 49: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/49.jpg)
Good Dialogue
![Page 50: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/50.jpg)
Good
Radiation is quite a weak carcinogen and the cancers usually take years to arise, if they arise at all
![Page 51: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/51.jpg)
Good Radiation is a weak carcinogen and cancers generally take decades to occur
Non cancer deaths 37, 137
Expected cancer deaths
9,801
Radiation excess deaths (570)
~ 1% excess deaths due to radiation-induced cancer Preston Rad Res 2004
Causes of death in atomic bomb survivors (2001)
![Page 52: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/52.jpg)
Bad Even a low risk multiplied by 70 million is a large number
![Page 53: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/53.jpg)
Ugly CT scanning was reported to cause epilation and erythema over 10 years ago and has continued
Hair loss from excessive dose of a CT angiogram
![Page 54: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/54.jpg)
Ugly Erythema from recent accidental overexposure
![Page 55: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/55.jpg)
Things that should be in our sights Lower dose, better aim
![Page 56: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/56.jpg)
Good
![Page 57: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/57.jpg)
Good translation and outreach
![Page 58: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/58.jpg)
![Page 59: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/59.jpg)
Coming soon…..
![Page 60: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/60.jpg)
Thank you
![Page 61: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/61.jpg)
![Page 62: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/62.jpg)
If you use too much radiation … you may get your ass in trouble
Always remember……
![Page 63: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/63.jpg)
Ugly Going through the learning process
![Page 64: CT scanning ICRP Symposium Oct. 25, 2011 Bethesda, MDicrp.org/docs/Fred Mettler CT scanning The good bad and ugly.pdf · Oct. 25, 2011 . Bethesda, MD . tube . stopwatch . batteries](https://reader033.vdocuments.net/reader033/viewer/2022051907/5ff9ad1052c017624271293d/html5/thumbnails/64.jpg)