Radiologists strive to do no harm

Acting in their capacity as medicine's designated custodians for issues involving ionizing radiation, radiologists defined strategies this year to address the dangers accompanying the explosive growth in the number of medical procedures that require ionizing radiation.

The situation warranted concern. Imaging involving ionizing radiation has increased sixfold in two decades. Yet few systems have been implemented to identify patients at risk of radiation-related cancer because of repeated exposure. This and other deficiencies may be addressed if the American College of Radiology adopts potentially historic recommendations proposed this year.

Simultaneously, radiologists are beginning to appreciate the implications of nephrogenic systemic fibrosis, a dreadful skin disease. Nearly 300 cases have been reported thus far. All involve patients with severe renal abnormalities and exposure to a gadolinium-based contrast medium used during an MR procedure.

And radiologists continued to enjoy the fruits of technical progress. New American Cancer Society guidelines and positive results from an ACR Imaging Network trial elevated the prospects for breast MRI to gain wider acceptance. Clinical trials affirmed the promise of coronary artery CT angiography. The combination of high technical success and low complication rates raised interest in image-guided tumor cryoablation. Virtual colonoscopy proved to be cost-effective in a study that gives insurers an additional incentive to approve reimbursement for the technique. The list goes on.

The record indicates that radiology remains strong. Its harnessing of natural forces explored by Wilhelm Roentgen over 100 years ago continues to be an essential and prominent feature of the medical profession.