When I was a resident, CT was still in its infancy. To witness its spectacular development over the last three decades has been a journey of continuing amazement. Considered by many the most important single development in diagnostic imaging, CT has become the modality of choice for the initial evaluation of many common emergent conditions.

Diego B. Nunez M.D.,
M.P.H.

Beyond its widespread use in the assessment of traumatic and neurological emergencies, patients with suspected pulmonary embolism, acute aortic syndromes, renal colic, appendicitis and other acute abdominal conditions routinely receive an emergent CT examination. Noteworthy is how the number of CT examinations performed in emergency department (ED) patients has climbed to alarming levels in recent years—this number has far exceeded the growth of ED patient volumes. Overutilization drives increasing healthcare costs and, importantly, raises serious concerns about radiation exposure.

Our challenge as radiologists is to achieve optimal image quality without compromising patient safety. What is our level of engagement in preventing the significant shortcomings of overuse? We must become actively involved in designing and implementing safe, accurate and cost-effective imaging protocols. Use of appropriateness criteria and clinical prediction rules in our ED practice is of paramount importance, while our contributions to evidence-based emergency imaging criteria are expected to optimize utilization. We must be familiar with dose reduction strategies and develop radiation risk assessment programs, particularly as this issue affects our youngest patient population.

We must help our referring physicians understand the risk of radiation and its cumulative effect and make these physicians sensitive to reviewing the prior imaging history of our patients. Ongoing educational campaigns in utilization and imaging alternatives should be established as part of our interdepartmental practice-based teaching sessions.

We must step up our involvement in the current cost sensitive and patient safety-driven healthcare environment.

Diego B. Nunez M.D., M.P.H., is chair of radiology at the Hospital of Saint Raphael and a clinical professor of diagnostic radiology at the Yale University School of Medicine, both in New Haven, Conn. Dr. Nunez, who chairs the Emergency Radiology Subcommittee of the RSNA Scientific Program Committee and is an associate editor of Radiology, further discusses the concerns emergency radiologists face as CT technology improves and multi-trauma case volume increases in a feature in this month's RSNA News.