COMARE Publishes 12th Report

The U.K. Committee on Medical Aspects of Radiation in the Environment (COMARE) has just published its 12th report: "The impact of personally initiated X-ray computed tomography scanning for the health assessment of asymptomatic individuals". The report is available through the COMARE Web Site.

Scanning of the asymptomatic individual by using a computed tomography (CT) X-ray machine is a practice that has implications for public health, despite the fact that CT scanning of the asymptomatic individual may provide benefits to that person. The committee has reviewed the literature regarding both the benefit and detriment associated with CT scanning in the health assessment of asymptomatic individuals. We have considered the detriment caused by radiation from the CT scan but also the subsequent psychological effects and potential physical detriment from further investigations. Furthermore, we have considered the economic implications for the NHS which may become liable for further tests and examinations. While reviewing this type of practice, alternative techniques using lower doses of ionizing radiation or non-ionizing radiation have been considered.

COMARE recommends that regulation of these commercial CT services should be reviewed. We also recommend that clients should be provided with comprehensive information regarding dose and risk of the CT scan, as well as rates of false negative and false positive findings. Commercial CT services should have well developed and confidential mechanisms for integrating examination results into an established care pathway. Scans and data relating to any individual should be in formats consistent with national NHS IT programs. We have also recommended that any individual displaying symptoms and requesting a CT scan from a commercial service should not be scanned and should be referred back to their GP. There is a regulatory requirement that all medical exposures using ionizing radiation should be optimized, and from our review it is not possible to optimize exposure parameters for CT scans of the whole of the body, and we have strongly recommended that services offering whole body CT scanning of asymptomatic individuals should discontinue to do so. In addition, CT should not be used in assessment of spinal conditions, body fat and osteoporosis in asymptomatic individuals.

Scanning of three specific anatomical regions have been considered in detail in this report. We have concluded that there is no evidence that CT scanning for lung conditions is of benefit. However, cardiac CT scanning has been shown to have value for predicting cardiovascular risk and similarly CT colonography has the potential to detect small lesions. Both cardiac CT scanning and CT colonography should only be carried out in certain asymptomatic individuals.