Risky business

Risks, or more aptly risk-benefit analyses, dominate many of this week’s top features. Two commonly performed imaging exams—screening mammography and CT imaging—never seem far from the discussion of risks and benefits.

In an attempt to clear up ambiguity regarding appropriate screening mammography intervals, Dejana Braithwaite, PhD, of the University of California, San Francisco, and colleagues shared results of a prospective study online Feb. 5 in the Journal of the National Cancer Institute.

The study indicated women ages 65 and older who underwent biennial screening mammography had similar tumor characteristics, but more false-positives, compared with women who underwent annual screening. The study is unlikely to resolve the question of appropriate screening intervals for older women. It does, however, reinforce the importance of ongoing conversations between radiologists and primary care providers regarding the importance of screening mammography for specific patient groups.

Meanwhile, Robert L. Zondervan, MS, from the department of radiology at Massachusetts General Hospital (MGH) in Boston, and colleagues suggested that the perception of the risk of death from radiation-induced cancer among young adults undergoing body CT far outweighs the actual risk. Their study was published Feb. 5 in Radiology.

“The impetus for our study was the concern that the lay press often focuses on potential harm caused to patients by CT imaging,” Susanna Lee, MD, PhD, chief of women's imaging at MGH, said in a press release. “Lacking in this discussion is a sense of how sick these patients already are.”

In the study of 16,804 patients ages 18 to 35 years old, the researchers estimated the risk of death from radiation-induced cancer at 0.1 percent. The risk of death from underlying morbidity during the 5.5-year follow-up ranged from 3.9 percent to 7.1 percent.

Meanwhile, James F. Holmes, MD, MPH, from the department of emergency medicine at University of California, Davis, and colleagues tested a prediction rule to identify children with blunt torso trauma at very low risk for intra-abdominal injury undergoing intervention, publishing their results in the February issue of the Annals of Emergency Medicine.

Using the rule as a guide, rather than a hard-and-fast formula, for decision making could help target imaging to children more likely to require intervention and obviate CT scanning for those at very low risk.

Another potentially risky endeavor for radiologists centers on patient communication and results delivery. As radiologists strive to find their patient care niche, results communication inevitably bubbles to the surface.

There is little enthusiasm for the practice among primary care physicians, Andrew J. Gunn, MD, from the department of radiology at Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues, reported Feb. 1 in the Journal of the American College of Radiology and in slides.

How does your practice handle these risky situations? What other risks keep you awake at night? Email and let us know.

Lisa Fratt, editor