Medical imaging exams have been directly linked to greater life expectancy, declines in cancer mortality rates, and are generally less expensive than the invasive procedures that they replace. However, widespread use has resulted in increased radiation exposure for Americans.

The American College of Radiology (ACR) advises that no imaging exam should be performed unless there is a clear medical benefit that outweighs any associated risk. The ACR supports the 'as low as reasonably achievable' (ALARA) concept which urges providers to use the minimum level of radiation needed in imaging exams to achieve the necessary results. ACR is a founding participant in the Image Gently™ campaign for dose reduction in pediatric imaging and has launched an adult radiation dose reduction effort.

While imaging growth is in line with, or below that of other physician services, appropriate use of imaging can be addressed by wider adoption of ACR Appropriateness Criteria®, which help physicians prescribe the most appropriate imaging exam for more than 200 clinical conditions (particularly when an imaging exam that does not use radiation may be more appropriate for a given condition), and point of entry physician ordering systems based on this tool, such as the 2010 Medicare pilot project mandated by the Medicare Improvements for Patients and Providers Act of 2008. Accreditation of imaging facilities, to be mandated under Medicare, effective Jan. 1, 2012, can cut down on radiation dose received from duplicative scans and help to ensure that patients receive appropriate dose per scan.
Specific to the Archives of Internal Medicine studies:

No published studies show that radiation from imaging exams causes cancer. The conclusions of the authors of the Archives' studies rely largely on data which equates radiation exposure and effects experienced by atomic bomb survivors in Japan to present day patients who receive computed tomography (CT) scans. Most CT is performed in controlled settings and results in limited radiation exposure to a small portion of the body. Atomic bomb survivors experienced instantaneous exposure to the whole body. CT exams expose patients solely to X-rays. Atomic blast survivors were exposed to X-rays, particulate radiations, neutrons, and other radioactive materials. The known biological effects are very different for these two scenarios. Cancer assumptions based on this paradigm should be considered, but not accepted as medical fact.

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