This study highlights one of the main dilemmas of modern medicine; namely, the threshold at which a clinician performs an investigation, particularly where this involves receiving a radiation dose such as computed tomography scan. The dilemma lies between not missing significant pathology and not utilising resources unnecessarily plus potentially increasing the patient’s future risk of cancer. In most specialities there are guidelines, from a variety of bodies including the national institute of clinical excellence and national specialty societies, which help determine the investigative pathway of patients. However, individual patients often present with a constellation of signs, symptoms and risk factors which may not fit within the guidelines. An example would be the young patient with a strong family history of coronary disease and first degree relatives presenting with myocardial infarction or death below the age of 40, with very atypical chest pain which is clearly non-cardiac in nature. A further example would be the patient who is in complete remission from cancer but notices vague intermittent bloating in the abdomen despite being very well with a normal clinical examination, ultrasound abdomen and blood profile. Some clinicians may just re-assure the patient whilst others may perform a coronary CT angiogram in the former case and CT abdomen in the latter case. Often the real-world decision making is based partly on clinical judgement of the physician but also increasingly on managing expectations and re-assuring patients. Patients should be made aware of the dose of radiation they receive and what implications this has on their future risk of cancer so they can be fully informed about the risks and benefits of their chosen pathway.

Source: BMJ