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Invited Critique
June 2013

X-rayted and Overexposed: Comment on “Comparison of Radiation Exposure and Cost Between Dynamic Computed Tomography and Sestamibi Scintigraphy for Preoperative Localization of Prathyroid Lesions”

Author Affiliations

Author Affiliations: The Office of Surgical Education, Baystate Medical Center, Tufts University Medical School, Springfield, Massachusetts.

JAMA Surg. 2013;148(6):503. doi:10.1001/jamasurg.2013.66

If you are not worrying about ordering tests involving radiation exposure, your patients certainly are. This concern has been widely discussed in the press recently, and this study by Madorin et al1 in this issue of the journal is both timely and pertinent. Although it should be incumbent on us to know the radiation exposure of a test, for the most part, we do not. A computed tomograph (CT) to identify parathyroids apparently delivers a radiation dose that is not much greater than background. My concern is the additional exposure engendered by the indiscriminate use of CT and other radiologic studies that we see all the time. The authors used a double-isotope sestamibi scan that takes more time and has no benefit over single-isotope scans and, actually, adds little additional radiation, but those of us who are not radiation physicists would not know this. If tests that involved radiation had the expected exposure listed, it would allow us to counsel patients appropriately.

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