Computed tomography with low-dose radiation versus standard-dose radiation for diagnosing fractures: systematic review and meta-analysis

Abstract

Ionizing radiation such as X-rays is a singular form of energy that surmounts the binding energy of electrons that orbit atoms and molecules. 1 In biological material exposed to X-rays, the most common consequential scenario is that this creates hydroxyl radicals from interactions between X-rays and water molecules. These radicals, in turn, interact with deoxyribonucleic acid (DNA) to cause breakage of bonds or damage to the base. 1 Thus, mutations, chromosomal translocations and fusions between genes can occur, which in some cases may lead to cancer. 1 All X-ray-based imaging methods have the characteristic in common of a trade-off between image quality and radiation dose, since all forms of ionizing radiation can damage tissues. 2 In patients undergoing radiographic and/or tomographic monitoring, the patient's exposure to radiation needs to be considered, and this poses a challenge to radiologists regarding dose reduction. 3,4 The main concern in diagnostic imaging is that a stochastic lesion of radiation-induced cancer could develop, which can occur with any radiation dose. [5][6][7] Conversely, deterministic effects occur only when the threshold has been exceeded and, above that, the incidence and severity of the injury increase with the radiation dose. 6,7 It also needs to be taken into account that the pediatric population is 10 times more sensitive to radiation than adults. 8 To date, no safe dose of ionizing radiation, below which there is no risk of cell damage and subsequent risk of cancer, has been established. 9,10 However, it has been estimated in the United States that about 1.5%-2.0% of all malignancies can be attributed to radiation from computed tomography (CT) scans. 1,6 Taking all imaging examinations into account, this proportion ranges