Imaging with Purpose: Balancing Risk, Benefit and Trust in Radiology

Recently, I had the opportunity to speak with attendees at an International Atomic Energy Agency (IAEA) meeting about why radiologist-led radiation reduction and clear, honest communication to patients and providers about imaging risk vs. benefits matters more than ever.

Medical imaging is an essential part of modern healthcare, but benefits should outweigh the risks for every scan that uses radiation. This is accomplished through both justification and optimization.

Radiology teams primarily manage optimization — keeping doses as low as reasonable — while justification is a shared responsibility of the imaging team, providers and patients to help decide when imaging is needed. This decision benefits from accurate and easily understood information from radiologists and allied imaging professionals.

Justification May Not Always Be Simple

Many people take part in imaging decisions — patients, doctors, radiologists, caregivers and regulators. Each group may see risks and benefits differently. Defining what counts as necessary can be challenging.

The clinical environment adds more complexity. Referring providers often work under time pressure. Many do not intend to order potentially unnecessary tests, yet imaging choices vary by training, resources and even time of day. In emergencies, for example, clinicians sometimes choose CT scans because reliable ultrasound may not be available.

A major tool supporting this effort for justification is clinical decision support, or CDS. These systems offer evidence-based guidance regarding which imaging tests may best fit a patient’s condition. Professional groups like ACR® developed widely used appropriateness criteria to help guide choices. CDS software tools provide the “how” for the guidelines, or the “what” within the CDS system.

AI may also be able to improve how clinicians enter imaging orders, making the process faster and more accurate. Better information can help reduce unnecessary scans and improve patient experience.

By working together, using strong guidelines and applying new technology wisely, the healthcare community can warm up the justification process and help ensure each scan truly serves the patient’s best interests.

Many Still Misunderstand the Real Risks

Imaging tests help doctors make fast, accurate decisions. The biggest risk for many, however, often is getting the right imaging in time. Families often hear about radiation risk and can be encouraged to imagine the worst. Parents may worry about rare cancer risks without realizing the much higher danger of delaying or missing a diagnosis guiding patient care. Providers also vary in how well they understand radiation exposure, and some avoid the topic or give mixed messages. This leads to mistrust, especially when people already feel anxious or rushed.

Children need special attention. Their bodies are smaller, they may need sedation (an additional small risk), and they depend on caregivers to make decisions. Most children are imaged in general hospitals, not centers with pediatric expertise, which may add challenges.

Making Progress

National campaigns such as Image Gently and Image Wisely help reduce radiation doses and improve awareness. Many teams now adjust techniques to keep exposure as low as reasonable while still getting clear images.

Building trust starts with communication that is human, simple and caring. Providers should be informed, sensitive and engaging, welcoming questions and being prepared to explain why an exam is needed, the amount of radiation exposure, how this exposure is minimized and what is known about risks. Instead of overwhelming patients with numbers, he suggests focusing on the purpose of the exam and the value it provides.

Patients depend on health professionals to recommend the safest and most effective care. Building patient trust requires communication, collaboration and realistic expectations. Clear, honest conversations help families feel seen and supported. They also help patients make better decisions.

Medicine is both an intellectual and moral profession. Imaging is not just about pictures — it’s about people.