Multidetector CT: Opportunities, challenges, and concerns associated with scanners with 64 or more detector rows

Extreme multidetector CT has the potential to truly revolutionize cross-sectional patient imaging. However, substantial infrastructure improvements may be necessary for maximal diagnostic utility of this technology. Radiologists will need to revise CT protocols, change viewing strategies, and develop new visualization skills to use these scanners to their full potential. The excellent temporal resolution of extreme multidetector CT will be used for rapid imaging in the heart and elsewhere, bringing a new appreciation of the functional capabilities of dynamic CT. Patient radiation doses will increase with these scanners, so those of us in the radiology community need to develop and adhere to up-dated appropriateness criteria for extreme multidetector CT examinations. There is also a need for scientifically based benefit-risk analyses of CT that are performed by scientists-not biased by an agenda. Such analyses should include patient age and parameters related to the health status of the patient. The increase in clinical applications and image quality that extreme multidetector CT scanners offer can lead to a sea change in disease assessment and diagnostic medicine. To remain masters of this technology, radiologists need to (a) know when to use it and when not to, (b) be conversant and knowledgeable about radiation risk issues, and (c) develop radically new interpretation practices that will improve the diagnostic accuracy of every CT examination.