Cancer risk associated with CT imaging: quantifying the evidence, addressing misconceptions, and optimizing risk communication.

Computed tomography (CT) is a cornerstone of modern diagnostics, but its increasing use has raised concerns about long-term cancer risks associated with ionizing radiation exposure. This narrative review evaluates the magnitude of cancer risk linked to CT imaging, identifies vulnerable populations, clarifies common misconceptions about radiation dose, and explores emerging strategies for risk reduction and patient-centered communication. Evidence from epidemiologic cohort studies, radiobiological models, technological assessments, and public health guidelines published over the past two decades is synthesized. The cancer risk associated with CT is small but quantifiable, particularly in pediatric and high-utilization populations. Recent advancements in CT technology have enabled substantial dose reductions, including photon-counting detector systems and AI-driven dose optimization tools that improve diagnostic quality while lowering exposure. Contemporary meta-analyses (2018-2024) also provide clearer dose-response estimates for low-dose medical radiation. Advances in imaging technology and protocol optimization have significantly reduced per-scan radiation doses; however, physician awareness and patient education remain inconsistent. Looking forward, precision imaging strategies, cumulative radiation tracking, and ultra-low-dose CT platforms represent promising future directions for minimizing risk. Minimizing harm while preserving diagnostic benefit requires evidence-based utilization, personalized imaging protocols, and transparent communication of risk, especially among high-risk groups.