Near the end of War and Peace, Tolstoy wrote (in Russian) that his protagonist Pierre Bezukhov fell ill and that, “despite the fact that the doctors treated him,” Bezukhov recovered. These words, written before the advent of X-rays, illustrate a premise that still holds true for modern medical imaging: that investigations and treatments offered to benefit patients nevertheless expose patients to risks. Preventable adverse outcomes occur in part because medical imaging can be performed without strict regard to appropriate-use algorithms and because it subjects patients to risks that healthcare professionals/providers (HCPs) do not fully understand.

Multiple historical texts, such as the Hippocratic oath, state that HCPs have an obligation to consider the harm that they could cause their patients in addition to the intended good, and this obligation persists in modern medical practice. In Western medicine and law, the move away from paternalism toward a patient-centered, patient autonomy first approach has made vital the communication of risks with patients to enable patients to make informed choices about their care, as reviewed elsewhere. Furthermore, common laws and medical policy-making organizations place responsibility on both individual HCPs and healthcare delivery organizations to recognize risks to patient safety and implement measures to reduce them, as reviewed elsewhere.

Among HCPs and the general public, awareness of potentially devastating effects associated with medical imaging has improved since its introduction into public use in the early 20th century. In 2019, the United States National Council on Radiation Protection and Measurements (USNCRP) reported that the American per capita dose of non-therapeutic medical radiation decreased between 2006 and 2016. Risk reduction strategies have led to equipment with better safety features, clinical algorithms advocating more judicious use of radiological imaging, and recognizing patient groups most at risk for complications from medical imaging.