The editorial by Orchard et al1 is a timely reminder of the mounting evidence of the negative bioeffects of imaging studies utilising ionising radiation in paediatric populations. This applies especially to CT and nuclear medicine, in which the doses are higher than X-rays, and which are much more commonly performed than in fluoroscopy. As the authors point out, these considerations are highly relevant to the practice of sports medicine, as the patients are often young, and bony injuries are commonly investigated using CT and nuclear medicine. So how are clinicians to integrate data from these increasingly well-designed studies2 into recommendations that will still allow accurate and timely diagnosis of sports-related pathology? As a professor of musculoskeletal radiology, I share the following thoughts:

• Appropriateness is key

There have been a number of studies that correctly point out the need …