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Get the whole picture before a CT; doctors, patients must weigh risks vs. rewards of medical imaging By Judith Graham
http://www.JewishWorldReview.com | (MCT)
After an imaging test revealed a small nodule in Dr. As deputy chief medical officer of the "The reality is, I thought the radiation dose from those follow-up scans represented more of a threat than the nodule," he said. As physicians find new ways to use diagnostic imaging to discover and deal with disease, concern is growing about Americans' increased exposure to potentially cancer-causing radiation. Annual radiation doses from medical imaging have soared sevenfold since the early 1980s, according to a report last year from the Meanwhile, as many as 14,500 people may end up dying annually from radiation-induced cancers caused by CT scans, new research suggests. Late last month, Scrutiny is focusing primarily on more than 70 million computerized tomography scans performed in the U.S. every year, up from 3 million in the early 1980s. The scans help doctors identify brain tumors, kidney stones, and obstructed bowels and have revolutionized medicine, virtually eliminating exploratory surgery and aiding millions of patients. People often ask for the tests, and for some doctors they've become an important source of income. For most, they're an essential medical tool. "You can run a patient through in just a few minutes, get amazing information about what's going on inside their body, and they don't glow green — so why not?" said Dr. Ionizing radiation is the reason; CT scans shower patients with far more of it than other diagnostic tests. For example, a routine head CT produces the same dose as 400 dental X-rays while the dose from a chest CT equals to more than 100 X-rays. That radiation can wreak havoc at the cellular level, breaking or altering DNA strands and causing mutations that spin out of control, generating cancers many years later. Yet patients' exposure to radiation from diagnostic imaging exams isn't regulated, with the exception of mammography. By contrast, regulations limit U.S. workers to no more than 50 millisieverts of radiation a year from nuclear materials. Someone who gets multiple medical scans can easily exceed that level, said The risks were highlighted in a recent study in the Archives of Internal Medicine warning that 29,000 radiation-induced cancers — half of them deadly — could result from the CT scans performed in 2007 alone. Two years earlier,
These conclusions are far from universally accepted, however, as no study has directly shown that CT scans cause cancer. Instead, scientific understanding of the link between radiation and cancer is drawn largely from studies of survivors of the atomic bombs dropped in "All the numbers are based on models," said Dr. In a landmark 2005 review of the data, the "The risk of death by drowning is greater than the risk of death from a cardiac or body CT exam," noted The biggest problem, McCollough said, is that operators of CT machines often don't have adequate education or training and "have not kept up with the rapid developments in the technology." As a result, some patients may get higher-than-recommended radiation doses. Also, most doctors are poorly educated about the radiation risks associated with medical imaging — two-thirds or more underestimate the doses, according to several studies. There is little standardization, and doses patients receive can vary by a factor of 13, according to a recent research report. Though the As an example, Dr. Thrall said: "Someone who has a simple headache without other neurological signs is very unlikely to have a serious medical problem that could be discovered with a CT scan. And yet tens of thousands of people are scanned for headaches of this kind every year." Responding to such concerns, the
Still, as long as doctors fear missing an important medical complication and being sued, practices are unlikely to change, said Dr. And some doctors who own scanning equipment have a financial stake in diagnostic imaging. Research shows that doctors who own machines perform two to seven times more imaging tests than those who don't, said Dr. Moreover, "the physicians who own this equipment and order the tests have generally had no training in radiology and little understanding of the complexities of radiation dosing" and its attendant health risks, Rao said. "For patients, this is absolutely the perfect storm." ——— ASK YOUR DOCTOR Experts say patients should not request an unnecessary imaging test just to be on the safe side. Nor should they let unwarranted fear scare them away from a test. Questions to ask: Why have you suggested this test? What do you hope to learn? Do you expect the results might change your medical recommendations? How? Are there alternatives that involve less radiation exposure? Could an MRI or an ultrasound substitute? What's the average radiation dose associated with this kind of test? How many times will I be scanned? Is there a way to perform this test that involves fewer scans and less radiation exposure? Are you keeping a record of my scans and my radiation exposure? Do you have an ownership stake in the machines used to scan me? (This applies if the scan occurs in a doctor's office.) Are the technicians licensed or certified? Do you have a quality assurance program for diagnostic imaging? Are the machines checked routinely? Is the facility where the scan takes place accredited? Will an expert radiologist interpret the test? Note: It's also important to tell doctors about scans received elsewhere. If possible, provide copies.
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