CT scans diagnose serious medical problems and often save lives, but this tool is OFTEN OVERUSED resulting in big doses of radiation and big medical bills that could’ve been avoided.
Absolutely they are a great tool. I don’t think anyone can dispute the value they have brought to humanity.
And yes, I do order scans every day, but that doesn’t mean I should be ordering them on people who don’t need them.
I, or any other physician, shouldn’t be ordering a CT scan on people with weak reasons to do it.
Only because it’s definitely needed - it’s definitely indicated according to the medical evidence - and not because “it’s easy - I have a scanner available - let’s just do it”.
CT scanning has certainly aided diagnosis and helped many patients avoid exploratory surgery, but it has also spawned concerns about misuse.
X-rays have been used for almost 120 years, but the introduction of computed tomography, or CT scans, in the 1970s, was revolutionary. The new tests, which use multiple X-ray images, allowed doctors to see with unprecedented precision the inner workings of the human body, and earned the inventors of the device the 1979 Nobel Prize in medicine. Use of the tests grew quickly, rising from fewer than 3 million per year in 1980 to more than 80 million now.
2. Don’t you have clearly laid out and written criteria for ordering a CT scan? So what are the concerns about CT scans?
Yes, we have internationally accepted very clear criteria for ordering say a CT scan of the head, or the chest or the abdomen and pelvis, but unfortunately, that doesn’t mean your urgent care or emergency physician will follow those guidelines.
Remember, these are just guidelines. They’re not rules and they’re not the law.
The ballooning costs of healthcare, including from duplicate procedures, the potential harm from the tests themselves and the overtreatment of harmless conditions found during scans. These are effects of overdoing it with the CT scans.
There’s such a thing in Medicine that physicians call “incidentalomas” — so named because they are found unexpectedly — include benign lung and thyroid nodules and other common conditions that can lead to even more unnecessary and expensive workups as well as treatment that can cause complications.
3. How many scans are done unnecessarily? Anyone watching this will probably think that their CT scan was actually necessary won’t they?
And many of them would be right.
Unfortunately, many patients have fallen prey to a sophisticated sales pitch.
Researchers know that doctors today order millions of radiation-based imaging tests each year, that many of them are unnecessary, and that the more radiation people are exposed to, the greater their lifetime risk of cancer.
Recent research shows that about one-third of those scans serve little if any medical purpose. And even when CT scans or other radiology tests are necessary, doctors and technicians don’t always take steps to limit radiation exposure.
4. OK so let’s say that some scans probably shouldn’t have been done. What are consequences of getting these so-called ‘unnecessary scans’?
All of that exposure poses serious health threats. Researchers estimate that at least 2% of all future cancers in the U.S.—approximately 29,000 cases and 15,000 deaths per year—will stem from CT scans alone.
No one is saying that you should avoid a CT scan or other imaging test if you really need it, and the risk posed by any single scan is very small.
But the effect of radiation is cumulative, and the more you’re exposed, the greater your cancer risk. So it’s essential that you always ask your doctors why they are ordering an imaging test and whether your problem could be managed without it.
15,000 : That’s the number of people estimated to die each year because of cancers caused by their previous radiation exposure from CT scans alone.
5. Given those risks, why are we—and our doctors—so scan-happy?
For one thing, patients aren’t necessarily aware of the danger.
A new Consumer Reports survey of 1,019 U.S. adults found that people are seldom told by their doctors about the risks of CT scans and other radiology tests.
It’s no surprise, then, that only 2% of those who had a CT scan thought they might have received the tests unnecessarily.
And only 4% ever told their doctor they did not want a CT scan.
That’s a bit worrying. Patients need to take the lead on this because their doctor may not.
Other studies show that doctors themselves often underestimate the dangers CT scans pose. Moreover, and this is a very worrisome situation, some doctors and clinics may actually have a financial incentive to order the tests.
“Health care professionals shouldn’t have the right to image children or adults unless they first show that they can do it safely and appropriately, and most of the time in this country, that’s not happening,” says Stephen J. Swensen, M.D., medical director at the Mayo Clinic in Rochester, Minn. “If the scan isn’t necessary or emits the wrong dose of radiation, the risks far outweigh the benefits.”
6. How much radiation can you get from a CT scan, and what are the risks of that?
CT scans can expose you to as much radiation as 200 chest X-rays.
CT emits a powerful dose of radiation, in some cases equivalent to about 200 chest X-rays, or the amount most people would be exposed to from natural sources over seven years. That dose can alter the makeup of human tissue and create free radicals, molecules that can wreak havoc on human cells. Your body can often repair that damage—but not always. And when it doesn’t, the damage can lead to cancer.
Cancers from medical radiation can take anywhere from five to 60 years to develop, and risk also depends on age and lifestyle. That’s why scientists struggled in early attempts to quantify the danger of medical radiation. Until recently, researchers often relied on evidence from the atomic bomb attacks on Hiroshima and Nagasaki. But now research shows that today’s medical patients are being harmed, too.
New evidence comes from a 2013 Australian study that looked at more than 680,000 people who had CT scans as children and compared them with some 10 million children who did not have a CT scan. Overall, people scanned once had a 24% increased cancer risk, and each additional scan boosted risk an additional 16%. Children who had one before the age of 5 faced a 35% spike in cancer risk, reflecting the fact that young bodies are more vulnerable to radiation.
Other researchers estimate that for every 1,000 children who have an abdominal CT scan, one will develop cancer as a result. And a 2012 study that looked at almost 180,000 British children linked CT scans to higher rates of leukemia and brain cancer.
All too often children are receiving adult-sized doses of radiation, which is many times the amount they need.
The dose directly increases the risk of leukemia or a solid tumor. And that’s not regulated today, especially outside the hospital setting. At least in the hospital, you will often have the academic input that prevents super-high radiation dosing, especially in kids.
7. And if you get one scan, does it increase the chances you’ll get another one?
That’s correct: one scan leads to another…
One of the insidious ways that unnecessary CT scans increase risk is that a single CT test often leads to another, then another. A disturbing example of that dangerous cascade was featured in an article in the September 2014 issue of the Journal of Patient Safety, co-authored by John Santa, M.D., medical director of the Consumer Reports Health Ratings Center.
An 11-year-old girl received a CT scan because of possible appendicitis. That was the first mistake: An ultrasound, which does not emit radiation, is the best initial test in such situations. The second error occurred when her CT showed a normal appendix but her doctors noted a spot on one lung and decided that it warranted a follow-up CT. Such incidental findings are so common doctors have a name for them: incidentalomas.
Expert advice is to ignore the vast majority of those results because slight abnormalities seen on scans are very common but rarely harmful. Yet many doctors find the urge to order follow-up tests irresistible. For the 11-year-old girl, the CT didn’t reveal a tumor or any other problem, but over the next two years her doctors recommended repeat scans of her lungs, all of which would further increase her cancer risk.
“Stories like this occur every day in the United States,” Santa and his co-authors wrote. “This unfortunate sequence of patient harm, waste, and needless anxiety could have been completely avoided with an ultrasound. None of this had to happen. None of this has to happen.”
8. So let me ask you again, why is there so much overuse of CT scanning?
The main reasons for excessive scanning are:
Some states allow almost anyone to work the equipment. The government relies on three outside accrediting organizations—the American College of Radiology, the Intersocietal Accreditation Commission, and The Joint Commission—to ensure the safety of advanced imaging facilities. But each group has different quality and safety standards.
9. So what can the public do to prevent unnecessary radiation from CT overtesting?
Here’s my advice on what to do before you get any radiation-based imaging test: