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Beware the CT Scan?

There's more evidence out today that CT scans and other medical procedures that expose patients to radiation may be putting many Americans at risk.

While CT scans and other procedures are very useful for accurately diagnosing a variety of medical conditions, a growing body of evidence has been raising concerns that they are being used so often that the radiation exposure they subject patients to may be increasing the risk for cancer.

In a new study published in today's New England Journal of Medicine, Reza Fazel of Emory University and colleagues studied nearly 1 million adults ages 18 to 64 between Jan. 1, 2005, and Dec. 31, 2007. During that period, 655,613 of those in the study -- nearly 70 percent -- underwent at least one procedure that involved exposing them to radiation. That essentially doubled the amount of radiation they were exposed to compared to the amount they would have received from natural sources. Nearly 20 percent received at least moderate annual doses of radiation from diagnostic tests and about 2 percent had high doses. Based on the findings, the researchers estimated that 4 million adults might be getting high doses of radiation exposure each year from medical imaging.

In an article accompanying the study, Michael Lauer of the National Heart, Lung and Blood Institute says the study provides more evidence for the need for more research into the risks and benefits of such procedures. Doctors also have to do a better job of keeping track of how many such tests their patients are getting.

Since 1992, the number of CT scans has quadrupled, he noted, and other research has estimated that as many as 2 percent of cancers could be attributed to radiation from CT scans.

By Rob Stein  |  August 27, 2009; 7:00 AM ET
Categories:  Cancer , Cardiovascular Health , General Health , Health Policy , Medical Technology  
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Comments

The NEJM article refers to radiation doses that are "moderate, high, and very high". Assigning that description to an arbitrary number (50 mSv for example) does not aid this important discussion, nor does it address the real issue. Appropriate studies provide great benefit and should continue without fear of the assumed increased cancer risk. Likewise, studies that provide no clinical information should not be performed even if they are “low dose”. Medical decisions always involve weighing the risks and benefits of a procedure or medication. You can visit the radiation dose calculator at www.xrayrisk.com to calculate cancer risk based on CT scans, x-rays, nuclear medicine and interventional procedures performed.

Posted by: hanleym | August 27, 2009 8:47 AM | Report abuse

Yes, there is no such thing as a safe dose of radiation, either from a diagnostic image or from the sun. But in general, the alternative to seeing inside a patient is "exploratory surgery", not the most risk-free experience there is. And the recovery time from the imaging procedure is zero while having a surgeon get his fingers inside you takes a bit of getting over.

And, although the article is clear to state that it is CT (Computed Tomography) the term "X-Ray" although valid, may scare those who would get a simple XRay test where the amount of radiation for a single "large" procedure is less than fifteen minutes in the sun.

Posted by: tommariner | August 27, 2009 9:02 AM | Report abuse

Post Obama, the problem with studies like this is the fact that they are so easily politicized to lower expectations in a push/pull manner, where the "push" are overt efforts to reduce health care costs and the "pull" is to lower expectations of availability of expensive services by denigrating their effectiveness or exagerating their risks. Since there is risk with any medical procedure, this leaves them all open to determinations more politically than scientifically driven.

Unfortunately, the scientists making such studies are no more immune from herd mentality and influence than anyone else, so, once politicized, scientific objectivity itself in the area of medicine (such as it is) must necessarily become devalued.

Posted by: RUKidding0 | August 27, 2009 11:27 AM | Report abuse

Yet when you have certain cancers, that's how they catch & identify it & then they use CT scans to follow up every 6 months or every year after.

Posted by: wadejg | August 27, 2009 12:33 PM | Report abuse

Over the course of five months last year I had four CT scans and four X-rays. Frankly, the CT scans were far less invasive than other diagnostic procedures would have been and posed little risk of turning a critical condition into a life-threatening/ending condition. And the scans were not nearly as unpleasant to prepare for or undergo as the alternatives. I'll take my chances on radiation exposure given how much more we know about cancer and how much better our ability is to detect and treat it.

Posted by: StrollerMomma | August 27, 2009 1:18 PM | Report abuse

I work at a nuclear plant. My co-workers and I are frequently appalled at the attitudes of the medical establishment towards radiation.

I have received far more "dose" from CT scans, x-rays, and barium swallows than I have from my workplace. The people administering and prescribing these procedures rarely have any idea of the amount of radiation involved in these procedures. I think these doctors have no concept of the relative risks of these procedures.

Try asking your radiologist how much exposure you will receive prior to your next procedure. You may be disturbed how little they know.

Posted by: alfredo22 | August 27, 2009 4:11 PM | Report abuse

As an Emergency Physician I must address this daily. Studies suggest that for every 1000 CTs performed at least 1 cancer is caused. The risk is highest in the young, who have far more years to grow tumors that the old, in which a number of the CT scans are performed. Abdominal pain in the elderly patient is frequently caused by serious conditions requiring surgical intervention and which often prove fatal if untreated. For young children with a minor head injury the risks of the CT often outweigh the risk of the injury and simple observation will suffice. In the right patient the CT saves lives, but when performed on low to no risk patients, especially the young, when other means may be available, even if they may require more personal effort on the part of the physician, the patient and the family. Patients that are not satisfied with an examination unless they have been evaluated with a high dose of ionizing radiation, whether through entitlement or fear are simply increasing their chances of cancer without necessarily benefiting from better diagnostic accuracy. Be careful what you ask for.

Posted by: notarzt | August 27, 2009 10:12 PM | Report abuse

Reading stuff like this makes me glad I don't have health insurance. (Well, Medicare A, but that is actually 'catastrophe insurance.') Nobody is going to give me an unnecessary CT scan...

Posted by: dotellen | August 27, 2009 10:26 PM | Report abuse

Try asking your radiologist how much exposure you will receive prior to your next procedure. You may be disturbed how little they know.

Posted by: alfredo22 | August 27, 2009 4:11 PM

If you ever actually *meet* the radiologist, you mean. These tests are administered by techs with who-knows-what level of training. I recently underwent a chest x-ray (they shot four films, I think) and two CT scans at a stand-alone "diagnostic imaging center." I never met the radiologist who reviewed the films and wrote the report to my GP; if I had asked to do so, I think the receptionist might have called the padded-wagon folks to come get me.

I would in fact expect a boarded radiologist to be able to tell me how much radiation I've been exposed to, and what the risk of that is, but I've never met such an individual in a clinical setting. It's a fact of life in modern American medicine: techs (and nurses) do the bulk of hands-on patient care.

Posted by: northgs | August 28, 2009 7:31 AM | Report abuse

Noted that Electron Beam Tomography (EBT) scans are not mentioned... they provide less radiation exposure.

Posted by: FreeHeartScan | August 29, 2009 1:56 AM | Report abuse

The comments to this entry are closed.

 
 
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