HealthPop
By

Michelle Castillo /

CBS News/ June 13, 2012, 11:49 AM

Patients' radiation levels boosted by increased medical scans

(CBS News) The number of CT scans and other medical imaging procedures are increasing at a rate that has researchers concerned about increased exposure to radiation.

Multiple CT scans in kids triples cancer risk, but researchers caution overall risk low

According to a new study published in The Journal of the American Medical Association on June 13, between 1996 and 2010, the number of CT scans tripled.

"The doses are not at a level that people should really be concerned," Dr. Rebecca Smith-Bindman, the study's lead author and a radiologist and epidemiologist at the University of California, San Francisco, told the New York Times. "It's rather that we need to minimize unnecessary exposures wherever possible."

Scientists were particularly concerned about the ionizing radiation that patients were being exposed to. Of the 1467 imaging codes, 1068 were associated with the delivery of ionizing radiation, including angiography/fluoroscopy, CT, nuclear medicine, and radiography. Ultrasounds and MRIs do not use ionizing radiation and were not included.

Radiation has been known to increase a person's risk of getting cancer, according to the study's authors. Some research shows that 2 percent of all future cancers will be caused by current imaging use. Another recent report in The Lancet showed a direct association between CT exposure in children and cancer risk. Children who get five to 10 scans triple their risk of developing leukemia, HealthPop reported.

The study looked at millions of health records of patients within the HMO Research Network, a group of 19 HMOs across the United States and in Israel. The specific records they looked at belonged to patients in several western and Midwestern states.

Researchers found that the amount of radiation in patients had doubled over the last two decades, as well as the number of medical imaging procedures. In 2010, 20 CTs were performed for every 100 patients. Three percent of patients overall, and four percent who underwent imaging, received radiation above the limit that the U.S. Nuclear Regulatory Commission sets for people who work at nuclear power plants and double what European regulators recommend.

For those in the 65 to 75 age group, the number increased to 35 CTs per 100 patients. Ten to 20 percent of children who had a single head CT had radiation doses known to triple the risk of brain cancer or leukemia.

The bigger problem is that a lot of these patients are exposed to multiple tests, which is significantly increasing their radiation levels, Smith-Bindman said.

"It's not just that we're doing more advanced imaging tests, but we are also doing these tests in such a way that the tests deliver higher - and more variable - doses of radiation," Smith-Bindman said in the press release. "I am concerned that physicians have lowered their threshold for advanced imaging so much that it is now used even when they may not believe it is necessary or will really change their management of the patient."

At "fee-for-service" hospitals and clinics, these procedures often provide a monetary benefit. But, the study revealed that medical imaging is increasing even for patients under health maintenance organizations (HMOs), which do not derive any financial benefits from doing the costly procedures.

"You would have imagined that the rate of increase would be lower," Smith-Bindman explained in the press release. "Our results showed very similar growth in imaging within these integrated settings as has been shown outside of these settings."

Smith-Bindman and her team said patients need to be more aware and "insist of the necessity and safety of all radiological scans ." The researchers encouraged patients to talk to their doctors to see if these procedures are justified, and added that facilities should monitor when patents are receiving repeated scans or more radiation doses than necessary.

Correction: This article originally suggested that MRIs were responsible for raised exposure to radiation. While the rate of MRIs has increased, MRIs do not use "ionizing radiation" and therefore were not included in the study's results.

© 2012 CBS Interactive Inc. All Rights Reserved.
15 Comments Add a Comment
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nohater says:
believe tests are administered whether warranted or not to protect hospitals, doctors from litigation. they run all sorts of tests to cover their behinds. doctors, surgeons, hospitals make mistakes and it's simply too bad. they aren't perfect and sometimes people die as a result of their mistakes.
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TomMariner says:
The headline scares everybody with "medical scans", but the article correctly mentions only CT scans. MRI's produce NO radiation, and a normal chest X-Ray is from 100 to 1000 times less dose than a CT.

Also the article didn't concentrate on the benefits to the patients that has come of the increased use of imaging. Of course, we could always go back to the two previous methods; Exploratory Surgery and guessing. Surgery takes the patient out of action for months, has a finite risk of death and costs many times more. Guessing for a patient that has mild symptoms will certainly cause painful, prolonged, expensive death. The silver lining, of course is that if you're dead, you won't cost any more for medical.

Sarcastic? Possibly -- but true.
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pdavis68 replies:
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To her credit, she's added a correction at the bottom of the article.
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2907RoganRd says:
The article highlights a huge problem. I am a reservist who finished a 15 month deployment to Iraq in 2010. Before I demoblizied, the Navy gave me head to toe xrays to include several full head dental scans for broken teeth and crowns. Afterward, the VA duplicated all those xrays and scans to determine service connection. At the same time, my civilian practitioners included head CT scans, duplicate xrays and mouth scans to fix the infected teeth and do sinus surgery. I also had many scans for a cyst under my arm that was finally removed by a civilian surgeon. Now, I need a knee replacement. Everyone wants to do more scans. I told the VA no and the staff became very angry at me. The VA radiologist told me I exceeded my limit and I had to manage my own exposure because others would not. He was so right. The VA treats me like a problem patient simply because I tell them they already have current scans and xrays. What can I do to minimize my risk when everyone duplicates and no one shares?
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pdavis68 replies:
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You're probably okay with the x-rays (though I'm not a doctor). X-rays use far less radiation than CT scans (1/100th-1/10th, depending on the type of CT scan). But you definitely want to minimize the CT scans. MRIs and ultrasound are safe as they don't produce any ionizing radiation.
TomMariner replies:
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2907 -- You are right! But we are fixing it. We have launched a nation-wide incentivized push to computerize your records and link them to every other medical professional who needs the info. That was included in the February 2009 stimulus act, ARRA, and will save more money and prevent more over radiation, and improve medicine more than ten ACA "healthcare bills".
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pdavis68 says:
Agreed. That's just horrendous reporting.
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pdavis68 replies:
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I tweeted her: "Please fix your CBSNews.com article on patient radiation levels. MRI scans do not use ionizing radiation like CT." Her response: "Thanks for the heads up, but MRIs still emit some form of radiation, which is what was looked at in the study"

She's clearly not qualified to report on this stuff. The study also covered ultrasound. I'm surprised she's not talking about the dangers of radiation from ultrasonic sound waves.

The study: http://jama.jamanetwork.com/article.aspx?articleid=1182858
pdavis68 replies:
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She has added a correction to the bottom of the article... My apologies for calling you unqualified to report on this stuff.
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dhp3 says:
CBS needs to have articles that are on technical matters reviewed by a competent scientist. As it is this article can cause considerable damage by making patients afraid of MRI scans. CT scans do represent a risk due to the ionizing radiation, but MRI scans do not involve ionizing radiation.
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Jim_NLN says:
The reason the medical professional do not care that increased exposure increases healthcare issues. It is no different than dentists who give out candy. It is a way to increase repeat business.
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owebamanomo says:
It's CBS THEY DON'T LET SILLY THINGS LIKE FACT GET IN THE WAY!!
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ionicatoms says:
This article erroneously links radiation exposure to MRI scanning.

CT and PET scans use ionizing radiation; MRI's do not.
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EricRFernandez70 says:
Michelle,

Your article should not give the impression that MRI scanning involves any radiation. I've been an MRI tech for over 10 years and MRI scan requests have quadrupled because physicians are recognizing that the gold standard of imaging techniques are moving away from CT towards MR. The benefits of MR include zero radiation and higher resolution of images whereas contraindications are limited (i.e pacemakers and ferrous metals).
Physicians are beginning to recognize the significant increase in radiation dosage your article points out which further increases the need for MRI scans.
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csvm says:
Why did the CBS science/health reporter begin the article by mentioning MRIs? An MRI does not involve any "radiation", commonly understood to mean ionizing radiation. MRIs do not increase your cancer risk or anything. It is nothing at all like a CT scan or an X-ray. Did the scientist in the article mention MRIs? If so, why did the reporter not question this? Or did the reporter just make up the part about MRIs by themselves? Either way, totally incompetent, misleading, reporting. Now some people will be worried about getting MRIs. CBS is giving bad medical advice, risking the health of their readers. Unethical. Incompetent. Irresponsible. Dangerous. CBS.
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