Nov. 28, 2007
Are CT Scans Worth The Cancer Risk?
Study Warns Scans May Cause 2% Of All U.S. Cancers In Coming Decades
-
Play CBS Video Video CT Scans Add To Cancer Risk A new study shows the cancer risks after years of CT scans that can save your life. Dr. Jon LaPook explains that precautions can protect you from too much exposure to radiation.
-
The average American's total radiation exposure has nearly doubled since 1980, largely because of CT scans. (CBS/EARLY SHOW)
-
Interactive Cancer Learn about the most common cancers, who gets them and how they are treated.
The report estimates the percentage of cancers caused by CT scans -- currently 0.4 percent -- will increase to as much as 2 percent in a few decades because the number of scans has increased so dramatically, reports CBS News medical correspondent Dr. Jon LaPook.
"Our concern is there are so many CT scans being done right now that we should really be starting to think: Do we need to all of these CT scans?" says Dr. David Brenner of the Center for Radiological Research at Columbia University.
Some experts say that estimate is overly alarming. But they agree with the need to curb these tests particularly in children, who are more susceptible to radiation and more likely to develop cancer from it.
“There are some serious concerns about the methodology used,” but the authors “have brought to attention some real serious potential public health issues,” said Dr. Arl Van Moore, head of the American College of Radiology's board of chancellors.
The radiation and risk from one CT scan is low, but it carries a dose 50 to 100 times greater than a traditional X-ray, reports LaPook.
“We are very concerned about the built-up public health risk over a long period of time,” said Eric J. Hall, who wrote the report with fellow Columbia University medical physicist David J. Brenner.
So what's a patient to do? Make sure your doctor explains why you need a CT scan and gives you the lowest possible dose, reports LaPook. It's also a good idea to keep a diary of X-ray exposure, especially for children.
The study was published in Thursday's New England Journal of Medicine and paid for by federal grants.
Quote
The average American's total radiation exposure has nearly doubled since 1980, largely because of CT, or computed tomography, scans. Medical radiation now accounts for more than half of the population's total exposure; it used to be just one-sixth, and the top source was the normal background rate in the environment, from things like radon in soil and cosmic energy from the sun.We were astonished to find, when we were researching materials for this paper, how many doctors, particularly emergency room physicians.
Eric J. Hall, study co-authorA previous study by the same scientists in 2001 led the federal Food and Drug Administration to recommend ways to limit scans and risks in children.
But CT use continued to soar. About 62 million scans were done in the U.S. last year, up from 3 million in 1980. More than 4 million were in children.
Since previous studies suggest that a third of all diagnostic tests are unnecessary, that means that 20 million adults and more than 1 million children getting CT scans are needlessly being put at risk, Brenner and Hall write.
Ultrasound and MRI, or magnetic resonance imaging, scans often are safer options that do not expose people to radiation, they contend.
CT scans became popular because they offer a quick, relatively cheap and painless way to get 3D pictures so detailed they give an almost surgical view into the body. Doctors use them to evaluate trauma, belly pain, seizures, chronic headaches, kidney stones and other woes, especially in busy emergency rooms. In kids, they are used to diagnose or rule out appendicitis.
"The CT scan is a wonderful tool for examining internal organs, organs that are below the depth of where a poking finger or a listening stethoscope can hear, and yet don't show up on routine X-rays," Dr. Michael Brant-Zawadzki, a clinical professor of radiology at Stanford University tells CBS News.
But they put out a lot of radiation. A CT scan of the chest involves 10 to 15 millisieverts (a measure of dose) versus 0.01 to 0.15 for a regular chest X-ray, 3 for a mammogram and a mere 0.005 for a dental X-ray.
The dose depends on the type of machine and the person - obese people require more radiation than slim ones - and the risk accumulates over a lifetime.
“Medical care in this country is naturally so fragmented. Any one doctor is not going to be aware of the fact that a particular patient has had three or four CT scans at some point in the past,” said Dr. Michael Lauer, prevention chief at the National Heart, Lung and Blood Institute.
People with chronic problems like kidney stones are likely to get too many scans, said Dr. Fred Mettler, radiology chief in the New Mexico Veterans Administration health care system.
“I've seen people who are 30 years old who have had at least 18 scans done,” he said.
That puts them at risk of developing radiation-induced cancer, Brenner and Hall said. They base this on studies of thousands of Japanese atomic bomb survivors who had excess cancer risk after exposures of 50 to 150 millisieverts - the equivalent of several big CT scans.
“That's very controversial. There's a large portion of the medical physics community that would disagree with that” comparison, said Richard Morin, a medical physicist at the Mayo Clinic in Jacksonville, Fla.
© MMVII, CBS Interactive Inc. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. The Associated Press contributed to this report.
More From Health
Best-selling author Mitch Albom on his first nonfiction work since "Tuesdays with Morrie."
If there is one thing that causes cancer more than anything else, it''s smoking. The next biggest concern in the cancer causing world would be the Sun.
If you need a CT scan, by all means get one. If your doctor is offering you a CT scan because he''s practicing defensive medicine and scared of being sued, don''t get one, and have an Advil.
The radiation-emitting decay of carbon-14 is used by archaeologists to determine the age of ancient objects of organic origin, including human remains.
The medical community for the last decade has been blitzed by little-publicized, traveling "legal seminars"-- these professing to help medical professionals avoid litigation.
As innocent as that sounds, some the methods taught by the seminars are anything but defensive. They cause needless pain and suffering, and are based upon manipulation of patient expectations.
Here is how the methods work. Suppose a patient and his family rush to the hospital for a critical procedure. They are beside themselves with anxiety, and need all the hope and reassurance possible. While emotional comfort sounds like an easy mission for staff, not so fast-- medical professionals are now told, this is "bad medicine".
(See Part 2, below)
The attending physician or other managing professional is instructed to inform the patient''s family with a poor prognosis-- "I am sorry, but the outlook is not the best. We''''ll do what we can, of course, but it appears all four wheels have fallen off. It will be difficult."
What a blow to an anxious family! What a failure of the oath to do no harm! At hearing such a report, family members have been known to become ill, as a result. But as the seminar tells medical professionals, it is all to the good. They are given the following explanation--
"If you promise the moon, but deliver coal and ashes, you probably will be sued by angry relatives, regardless of the effort you made and difficulty of the case. If you promise little or nothing-- yes, even advise of the worst-- but deliver something, anyway, and maybe even the sun and moon, combined, you will be hailed as a miracle worker. Your fees will be received with gratitude, not scrutiny."
The medical community for the last decade has been blitzed by little-publicized, traveling "legal seminars"-- these professing to help medical professionals avoid litigation.
As innocent as that sounds, some the methods taught by the seminars are anything but defensive. They cause needless pain and suffering, and are based upon manipulation of patient expectations.
Here is how the methods work. Suppose a patient and his family rush to the hospital for a critical procedure. They are beside themselves with anxiety, and need all the hope and reassurance possible. While emotional comfort sounds like an easy mission for staff, not so fast-- medical professionals are now told, this is "bad medicine".
(See Part 2, below)
---
Your comment copies propaganda straight out of HMO public relations of 15 years ago, regurgitated in faulty chapter and verse. Unfortunately for you, the insurance and HMO campaign against attorneys was not true then, and is not true today.
The main driver of medical liability insurance premiums for general surgeons, obstetricians and internists, concludes a 2005 Dartmouth study, has little to do with litigation awards. The 20-25 percent liability premium increase seen in 2002, for example, cannot have come from awards that year. The jury award stats simply don''''t support it.
So where did the malpractice premium increase come from? The study''s lead author reminds us insurance is like any other industry. If investment income in 2002 for the insurance industry were disappointing, premiums would have to make up the difference.
Today, liability rates remain anything but transparent. But count on it-- insurers will charge what the market will bear, and blame somebody else for it.
Your bias against attorneys is utterly disingenuous. In practice, you do not actually oppose all attorneys and litigation, only other people''''s attorneys and litigation.
This remarketing has little or nothing to do with the practice of medicine, but as hospitals begin to turn away from their primary mission of healing (remember?) for the new mandate of profit, something must be hidden or compromised in patient care.
That "something" is patient safety, an increased risk of cancer.
Although CT scans have immensely valuable applications, their potential abuse soars at hospitals viewing their high-tech medical equipment as a major new source of revenue.
Many points in this article are accurate.
My wife went to a doctor because she had some stomach pain. That quack asked 2 simple questions like where the pain was and how long she had it. He then poked her stomach once and ordered a CT scan. Total time for the appointment = 3 minutes! And, this was during a normal doctor''s appointment - not an emergency.
Fortunately, we knew CT scans are not to be taken lightly, so we went to a second doctor. This doctor did a proper physical exam, asked her to do a harmless ultrasound and a stool test. He then prescribed some medicine. Pain was gone in a few days.
So, you can see that the first doctor was using the CT scan as a diagnostic crutch. He didnt want to spend the time to perform a proper diagnosis.
Even more disturbing is the fact that many doctors make a cut from the CT scanning centers based on the number of patients the doctors send their way. Many doctors end up ordering CT scans much too often to line their own pockets.
Like I said, frikking doctors!
The amount that people are exposed to with CT scans is incredibly high.
The amount of money doctors receive through it''s use is quite a large amount.
Figure it out.
When an option, MRI should be used in place of CT.
You are probably at a greater risk working as a flight attendent or pilot high in the stratosphere than you are from getting a CT scan of your leg...
It raises a good question though - Is this CT scan really necessary??
The photograph used for this article appears to be of an MRI machine, which has nothing to do with x-rays.
Ultrasound are used for localized areas, such as specific sections of the abdomen, not the entire abdomen. They are limited and cannot be used with the level of certainty in many areas of the body as are CT scans. They are great for the things that they can be used for, but this article implies that doctors are holding out. There is a lot to this article that is missing, like MEDICAL DATA!
- by me4prezz November 28, 2007 10:44 PM EST
- Do you understand WHY these doctors, ESPECIALLY the emergency room physicians order these CT scans?
- Reply to this comment
See all 19 CommentsConsider the scenario:
A patient comes in to the emergency room, via ambulance, after being in a motor vehicle accident. The ER physician understands that the patient is not seriously injured, but the patient is complaining of neck and back pain and later complains of abdominal pain. The ER physician performs CT scans of the chest, abdomen and pelvis and then x-rays on the the levels of the spine that the patient has complaints of. All are negative.
OR
The ER physician observes the patient, performs symptomatic treatment, and ensures that the patient has no broken bones and sends the patient home.
A few weeks, the patient has significant lower back pain and states that the car accident caused his pain and sues the emergency room physician, the hospital, and the paramedics for failing to diagnose his back ailment. The ER physician who performed those CT scans can VERIFY without a doubt that the patient had no such problems immediately following the car accident. The ER physician without doing them, cannot. Who will be sued and left with nothing?
Consider not the amount of CT scans used, but of America''s obsession with litigation of physicians that forces them to perform medical procedures, testing and imaging studies that ordinarily they woudl not need to perform to save themselves from losing their medical license or everything they have worked for.