Cool Down on the CT Scanning?

As the L.A. Times reports, two new studies, from researchers at the University of California-San Francisco and the National Cancer Institute, suggest that hospitals may want to cut down on the volume of CT scans. One of the studies estimates that “about 29,000 future cancers could be related to CT scans performed in the United States in 2007 alone.” The researchers’ advice to patients: keep track of how many CT scans you receive, and argue against them with your doctor. (HT: David Friedman) [%comments]

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  1. William G says:

    From what I can gather, MRI gives a greater resolution without the dangers associated with CT. Why does anybody get cat scans anymore? Is it simply a matter of convenience (faster to perform)?

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  2. Ross says:

    @ Wililam – There’s a lot of reasons CT is need in addition to MRI… The cost of a CT is usually lower (due to the time needed to perfom as you mentioned). Also, certain tissues cannot be differentiated reliably with an MRI, but can be imaged well with CT. Another big reason is that the “M” in MRI stands for “Magnetic”, so metal near an MRI machine is dangerous. It’s not an option for a lot of people with stainless steel implanted devices, pacemakers, difibrillators, etc. There’s a multitude of other situations where CT is preferred over MRI, but there’s tradeoffs with both.

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  3. Nile says:

    It’s all about incentives: do the unnecessary interventions – tests, scans, exploratory surgery – because there’s revenue in this activity.

    And, more importantly, being defensive and doing extra tests is your only defence against a medical negligence lawsuit that can end your career.

    What incentive is there, I wonder, for running a scare story about the cumulative risk to patients and to the wider population of the extra X-rays?

    The moment you ask the mildest of questions, the hospital administrators will seize upon your words: “SHE’S REFUSING TREATMENT!!! EVERYBODY LOOK OVER HERE!” and the only way you’ll get the shouting to stop will be signing a truly watertight disclaimer that absolved them of all responsibility for any failure of treatment, for whatever cause, on an irrational patient who’s refusing treatment.

    It’s an economics column: would anybody care to ask “Who profits?”

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  4. Tim says:

    MRI is excellent for imaging soft tissue. Hard tissues require CTs. CTs are more convenient than standard x rays, but MRIs and CTs are called for in different situations.

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  5. Tony says:

    Just a word of caution, if your doctor recommends something, even if its wrong, you refuse it and he notes it, your health insurance company will use it as a way cut coverage via resision in the future by playing the “refused care” card.

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  6. John says:

    This is a job for the Freakanomic statistics team. My wife is a CT/MRI Technologist. She read several of the news reports (we haven’t found the actual data), and she says that this is not necessarily comparing apples to apples. One example is no one mentions how many thousands and thousands of patients by early detection of cancer.

    Also, these reports mention “since 1980″ as the comparison with today. In 1980, CT was fairly new and was not capable of detecting many things that today’s CTs can. Plus modern CTs expose the patient to much less radiation than earlier models.

    Another note. One of the reports stated that the amount of radiation exposure is greater in patients seen in the evenings over those seen during the day. Machines don’t care what time it is. There has to be something else going on. Maybe later shifts get the patients who need more studies, or who need repeats? (sorry, I can’t find the source right now0?

    On the other hand, insurance and the drive to reduce costs does cause more CTs to be given. Versus MRI, they are cheaper and in some cases, just as effective. This issue gets complicated when MRI is the better modality, but because of cost, CT is done first, the MRI if the CT is inconclusive.

    One example is in suspected stroke patients who come into the emergency room. Some hospitals send these patients to CT first, even though the more expensive MRI can find evidence of stroke much better and earlier in the process than CT.

    As with all medical issues, it is complicated and someone with a statistics background should sit down with some imaging specialists and review the data and conclusions

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  7. Eric M. Jones says:

    Every hour flying in a jet over 30,000 is the rough equivalent of a chest X-Ray. If the background radiation from Radon in your house was part of the Real Estate pitch, you wouldn’t have bought it . I used to stare at the bones in my feet inside one of those X-Ray shoe fitting machines.

    Everything has a cost.

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  8. Chris says:

    So, a few months ago, I went to the emergency room for a kidney stone. They verified that I had the stone with not one, but two, CT scans. The shocking thing is that they didn’t bother to check the results of the first scan before doing the second! (I only found out that I got two scans after the fact, when I got the bill — when you’re face down and in pain, you don’t really notice that they ran you through the machine twice.)

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