Study: CT Scan Overuse Linked To Cancer Threat

Without question, the development of the CT scan was one of the biggest breakthroughs in 20th-century medicine. This test has allowed diagnosticians to examine every internal organ in the finest detail. The tiniest tumors can be identified, hemorrhages in the brain recognized early, and problems in bones and joints characterized to assure the most appropriate therapies.

But it seems that in health nothing comes without problems, and for CT scans it is excessive irradiation. In a report published in The New England Journal of Medicine, Dr. Rebecca Smith-Bindman, a leading authority in the field, cautions about the danger and the excessive use of this invaluable technology.

Smith-Bindman says that one CT scan delivers the same amount of irradiation as 100 to 500 traditional X-rays. And in the future, CT scans will contribute to and become a major cause for cancer in the United States. Others have stated that one CT scan provides the same amount of irradiation to that part of the body as if the patient was a few miles from ground zero when an atomic bomb explodes.

Alarmingly, on occasion the machines themselves can be defective. In this report, Smith-Bindman tells of a patient who developed permanent brain damage because she received massive irradiation to her brain during a CT scan. Currently, 378 patients are part of a lawsuit seeking damages because of excessive irradiation from faulty machines.

There are several problems of which we must be aware when it comes to this diagnostic test. First and foremost, because the CT scan provides such exquisite detail of the body, it is frequently ordered for even the most minor symptoms. Each year, approximately 10 percent of the American population has a CT scan. In 1980, 1 million CT scans were done annually, which increased to 70 million in 2007. The number of scans done in America is five to 10 times higher than any other developed country, and approximately 7 million CT scans are done annually on children. The amount of irradiation delivered to children is somewhat higher than older patients, and the relative lifetime risk of cancer is five times higher than in adults.

Clearly, we must more compulsively assure that CT scans are done when there is an appropriate clinical indication and only used repetitively if there is a justifiable reason. CT scans done on healthy people are particularly egregious. Despite the clear risk of this powerful tool, some medical groups market whole-body CT scans to seek early disease — millions of people receive the so-called "heart saver CT" to identify coronary artery disease.

There is no evidence that screening healthy people for disease is of any value. Doing a CT scan of your whole body for no clear medical reason is not only preposterous, but it is also a dangerous misuse of medical power. Though heart saver CT scans can identify coronary artery disease, it is a diagnostic tool that should be used appropriately in symptomatic patients and only ordered by an expert, usually a cardiologist.

We must insist on better training of medical students and physicians on the indications and risks of CT scans. The true experts, such as radiologists, should become more proactive in assuring appropriate use of the test. For example, CT scans vary in the amount of irradiation they deliver: The finer the detail, the more the irradiation. Not every test requires the most accurate machine.

The causes of excessive use of CT scans are complex. These scans are highly profitable and potentially strong generators of revenue for medical clinics. As such, these machines are available in radiology centers or hospitals as well as in doctors' offices and freestanding for-profit facilities. Payment for CT scans must be modified to discourage unnecessary testing, and the health industry must do more to make CT scans safer by delivering less irradiation. In Massachusetts, research indicates that 10 percent of CT scans are done because of fears of litigation.

We all have a responsibility in assuring the appropriate use of CT scans and all other medical tests. In doing so, we can avoid harm as well as reduce costs and contribute to a better, more effective health care system.

Dr. David Lipschitz is the author of the books, "Breaking the Rules of Aging" and "Dr. David's First Health Book of More Not Less." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.DrDavidHealth.com.

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