Studies Say Too Many CT Scans

[bartleby]

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There is no truly good data about this...it's all extrapolated from Hiroshima survivors or the like. Suffice to say that any radiation is bad radiation, and CTs offer lots of it.

We get "my kidney stone is acting up", and when you check the old recs, they've had 20 CTs in 3 years, all showing stable intrarenal stones. Unless they have hydronephrosis on u/s, or infected-looking urine, they get motrin and urology referral (which they never keep).

Do CT's really increase to the overall cancer risk by 2%! That is a crazy # to believe. It is stated in the NEJM article.

 

[Whisker Barrel Cortex]

There is no truly good data about this...it's all extrapolated from Hiroshima survivors or the like. Suffice to say that any radiation is bad radiation, and CTs offer lots of it.

We get "my kidney stone is acting up", and when you check the old recs, they've had 20 CTs in 3 years, all showing stable intrarenal stones. Unless they have hydronephrosis on u/s, or infected-looking urine, they get motrin and urology referral (which they never keep).

While I wholeheartedly agree that too many CT scans are not good (the young patient with flank pain CTs is the number 1 example), the statement that any radiation is bad radiation is still up for debate. There is a lot of discussion about the concept of radiation hormesis and the inaccuracy of the Linear no-threshold model (which many of the studies that predict cancer from CTs utilize).

Here are some sources on radiation hormesis with references:

http://www.belleonline.com/
http://www.angelfire.com/mo/radioadaptive/inthorm.html
http://en.wikipedia.org/wiki/Radiation_hormesis\
http://bjr.birjournals.org/cgi/content/abstract/78/925/3

But again, I agree with the the need to limit scanning, whenever possible. Usually, when I notice that a young patient has received numerous flank pain CTs, I usually discuss that with the ordering physician and discuss the option of using abdominal x-ray to follow stones and ultrasound to look for hydronephrosis (unfortunately, ureteral stones are rare visible sonographically).

 

[Gunny]

As a European student on elective in the US last year, I can confirm that at least by our standards, you 'Yanks' order an obscene amount of CT scans.

It's called clinical acumen, people! 😎

 

[docB]

As a European student on elective in the US last year, I can confirm that at least by our standards, you 'Yanks' order an obscene amount of CT scans.

It's called clinical acumen, people! 😎

We have plenty of clinical acumen. We also have a system that makes it so that if your clinical acumen fails you on an atypical case you lose your house and your kids don't go to college.

 

[southerndoc]

As a European student on elective in the US last year, I can confirm that at least by our standards, you 'Yanks' order an obscene amount of CT scans.

It's called clinical acumen, people! 😎

As someone who spent time in the UK, I can assure you that many of our CT diagnosed appies would be sent home undiagnosed in the UK, only to return a few days later with a "more convincing" story.

 

[Dr.Evil1]

This is a bit off topic, but I believe pertinent. From the original news release:

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.

It was published in Thursday's New England Journal of Medicine and paid for by federal grants.

Does it seem to you that those two underlined portions "serious concerns about the methodology" and "New England Journal of Medicine" shouldn't be in the same paragraph? Has anyone else noticed how utterly crappy some of the methodology is in studies that get published in these HUGE journals. Have any of you recently attended a journal club where you objectively looked at an article and torn it to peices only to realize that it was published in JAMA or NEJM? Don't these journals screen for the methodology used and shouldn't they reject these crap articles? I recently reviewed an article about giving NAC IV for prevention of contrast allergy that was published in NEJM...it wasn't even BLINDED. (N Engl J Med. 2006 Jun 29;354(26):2773-82). Sometimes you have to wonder if all these journals care about is impact factor and not the science that they publish.

 

[kungfufishing]

weird I read the same article with the same conclusion.

Kind of makes you wonder about the potential for "sensationalist journalism" within our own medical literature.

 

[Moose52]

As a European student on elective in the US last year, I can confirm that at least by our standards, you 'Yanks' order an obscene amount of CT scans.

It's called clinical acumen, people! 😎

It's also called the benefits of working in a non-socialized (at least not yet) medical system....when I was in Sweden, those poor SOBs didn't have the capacity (or the overall framework) to promptly do half of the CT scans we do here (outpatient and inpatient, not just ER). Guess it goes along with that whole government controlling the supply of medical services to keep costs down....

 

[docB]

Interesting. This is ACEPs official position on this controversy.

http://www.acep.org/pressroom.aspx?id=34322