CT scans and the news

Cut to Cure and Rangel have both commented on the “I’ll get a CT a year to screen for disease” fad/industry that has sprung up recently, and the concerns that the radiation dose of total body CT’s, especially repetitively, could be harmful.

Interestingly, a couple of days ago a colleague ordered a CT scan of the abdomen and pelvis on a patient. The patient refused the CT, citing the recent article in the paper about “the risks of radiation from CT’s”, and no amount of explanation would assuage this patients’ fear (irrational as I think they are). The patient said they’d bring the article up so we could read it, as we were obviously unaware of it, with not just a little condecension. The treating doc and nurse both relayed that we’d read it, and didn’t need to read again. Attempts to explain why this CT was needed were made, to no avail. The patient left without getting the CT to look for acute disease.

Yes, CT’s deliver radiation to the body. A whole-body CT is pretty rare in acute-care medicine (except in the multiply injured trauma patient), so although I think about radiation exposure, my worries are always acute-injury-or-illness diagnosis, which allows me to justify the risks involved.

I hope that patient gets their CT in the very near future, and I don’t know how we’d practice medicine without them. Well, I do know. We’d get 1970’s medicine. Anyone want that?


Comments

  1. We are getting more and more CTs for almost anything. Now if we start screening people with CT I am sure we will see some problems ahead !

    Leo

  2. With so much publicity it is hard, as patients, to know what we should allow our Drs. to order for us. I went through a similar occurance with my Physician ordering a full body bone scan a few years ago. I have horrible arthritis that is recent years has cut donw on my activity level a great deal. One example is that I use to ride my husbands goldwing with him for trips each year that took us any where from 4-8 thousand miles per trips. I went from that to not being able to ride more than 100miles to within 2 years not being able to ride at all.. 2 years ago during a routine pap test I found I could not accomodate this test without experiencing extreme hip area pains. The tests could almost not be completed. Following this test my Dr. told me he thought my PAP results would be fine but that he wanted me to have a full body bone scan as soon as he could get one scheduled. When I questioned it he told me he was ordering it because of the obvious “bone” pains.

    I went ahead with the tests even though I was almost certain the pains were arthritis related. I based that on the fact that had this pain been something such as bone cancer I would have already been dead. These pains had been going on for a LONG time. .

    If it were today that this incident occured I would have refused the bone scan based on the publicity of dangers involved with these type tests.

  3. “With so much publicity it is hard, as patients, to know what we should allow our Drs. to order for us.”

    Well, (how can I put this diplomatically?) isn’t that the reason
    you went to the doctor in the first place? You must have chosen your doctor because you thought he had some expertise in bone-related disease, didn’t you? Do you think yourself to have a greater expertise in deciding which diagnostic tests are most appropriate? If you do, then why seek a doctor’s advice at all?

    I get this kind of thinking from patients in my own practice from time to time. It is illogical, and sometimes downright
    reckless. There is a difference between information obtained from a news story and heard by a layperson and information from a professional who is being consulted to give professional advice. If you don’t like the advice you are getting from your professional, then seek a qualified second opinion. But unless you are an equally qualified professional, then for your own good, that opinion shouldn’t be coming from you.

  4. Actually, bone pains had absolutely nothing to do with why I was at my Drs. office on that date. I was there for my yearly PAP test!

    I had also lived with arthritis pain for over 30 years and had already had surgery on both knees. It was also documented that I had OA in both hips and was being treated by an OS with bextra and ultrasound treatments.. I was just stating that if this hip pains had been from something like bone cancer, my chances of beating it would probably not have been good considering I had this type pains that had progressively worsen over a 30 year period.

    Besides, I do trust my PCP and I DID have the bone scan..

  5. Sometimes it does help to read an entire post before jumping to conclusions and offering insults or attacking ones mentality.

  6. “Sometimes it does help to read an entire post before jumping to conclusions and offering insults or attacking ones mentality.”

    Sara Ann:

    I don’t see any insults posted here. For that matter there isn’t anything anywhere written here that questions anyone’s “mentality” either. Where do you see insults? If you think that stating that a professional opinion might be of greater value in deciding a course of treatment than the opinion of a layperson, however well intentioned and concerned, then that is a very peculiar concept of insult.

    Before I commented, I rethought the scenario the poster gave in other terms. Suppose the concern was not medical but was about a tax question or a legal problem. Would I consider my own opinion the equal of a qualified accountant or attorney? Not at all. I don’t have training, experience or qualifications in these areas. My opinions about tax and legal matters are layman’s opinions.

    As to reading the whole of the above posts, if you are asking whether I was sure to read the whole post above mine before commenting, I can assure you that I did, and more than once.

  7. I was posted and everyone thought it was a chip, but that may be the NFL!!!!