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Over Exposure

By Jock Hoffman, CRICO

Related to: Communication, Primary Care, Other Specialties


As the availability and quality of computed tomography (CT) scanning improved in the late 20th century, utilization increased significantly: from three million patient scans in 1980 to 63 million in 2005. That trend is likely to continue upward as the quality of CT scanning gets even better.

Original scanners provided from 12-20 image “slices” per patient scan; contemporary machines provide 64 slices, and 256-slice machines are now available for clinical use. With more than 6,000 machines in place around the United States, and insurance reimbursement commonplace, access is not a major problem. Indeed, CT scanning is now replacing low or no dose techniques (traditional X-ray, MRI, endocscopes) for detection of colorectal cancer, lung cancer, and heart diseases. Diagnoses that would otherwise be missed or delayed are achieved without invasive procedures and without patient risk.

Well, not without any risk.

The slight risk of radiation exposure from a single CT scan has always been outweighed by the benefits, and relatively few patients underwent multiple scans. Now, however, increased utilization and more powerful equipment (i.e., higher dosages) is raising an alarm. A recent article in the New England Journal of Medicine suggest that about one-third of CT scans are unnecessary and that, at the current utilization rate, CT scanning could, in the near future, cause two percent of all cancers. Children undergoing multiple scans were deemed most at risk for subsequent ramifications.

Responses to this study range from physicists debunking the data to hospital administrators asking physicians to rethink their ubiquitous use of CT scanning. The NEJM study also suggests that the benefits of large-scale CT scanning for colon cancer screening and heart disease detection need to be weighed against potential exposure-related risks, at least for some patient populations.

Our Recommendation

Patients assume that the potential risks and benefits of every medical procedure or intervention (especially a routine one) have been carefully considered—and considered specifically for them. If a CT scan has been ordered (especially the “just to be safe” kind), they will expect that the potential for overexposure has been assessed (some hospitals now record radiation dosages in the patient’s medical record). If the potential risk raises a significant concern, the patient has the right to be offered alternatives.

Additional Materials

Doctors concerned about the exploding use of CT scanners

Doctors May Risk Overuse of CT Scans

January 1, 2008
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