Should use of CT scans be reduced?

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Last night I was reading about the latest Iressa (gefinitib) data in lung cancer published in the NEJM, but unfortunately the DOI code isn't yet available for easy tagging and linking of the article in Research Blogging, so it will have to wait until it's out.

There was, however, a pair of interesting articles on computerised tomography (CT) scans (see references and links below).  While the use of such scans has clearly improved diagnosis, it has come at a cost – both in terms of expenditure and also with respect to increased risk of radiation exposure:

"We found that the risk of cancer from a single CT scan could be as high as 1 in 80 — unacceptably high, given the capacity to reduce these doses."

Source: Smith-Bindham, NEJM



"Changing the culture of medical practice to encourage more thoughtful use of imaging today will help to ensure that future patients will benefit from continued imaging innovation." 

Source: Hillman and Goldsmith, NEJM

Good points both, but little is likely to change unless the payers and insurers force them economically. Physicians are typically cautious and conservative by nature and would rather check to see if any cancer might be present than risk missing it or be hit with a law suit for negligence.  Given that radiation has not been shown conclusively to be cancer-causing, most would probably rather be safe than sorry.

rb2 large gray Should use of CT scans be reduced?

Smith-Bindman, R. (2010). Is Computed Tomography Safe? New England Journal of Medicine DOI: 10.1056/NEJMp1002530 

Hillman, B., & Goldsmith, J. (2010). The Uncritical Use of High-Tech Medical Imaging New England Journal of Medicine DOI: 10.1056/NEJMp1003173

  • BartW

    You wrote: ” Given that radiation has not been shown conclusively to be cancer-causing…”
    Can you elaborate? In the light of for example this:
    http://www.cancer.org/docroot/ped/content/ped_1_3x_radiation_exposure_and_cancer.asp
    “Ionizing radiation is a proven human carcinogen (cancer causing agent). The evidence for this comes from many different sources, including studies of atomic bomb survivors in Japan, people exposed during the Chernobyl nuclear accident, people treated with high doses of radiation for cancer and other conditions, and people exposed to high levels of radiation at work, such as uranium miners.”

  • http://profile.typepad.com/maverickny MaverickNY

    Hi Bart,
    I think there is no doubt that excessive doses of radiation, such as happened at Chernobyl, will be potentially drastic and toxic to man.
    I was referring to a statement by one of the authors in the NEJM where she was talking about low dose exposure from the CT Scans:
    “Although it has not been shown directly that CT increases cancer risk, radiation is a known carcinogen, and extensive epidemiologic and biologic evidence links ionizing-radiation exposure with cancer. ”
    However, accidental overdose would likely be a very different thing!
    Sorry for the lack of clarity.

  • http://www.medical-negligence-ireland.com/medical-negligence-solicitor/ Medical Negligence Solicitor 

    A medical negligence solicitor is a specialised personal injury claims solicitor who is familiar with the procedures and terminology used in litigating cases of medical negligence in court. His services would be required if you have been a victim of medical negligence or malpractice by a member of the medical profession, either in a hospital, clinic, doctor´s surgery or in your own home.