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CT Scans - Single Dose Radiation Can Trigger Cancer

Posted by Jane Akre
Tuesday, December 15, 2009 11:39 AM EST
Category: Major Medical
Tags: CT Scans, Radiation, Cedars-Sinai, General Electric, Archives of Internal Medicine

CT scans are delivering unnecessary radiation to patients, two published reports conclude.

CT Scans and the Cancer Link

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IMAGE SOURCE: Wikimedia Commons/ CT scan/ author: NithinRao

Two newly published studies find that commonly used CT scans appear to pose a risk of cancer greater than previously thought.

The studies, published in the Archives of Internal Medicine, support caution and restraint in using CT scans and other procedures that involve radiation.

CT- short for computerized tomography scan - is used to find injuries and tumors. Since the early 1990s, its use has tripled in the U.S. to more than 70 million in 2007, reports the Wall Street Journal.

While the scans use radiation, the exact amount is often uncertain.

One study attempts to find out.

Among more than 1,000 patients, the estimated dose of radiation for a heart scan received at age 40 would result in cancer in 1 in 270 women, and 1 in 600 men. For a CT scan of the head, 1 in 8,100 women, and 1 in 11,080 men would likely develop cancer.

While the scanners deliver radiation from calibrated machines, the dosage varied wildly, according to the study, even within the same hospital. The University of California San Francisco study finds some patients received one-tenth the radiation of others.

Why do the doses differ?

That’s the concern, says author Rebecca Smith-Bindman, of UC San Francisco, a professor of radiology and biomedical imaging, epidemiology and biostatistics.

“They don’t have to be this high” she says to the WSJ, attributing the differences to a lack of standardized settings and how different technicians use the CT scan for different patients.

A higher radiation dose generally generates a clearer picture. The trick is not to use too much radiation.

The second study published Monday, estimates that 29,000 future cancers, particularly those in the abdomen and pelvis, could be related to CT scans received in 2007.

Most impacted are females who receive an abdominal scan at the age of three. She has a 1 in 500 chance of eventually developing cancer.

Mammograms emit a much smaller dose of radiation than CT scans, but the effects are cumulative. These studies echo recent federal guidelines that women should cut back on mammograms, starting later in life and receiving them less frequently.

After Cedars-Sinai in Los Angeles reset a CT scan machine in February of last year, the patients received brain scans received more than eight times the normal dose of radiation, the Los Angeles Times reports.

It came to light when a patient reported he began losing his hair after the scan. More than 200 people had the same exposure and also suffered skin rashes.

A reaction such as hair loss or skin rash should be reported immediately. The Food and Drug Administration (FDA) has issued an alert warning hospitals across the country to check their CT protocols.

CT Scans

Every day more than 19,000 CT scans are performed in the U.S. subjecting each patient to the equivalent of 30 to 442 chest radiographs per scan.

The CT scan is a relatively quick, cheap and painless way to get 3-D pictures into the body to evaluate trauma, belly pain, seizures, chronic headaches, kidney stones especially in the emergency rooms. In kids they are used to diagnose or rule out appendicitis.

Medical radiation now accounts for more than half of the population's total exposure. Previously it was one-sixth, and the top source was the normal background rate in the environment from things like radon in soil and cosmic energy from the sun.

Since previous studies suggest that a third of all diagnostic tests are unnecessary, that means that 20 million adults and more than 1 million children getting CT scans are needlessly being put at risk, according to a published report in 2007 in the New England Journal of Medicine. #


3 Comments

Anonymous User
Posted by Dave Fisher
Tuesday, December 15, 2009 5:05 PM EST

Media coverage of the two recent studies published in the Archives of Internal Medicine, claiming increases in cancer due to use of computed tomography (CT), raises vital public policy issues that must be considered.

First, it’s important to understand that medical imaging manufacturers have made incredible strides in innovating advanced equipment that minimizes radiation dose. In fact, new medical imaging technologies and systems introduced during the past 20 years have significantly reduced radiation dose.

Even with this progress, manufactures continuously explore the next frontiers of innovative medical imaging technology that will exponentially reduce radiation exposure while exponentially increasing the capability and quality of the images it delivers -- allowing physicians to save more lives. To that end, we believe policymakers should encourage technologic development so that companies can continue to innovate and produce diagnostic equipment that reduces radiation dose and improves patient outcomes.

Next, while nobody disputes the effectiveness of CT scans, the assertion that CT scans are overused is an outdated perception. In fact, an analysis of Medicare claims data from 1998-2007 demonstrates that beginning in 2007, spending on advanced diagnostic equipment decreased by 19.2 percent while volume grew by a modest 1.9 percent. Any claims that the use of CT is rapidly growing is false.

Imaging manufacturers believe that they way to continue driving proper use of CT, as well as other diagnostic equipment, is to ensure physicians have access to, and are relying on, evidenced-based guidelines at the point of care to determine which diagnostic test should be ordered (or not ordered). That’s why MITA strongly endorses a robust build-out of appropriateness criteria in the Medicare program. and research supports this approach. This is the best way to drive proper utilization while ensuring patients have access to the diagnostic procedures they need.

Lastly, it’s important to point out that medical imaging, when used appropriately, minimizes other risks that more invasive procedures present to patients, and enables doctors and patients to more effectively tackle the very real and very deadly diseases they already have. We must preserve access to these scans while smartly fostering the development of new technologies and ensuring their proper use.

Dave Fisher
Managing Director
Medical Imaging & Technology Alliance (MITA)

Posted by Jane Akre
Tuesday, December 15, 2009 11:47 PM EST

Dave-

Thank you for your very thoughtful response. I believe the two published articles would take issue with your assertion that the use of CT scans is not growing in popularity.

What we reported in the Cedars-Sinai case is that the tehnicians actually over-rode the settings on the machine, which is somewhat disconcerting. That's why GE blames the technicians for the radiation overexposure.

Is it fair to say there is not one guideline for dose per procedure that would be altered for size of person, their weight etc?

Thanks again-
Jane Akre

Anonymous User
Posted by Suzanne McClain
Sunday, December 27, 2009 11:08 PM EST

This is one more thing I can add to my list of worries. I have had two CT scans recently, the first in 2008 and the second in 2009.

My urogynecologist ordered the first scan after a partial mesh extraction surgery, in which I was experiencing a great deal of pain. I was told all my organs look healthy, and I came to the logical conclusion that the only feasible reason for the pain I live with is because of the bladder mesh that remains in my body.

He ordered the second scan a year later, as I continued experiencing mild to moderate to severe pain in which I felt I was being poked, prodded and stabbed from the inside out. Again, the scan showed all my organs to be healthy.

I now live with pain nearly every day, and it’s scary to know that the tests that have in the past been ordered for me, and tests I likely will be advised to have in the future can cause cancer. Ms. Akre reports “The second study published Monday, estimates that 29,000 future cancers, particularly those in the abdomen and pelvis, could be related to CT scans received in 2007.” Both CT scans I had in the recent past have been of my abdomen and pelvic region, though my GYN told me that in the second CT scan he could even see my heart; which I too was told is healthy.

I have totally lost faith in our medical system. The solution for me, because the remaining mesh which is imbedded and intertwined within my tissues is too risky to remove, is to live on muscle relaxers. I must live with the pain during the day, because I can’t take muscle relaxers during the day, go to work and expect to function at full capacity. I am angry that my life has been turned upside down, and instead of reform the solution is for me to live on pills.

If President Obama is truly committed to health care reform, it needs to start with pharmaceutical companies, the FDA’s 510K approval process and structuring the law in such a way that doctors are prevented from taking kickbacks and/or receiving gifts or compensation for pushing pharmaceutical products.

Comments for this article are closed.

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