Do You Really Need that CT Scan?
In the ER, the doctor insists on it. Maybe you should push back.
When you find yourself unexpectedly in a hospital’s ER, you might not be in a position to question the medical necessity of a CT scan. But if there is time for debate, ongoing research suggests it is in your best interest to at least inquire if there is a better alternative, such as an X-ray, ultrasound, MRI, “watching and waiting,” or obtaining a second opinion.
CT scans are powerful diagnostic tools, but they aren’t always worth the inherent risks. Their usage has increased considerably, with fewer than 3 million done each year in the 1980s and 80 million per year currently.
That is a 2,500 percent increase, Consumer Reports noted in a 2015 investigation. The report also found that one-third of the 80 million CT scans taken every year lack medical backing.
Are these tests being ordered because they are in a patient’s best interest, or is financial gain the goal? Diagnostic imaging is incredibly profitable and has ballooned into a $100 billion-a-year business, according to the Journal of the American Medical Association.
Computed tomography, or CT scans, are a series of radiological images that give providers a unique view inside the human body — allowing radiologists to "see a slice of bread from the middle of the loaf." And by layering the slices on top of one another, a crisp 3D view of internal structures is created.
The concern with CT is that one scan can expose a patient to radiation — at a minimum — equal to 150 times the radiation of a conventional X-ray and potentially as much as 1,100 times that amount. The exposure leaves patients at an increased risk for cancer in the long term.
While studies continue to evaluate the risks and reasons for the spike in use of the scans, "a growing number of clinicians and medical associations are not waiting for definitive results about health risks and have already begun figuring out how to reduce radiation levels," the Scientific American reported in July 2013. "Likewise, a few medical associations are trying to limit superfluous imaging and prevent clinicians from using too much radiation when CT scanning is necessary."
Radiology can be live saving. Yet many patients are falling victim to over-testing and its possible side effects. Patients are advised to feel empowered enough to question the necessity of testing.
"The CT scan issue is nuanced," Dr. Ramin Oskoui, a cardiologist in the D.C. Metropolitan area, told LifeZette. "Patients and providers are aware of the FDA guidelines and concerns regarding radiation," and in his personal experience, "doctors order them pretty thoughtfully."
Dr. Oskoui does concede that issues may erupt in ERs. By obtaining a CT scan, it may "keep the ER length-of-stay short," making it a win-win situation. But he added that radiology procedures should always be performed judiciously, and providers shouldn’t be driven by fear, a crowded ER or a litigious society.
What this means for patients: The American Cancer Association reports that the largest cancer concerns aren’t for those exposed to a single test. The exposure from just one CT poses a "very small" cancer risk. It’s the cumulative effects of radiation that are most concerning, raising a red flag for patients that are exposed to "multiple tests or high dose procedures."
Where children are concerned, parents should especially weigh the benefits of a CT over any other possible test doctors could run.
In a first-of-its-kind study in 2012, researchers from the United States, the U.K. and Canada tracked cancer rates among children who had had CT scans during their first 15 years of life. The researchers compared that group to children without the same exposure.
The 20-year study found that children who had two to three CT scans in childhood had three times the risk of developing brain tumors later on. Five to 10 scans during childhood also appear to put a child at three times the risk for developing leukemia, a blood cancer.
Children are also more vulnerable to what the medical community calls "incidentalomas." These are secondary findings from a CT that leads to serial CTs, which means doctors essentially over-treat harmless incidental CT scan findings.
CTs are highly revered tools, especially when providers are looking for an elusive diagnosis or caring for a trauma patient; its benefits often outweigh the risks when taken in perspective. When you have a child that suffers a 20-foot fall from a tree, for example, chances are you may be grateful the technology is available.
But it is simply an option — a choice. The research continues to suggest we may want to keep all our options open when faced with a medical crisis.