The articles in this issue make clear that there is far more radiation from medical CT scans than has been recognized previously, in amounts projected to cause tens of thousands of excess cancers annually. Also, as these scans have become more sensitive, incidental findings lead to additional testing (and often more radiation), biopsies, and anxiety. Although a guiding principle in medicine is to ensure that the benefit of a procedure or therapy outweighs the risk, the explosion of CT scans in the past decade has outpaced evidence of their benefit. Although there are clear instances when CT scans help determine the treatment course for patients, more and more often patients go directly from the emergency department to the CT scanner even before they are seen by a physician or brought to their hospital room. To avoid unnecessarily increasing cancer incidence in future years, every clinician must carefully assess the expected benefits of each CT scan and fully inform his or her patients of the known risks of radiation.
This data is cause for concern. Sure CT scans are necessary to diagnose and treat disease and have revolutionized the practice of medicine and surgery in a number of ways… BUT! The frequency and *ease* at which these scans are ordered is troubling. A simple check box on an order form may be causing cancer in one out of 270 scanned patients!
Many health care reform proponents will claim the increase in number is due to the quest for profits… I honestly believe that is nonsense. Perhaps a small number of scans ordered by physicians who own a scanner can be attributed to a profit motive, but, clearly, the most significant reason for the increase in the number of scans is in the practice of CYA medicine.
Should we have a black box warning on the order form noting what the risk is to the patient? Should the physician need to acknowledge the risk and check off that he/she still feels the scan is *necessary*?
The informed consent, informed choice argument clearly applies for the conscious patient or their family (in the ER). Patients will need to be informed of the risks of the scan and the potential risks assumed in electing NOT to have the scan. They can then formulate a decision based on facts and determine if they feel the potential benefits outweigh the potential long term risks.
This article also points to the need for diagnostic criteria which could trigger the need for a CT scan or support the physician in choosing a potentially “*safer*” option. Most car accident victims don’t need a CT of chest, abdomen and pelvis… yet in many instances it is almost automatic.
Years ago a group of ER docs published a set of diagnostic criteria which determined when ankle Xrays were necessary. It has been widely accepted and utilized… it has also led to fewer X-rays of the ankle throughout ERs across the country. Why can’t the same community come up with criteria for CT imaging… will the CT scan or the lack of a CT scan save more lives ?!?!?