I read two articles yesterday that complemented each other:
In Kaiser Health News (KHN) Heavy Use Of CT Scans Raises Concerns About Patients’ Exposure To Radiation
And on KevinMD two radiologists posted The financial costs of treating CT-induced cancer
Each underscores the fact that CT scans are significantly overused in American healthcare.
Although CT scans are an essential diagnostic tool, the Food and Drug Administration reports that an estimated 30 to 50 percent of imaging tests are believed to be medically unnecessary.
Considering we spend tens of billions of dollars every year on diagnostic imaging, that’s a lot of wasted money.
But direct costs aside, the risk of radiation-induced cancers and the cost of treating those is also huge.
Like X-rays, CT scans represent a potentially significant health problem, one that experts say may not show up for years: cancer caused by radiation. In most cases, it is impossible to definitively attribute cancer to radiation exposure that occurred years or even decades earlier.
A JAMA article looking at the overuse of diagnostic imaging, including CT scans, determined:
Computed tomography and nuclear medicine examinations deliver much higher doses of ionizing radiation than conventional radiographs, and extensive epidemiological evidence has linked exposure to radiation levels in this range with the development of radiation-induced cancers. It is estimated that 2% of future cancers will result from current imaging use, if imaging continues at current rates. [my emphasis]
The radiologists from the KevinMD post wrote:
A criticism may be that CT-induced cancer costs may occur decades from now but are non-existent at present because cancer requires several years to decades to develop after radiation exposure. We disagree. For years, the problem of radiation-induced cancer from medical imaging has been framed as a future event. Hundreds of millions of CT scans have been performed in the U.S. since the 1990s, thus, we have already been paying for those excess cancers.
They calculated that CT-induced cancers cost around $260 million every year.
Why is this happening? There are a lot of reasons.
Physicians often blame the patients for demanding certain services, such as CT scans. That may be true. Don’t insist on a CT scan if the physician doesn’t recommend it. (And question it if s/he does.)
Newer CT equipment uses less radiation, but it’s expensive. Until now, hospitals and imaging centers have been paid the same whether the machine is new or old, so there is little incentive to invest hundreds of thousands of dollars in new equipment. A new Medicare rule this year will reduce payment if CT machines fail to meet certain safety standards.
And physicians order more CT scans and other diagnostic tests because it works to protect them from medical malpractice suits. I posted about this sad fact recently: Cover your a** health care.
What was most frightening to me in the KHN article was the apparent lack of radiation dosing standards in the industry.
Smith-Bindman [Rebecca, MD] said that excessively high radiation dosage is a problem requiring urgent attention. A 2009 study she led found that the actual radiation doses from CT scans varied as much as 13-fold for the same test performed at the same hospital, and these doses were much higher than those required to make a diagnosis. Except for mammography, there are no federal regulations governing radiation doses.
There are several reasons for the variation, Smith-Bindman said, including the failure to adjust the radiation dose based on body size and a desire to achieve more finely detailed images, which can be achieved by ramping up the dose. Nor are there national standards for technologists who administer CT scans, which involve increasingly sophisticated equipment. Some states don’t even require that they be licensed, allowing virtually anyone to operate the equipment.
“There’s no standardization of how these exams get conducted,” Smith-Bindman said. “There’s no oversight and no one’s responsible for this.”
What’s a person to do? Ask questions. Ask about alternatives. Ask about risks and benefits. CT scans are a useful tool, but only when used appropriately.
KHN also suggests two websites that are dedicated to promoting safer, more informed use of imaging studies.
- Image Wisely: Radiation Safety in Adult Medical Imaging
- Image Gently: The Alliance for Radiation in Pediatric Imaging
Am I the only one who thinks our health care system is a wild west where a sign should warn”Venture at your own risk”??