As a family physician, I have always tried my hardest to avoid unnecessary x-rays and CT scans. Patients often come in hoping for an x-ray for a sprained ankle, jammed fingers and bruised ribs. In most cases, the diagnosis can be made clinically and I try to talk them out of it when appropriate. CTs have been a great addition to modern medicine and I could not imagine no having them. However, they have become too easy.
It is important to realize that not all headaches are likely cancer and don’t need a CT. Patients and their doctors need to be prudent when deciding whether or not to do a head CT. A recent report in the New England Journal of Medicine (NEJM) reports that our exposure to radiation has doubled since 1980, most of this medical radiation.
It is estimated that in the years to come, 2% of all cancers will be x-ray/CT induced.
About 62 million scans were done in the U.S. last year (2006) while only 3 million were done in 1980. More than 4 million were in children, usually to rule out appendicitis. A big reason for this is fear of lawsuits. I have seen many patients go to the ER for constipation and gas and end up having a CT exam. If the doctor would have simply spent a few minutes and talk to the patient, they could have made a clinical diagnosis.
However, due to understaffed ERs, fear of lawsuits and a missed diagnosis, CT exams are done. Primary care physicians are also just a guilty. A simple tension headache or migraine in the ER will usually result in head CTs and likely will cause a fair number of brain tumors. Not all headaches are brain tumors, although if one knows someone with a brain tumor, they are usually more concerned.
In the end, we will likely make more cancers than we ever thought. Studies show that more than 1/3 of all CTs are inappropriate, in other words, 20 million adults and 1 million kids have unneeded CTs. At an average cost of $1500 per CT, over $31,500,000,000 will be wasted, that is $31 Billion, or $105/yr for every person in this country.
How much radiation does a CT emit? A CT scan of the chest involves 10 to 15 millisieverts (a measure of dose) versus 0.01 to 0.15 for a regular chest X-ray, 3 for a mammogram and a mere 0.005 for a dental X-ray.
In other words:
- 1 CT is equivalent to 10 to 100 x-rays, depending on the type.
- 1 CT is equivalent to 3 to 5 mammograms
- 1 CT is equivalent to 3000 dental xrays
To sum it up, CT exams are life saving and a very vital part of medicine in 2007. However, discuss with your physician if it is really the right thing to do.
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