CT scans: A Radioactive Risk

[Guest guest]

BlankCT scans: A Radioactive Risk

By Terry J. , In These Times

Posted on December 13, 2006, Printed on December 17, 2006

http://www.alternet.org/story/44786/

My dentist and I have been bickering for decades. Steve advocates diagnostic

x-rays; I argue that ionizing radiation, an established cancer risk, is not

worth the benefit of catching a cavity early. Every couple of years, he

threatens to dump me as a patient, and I agree to a few x-rays after factoring

in the benefits of his skill and his generous hand with the nitrous oxide.

Our negotiations rest on conjoined principles of Western medicine: risk-benefit

analysis and informed consent.

But when it comes to the far greater risk of a " procedure performed more than

150,000 times a day in the United States most consent forms are silent, " notes

town University's Fugh-Berman, in a report for the Hastings Center,

an independent bioethics research institute.

Computed tomography (CT) scans take multiple x-ray images from different angles

and link them into cross-sections of body tissues and organs. Researchers at

Yale found that only a minority of U.S. academic medical centers inform patients

about alternatives to diagnostic CT, including sonograms and MRIs, or about the

radiation.

One abdominal CT, says the Food and Drug Administration (FDA), exposes a patient

to 500 times more radiation than a conventional chest x-ray. Exposure from a

single full-body CT scan is within the same range as doses that increased the

cancer risk of Japan's A-bomb survivors. Full-body scans can cause a one in

1,250 increased chance of dying from cancer, Radiology reports. That risk more

than doubles for the 2-3 million children scanned, and leaps again for the third

of those kids given at least three scans, according to the National Academy of

Sciences.

Of course, many CT scans are well worth the risk. They can be superb diagnostic

tools that result in more effective treatments and, possibly, cures.

But early diagnosis does not always mean longer survival. " If I pick up a tumor

that is one centimeter today and you live five years, or I pick it up four years

later and you live one year, it's the same thing, " Dr. Elliott Fishman, a

professor of radiology and oncology at s Hopkins Hospital, told the New York

Times.

The risk-benefit equation skews further at facilities touting CT scan screening

for apparently healthy people.

" Are you at risk?, " ask the big red letters of a Web pop-up ad. " Find out for

only $99 " for a heart scan at Pulse Medical Imaging, " located in the White

Plains [NY] business district. "

Or " Come to Florida, for a scan and a tan, " flashes a Web ad for HealthTest Scan

Center, where a pelvic, abdomen and chest scan will set you back $895, with a

heart scan thrown in.

When Tania answered the phone at the Boca Raton, Fla., office, I said I wanted

information but thought I was healthy. She chuckled, " Everyone thinks that, but

it's just to make sure. Prevention is better than a cure. " What can a scan

prevent? " Death, " she replied. And if my doctor refuses to prescribe it? " See

our doctor [either Dr. Marc Kaprow or Rohtem Amir]. He'll give you the OK. "

I asked Tania about radiation danger. " It's minimal with this machine, " she

reassured. How often should I get one? " Talk to the doctor, but some people have

them four to five times in a six-month period. " Why? " Some people are

hypochondriacs, " she confided.

Downplaying or ignoring the radiation risks extends to major studies and

journals. Researchers at Presbyterian Hospital/Weill Cornell Medical Center

assessed annual CT scans for smokers and former smokers without symptoms and

concluded CTs save lives by detecting lung cancer early. The study, published in

the October New England Journal of Medicine, never mentions radiation risk. The

Center would not release its consent form Behrman, head of the

Institutional Review Board could not confirm how, or if, it described the

radiation risks. But " I can't imagine subjects were not informed, " he said.

A New York Times article and editorial pointed out design flaws in the study,

including the lack of a control group, and noted that CT scans carried risks

such as false positives, unnecessary biopsies and " needless surgery to remove

tumors that might never have become a problem. " It, too, omitted radiation

concerns.

The number of CT scans in the United States is at 60 million a year and rising.

The journal of American Society of Radiologic Technologists estimates that " 20

percent of radiologic imaging exams are not clinically useful [and] lapses in

safety protocols also are common, unnecessarily increasing radiation exposures. "

Overuse of CT scans " points out a larger problem, " says Fugh-Berman. Relying on

information from the pharmaceutical and medical device industries, " physicians

are more informed about the benefits of therapy than the risks of drugs and

procedures; risks related to diagnostics are off the radar screen. " And once

hospitals and medical practices invest in expensive equipment such as CT

scanners, the more they use them the more they make. " They are a very high

profit item, " says Fugh-Berman.

And profitability is one benefit that commercial medicine always factors in.

Terry J. is a senior editor of " In These Times. " Her work has appeared in

" Harper's, " the " Nation, " " New Scientist " and other publications.