[OT] Weighing the Costs of a CT Scan's Look Inside the Heart

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June 29, 2008

Weighing the Costs of a CT Scan's Look Inside the Heart

By ALEX BERENSON and REED ABELSON

A group of cardiologists recently had a proposition for Dr. Rosenblatt,

who runs a busy heart clinic in San Francisco: Would he join them in buying a CT

scanner, a $1 million machine that produces detailed images of the heart?

The scanner would give Dr. Rosenblatt a new way to look inside patients'

arteries, enable his clinic to market itself as having the latest medical

technology and provide extra revenue.

Although tempted, Dr. Rosenblatt was reluctant. CT scans, which are typically

billed at $500 to $1,500, have never been proved in large medical studies to be

better than older or cheaper tests. And they expose patients to large doses of

radiation, equivalent to at least several hundred X-rays, creating a small but

real cancer risk.

Dr. Rosenblatt worried that he and other doctors in his clinic would feel

pressure to give scans to people who might not need them in order to pay for the

equipment, which uses a series of X-rays to produce a composite picture of a

beating heart.

" If you have ownership of the machine, " he later recalled, " you're going to want

to utilize the machine. " He said no to the offer.

And yet, more than 1,000 other cardiologists and hospitals have installed CT

scanners like the one Dr. Rosenblatt turned down. Many are promoting heart scans

to patients with radio, Internet and newspaper ads. Time magazine and Oprah

Winfrey have also extolled the scans, which were given to more than 150,000

people in this country last year at a cost exceeding $100 million. Their use is

expected to soar through the next decade. But there is scant evidence that the

scans benefit most patients.

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