CT Scans and Patient Safety: The Debate for Solutions Rages On

A recent article addressing the ongoing debate over the safe use of medical imaging features the opinions of two industry experts on how we should be working to lower radiation doses from CT scans and other imaging exams.

On one side of the debate is Dr. Rebecca Smith-Bindman, who believes that it should be the job of the U.S. Food and Drug Administration to protect patients by regulating radiation from CT scanners. “Radiation doses are higher than they should be and they vary dramatically within and between facilities and that is not acceptable,” she said in the article.

Dr. Bruce Hillman, on the other hand, believes that the problem lies with doctors who order too many scans (which can lead to finding conditions that might have been better left untreated). And, according to the article, he thinks that “heaping more regulation on an industry that has already been squeezed by Medicare cuts may squelch the kind of innovation that produced CT scanners in the first place.”

In my opinion, there are three answers to this storm:

1.  We need to make greater efforts to strive for appropriate use of CT. For that we can turn to the best authority available: the American College of Radiology Appropriateness Guidelines. Computerized decision support programs in electronic medical records can help, too.

2.  We need to strive for much lower radiation dose per scan. We know that the dose per scan frequently can be reduced by up to 60 percent by the use of better CT techniques (selection of imaging parameters, shielding) and by modern CT technology. Here guidelines from organizations like the Society for Computed Body Tomography (SCBT/MR), an arm of the ACR, can be helpful and can drive education for all levels of healthcare providers.

3.  We need to ensure that financial incentives leading to conflict of interest are minimized, so that patients can be comfortable that any CT scans are done only for appropriate diagnostic investigation.

Finally, in all the storm about cost and radiation fear, we need to remember that CT is a very powerful diagnostic tool that provides definitive information which can be used to save lives and select the best therapy quickly. It does far more good than harm — in every institution, every day.

2 thoughts on “CT Scans and Patient Safety: The Debate for Solutions Rages On

  1. The brain is not very radiosensitive, so those scans may not carry much risk. The scans you had of your abdomen carry a risk, by an ultra-conservative way of estimating, of about 1 in 2000 of causing cancer and 1 in 4000 of causing death from the cancer. To put it another way – there’s a 3999 chance out of 4000 that they WON’T cause death from cancer.

    How much risk is that? Let’s think in terms of the risk of driving a car. If you drive a car 64,000 miles over 4 years, based on the accident rate in the USA, you will incur a 1 in 4000 risk of dying in a car accident. Yet we all drive cars – because we perceive that the risk is worth it due to the benefits we derive from the transportation. Same with the CT scan – your doctor judged that the potential benefits to your healthcare outweighed the risks to you substantially.

    You do make another good point – all risks should be explained and discussed. We healthcare providers need to get better at that. Then we can help you make informed choices.

  2. Dr. Shuman, I had a full body ct in 1995 at Yakima Radiology, a brain ct at Harborview Nov. 2010 and another brain along with a scan of my kidneys and bladder at Yakima Urology last week. Not one doctor has mentioned the risk of these scans. I just learned about it while looking something else up. Now I am completely worried that I may have cancer down the road. I wish the doctors would have given me the option to make a potentially dangerous decision about my body. If I had known that MRI or ultrasound was a good alternative, I would have chosen one instead. Kim Lea

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