[ RadSafe ] RE: radsafe Digest, Vol 122, Issue 10

Steven Dapra sjd at swcp.com
Mon Dec 3 20:55:15 CST 2007

Dec. 3

         Your points are well taken.  However:  how was appendicitis 
diagnosed before the advent of CT scans?  My appendix began acting up in 
1977, and when I went to the emergency room the first thing that happened 
was some ER Dr. started letting up on me.

         With regard to the theoretical cancers versus a presently existing 
life-threatening condition, I am at a loss to understand the panic over a 
mathematically derived possible cancer increase of two percent.  I am 
especially unable to understand it in light of the universally accepted 
fact that 65 percent of cancer is caused by smoking and diet.  Drs. Brenner 
and Hall, the authors of the NEJM review article about CT scan dangers, 
would be better advised to get busy exhorting people to stop smoking and to 
stop living on fatty, greasy food.  Some of the things people get worked up 
over don't make a whole lot of sense.

Steven Dapra

At 08:51 PM 12/1/07 -0500, David & Susan McElrath wrote:

> > Why are CT scans being used to diagnose
> > appendicitis in children?  Why not do white blood cell counts; and
> > do what is called "letting up" on the patient's abdomen?  (Those who
> > have been "let up" on will know what I mean.)
>Leukocytosis and the presence of rebound tenderness is non-specific to
>appendicitis. Assessing for rebound tenderness ("letting up") may cause
>severe pain and further trauma, especially in pediatric patients. A
>diagnosis of appendicitis based solely on leukocytosis and the presence of
>rebound tenderness is irresponsible in this day of modern imaging technology
>(IMHO). I would imagine this practice would result in a large number of
>unnecessary appendectomies.
>I prepare patients for CT scans all the time and have yet to have a patient
>or family member express any concern whatsoever about the radiation
>exposure. Somehow a theoretical increase in the risk of cancer "someday"
>pales in comparison to the problem at hand, usually a potentially
>life-threatening condition. I understand the concern is over unnecessary CT
>scans and exposure of large populations but this simply breaks down and
>becomes irrelevant at the individual patient level. They're hurting, they're
>sick; someone has to do something. CT sure beats exploratory surgery and all
>its associated risks.
>-Susan McElrath, RN, BSN, BSHP

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