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

[John Jacobus]

Before CT scanning became the standard, evaluations
for appendicitis and a number of other vascular
conditions was done by exploratory surgery, with the
inherent risks of anesthesia and infection control. 
MRI and CT have both eliminated the the need for the
vast majority of exploratory surgery and "wait and
watch" diagnositic procedures.

Regarding the publics knowledge of cancer risks, as
someone what are the odds they will get cancer in
their lifetime.  The answer is 43%.

--- Steven Dapra <sjd at swcp.com> wrote:

> 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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+++++++++++++++++++
"Courage is what it takes to stand up and speak, Courage is also what it takes to sit down and listen." -- Sir Winston Churchill

-- John
John Jacobus, MS
Certified Health Physicist
e-mail:  crispy_bird at yahoo.com


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