[ RadSafe ] Medical x-ray vs. CAT scan

Daniel Kane dankane at mindspring.com
Fri Sep 24 13:56:05 CDT 2010

Medical imaging is progressive. That is to say that the simplest and lowest
dose study is done first and if that study insufficiently describes the
pathology, more advanced images are procured. The simplest and lowest dose
study is often the cheapest. It is not in the least unusual for payers and
to a certain extent, common sense to require plain films first and if
inadequate more advanced imaging. I would not be shocked if the CT is
equivocal that a nuclear bone scan or MRI be ordered to detect some occult

If we started with CT we would likely triple the cost of evaluating
fractures (I am guessing hip or spine) and quadruple the public dose
catching maybe 25% disease out of the box with one imaging try. Often plain
films are sufficient, saving dose and dollars. As well, everyone has a
different shape and a different ability to hold various positions for
imaging and this is especially true when in pain or injured. All of this is
in general taken into account.

I wish your wife well and hope that they determine the cause of her symptoms
in a timely manner. In general medical imaging is a progressive business
from simple, cheap, available and low dose to complex, expensive, hard to
find and high dose. Finding the sweet spot for many individual patients
every day is an art.

Dan Kane
Associates in Medical Physics, LLC

-----Original Message-----
From: radsafe-bounces at health.phys.iit.edu
[mailto:radsafe-bounces at health.phys.iit.edu] On Behalf Of Joel C.
Sent: Friday, September 24, 2010 2:25 PM
To: radsafe at health.phys.iit.edu
Subject: [ RadSafe ] Medical x-ray vs. CAT scan

My wife recently had an x-ray; they were looking for a bone fracture.  The
Dr. wasn't happy with the x-ray and ordered a CAT scan.  Is there any reason
why drs. don't skip the standard "film" and go right to the CAT scan, if
they suspect they need the extra resolution?  Do they have to show that the
film isn't adequate first?  I know the film exposure is low, but if there's
no benefit...

Joel I. Cehn, CHP

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