Re: Overexposed? CT in the emergency room

["Donna O'Kelly" <djokelly@MAIL.UTEXAS.EDU>]

I don't post often here, but I feel compelled to add my two cents....



In Sept 2003, I went to the ER because my arm hurt.  They were doing all 

sorts of tests and were finding nothing.  One alert cardiologist noticed 

one abnormal blood result.  I was sent for a contrast CT for a better look 

at me.  The next day I was sitting in a doctor's office being told that I 

had renal cell carcinoma (kidney cancer).  Followup bone scan and then CT 

to the head and neck revealed a lesion in my right eye orbit and what 

turned out to be a hurthle cell adenoma and a papillary thyroid cancer.



Both of those initial CTs probably would have been deemed unnecessary by 

many most likely saved my life as in all cases I was showing no symptoms 

except for an expanding derriere due to other thyroid issues that we were 

unaware of at the time.



A recent article in Radiology was summarized in a lot of the online news 

sites.  It was basically saying that if you have a CT you are unreasonably 

increasing your chances of cancer due to the radiation from CT - something 

about one CT/yr for 30 years.  I looked up the paper.  There were no 

population studies - comparisons to other studies I believe - and errors on 

the data that were a factor of two to three in EITHER DIRECTION.  To my 

mind that's not a study, but a biased article.



I'm squarely on a particularly side of the fence here.  That little CT that 

was questionable at the time saved my life and has probably enabled me to 

live an additional 40 years.  Of course, I'm not going to complain about 

the possibility that it might have decreased it by a year - MAYBE.  Without 

that CT, it's very possible that I would have had less than 5 year left.



We're all aware of ALARA.  Isn't one tenet of ALARA the consideration of 

risk versus benefit?  I think it's the case on CTs that you can change the 

size of the cuts - that decreases exposure to the patient.  Perhaps there 

are other considerations in administering CTs that could be 

adopted.  There's all this talk about plan films.  I know of many instances 

where x-rays came up beautifully clear, but a CT turned up a splatter 

pattern of mets in the lungs.



Cancers are being found earlier and earlier in many instances due to the 

incidental findings during CTs.  In MANY of these cases, these cancers are 

in early stages and deemed easily curable.  Found later by conventional 

means and when symptoms appear - it's too late.  I'm not advocating CTs for 

a common cold, but I will push for a CT rather than x-rays because of the 

better imaging.



Another nice thing to have would be the ability of the radiologists, 

technicians, and primary caregivers to provide to folks that don't 

understand all the "radiation lingo" explanations they could understand by 

making comparisons so they can relate it to things they DO understand.  I 

was thankful I was in the position to understand the terms because they 

administrators of the Tc-99 and the CT techs didn't know how to explain how 

or what their machines did - that old black magic crap again.



These comments of course are mine due to my experiences over the last 

year.  Any comments are most welcome.



Donna O'Kelly





At 10:45 AM 10/22/2004, John Jacobus wrote:

>There are also big costs, e.g., hundred's of dollars,

>that are also involved with the use of CTs.  From what

>I was told years ago, if you cannot pay off the price

>(about $1M) of a CT in a year, you should not have

>gotten it.

>--------------------------------------------------------------------------------

>

>Overexposed? CT in the emergency room

>10/21/04

>By: Eric Barnes

>

>SAN FRANCISCO - Dr. Gene Hern uses a brand-new

>multislice CT scanner at Highland Hospital's brand-new

>trauma center in Oakland, CA. It can scan a trauma

>patient head to toe in 45 seconds, and frequently

>does. But is trauma CT being overused, or used for the

>wrong indications?



************************************************************************

You are currently subscribed to the Radsafe mailing list. To

unsubscribe, send an e-mail to Majordomo@list.vanderbilt.edu  Put the

text "unsubscribe radsafe" (no quote marks) in the body of the e-mail,

with no subject line. You can view the Radsafe archives at

http://www.vanderbilt.edu/radsafe/