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Re: Overexposed? CT in the emergency room
I am glad to hear that you finally received the
correct diagnosis and medical care you needed. I
think it is interesting is that the conditions were
originally determined from a blood test. That is what
led to the follow-up CT scans. Certainly, the
exposures you received were beneficial. A clear
example of a risk v. benefit analysis.
With regard to the article you mention (Brenner DJ,
Elliston CD., "Estimated radiation risks potentially
associated with full-body CT screening," Radiology
2004 Sep;232(3):735-8) the study was done in part to
look at the risks from the routine scanning of
asymptomatic individuals who are self-referral. I
call it boutique CT scanning. See
http://www.fda.gov/cdrh/CT/screening.html There is
strong bias against these kind of scans in the medical
community.
--- Donna O'Kelly <djokelly@MAIL.UTEXAS.EDU> wrote:
> 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?
>
>
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=====
+++++++++++++++++++
"A devotee of Truth may not do anything in deference to convention. He must always hold himself open to correction, and whenever he discovers himself to be wrong he must confess it at all costs and atone for it."
Monhandas K. Gandhi, in "Autobiography"
-- John
John Jacobus, MS
Certified Health Physicist
e-mail: crispy_bird@yahoo.com
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