Benign symptoms, but actually a medical emergency - examples?

[mozchron]

No one is saying that CT scans are not a valuable tool. The data (as I saw them) indicate that they are being needlessly used. If there is a reason to need a CT scan, by all means they should be performed.

While there is no specific data on whether the radiation from CT scans is a cancer risk, I think it is well recognized that ionizing radiation is in general not a Good Thing. It’s known that X-rays can cause cancer, if a CT scan gives 100X more radiation than a common X-ray scan it is not unreasonable to think that the cancer risk is increased as well. By what scale needs to be investigated of course.

Serious question - why are not MRIs used in place of CT scans (assuming you don’t have a pcaemaker etc)? From what I can gather, the resolution is similar (if not better), with no risk of radiation. Is it just cost?

[outlierrn]

Of course, that’s assuming the hospital doesn’t reprogram the scanner to give you 8x the correct dose.

Hospital error leads to 206 radiation overdoses

[threemae]

@mozchron

It’s known that X-rays can cause cancer,

Not really, that inference is based upon the same datasets used to do the CT calculations.

Appropriate use is a much more complex question which really isn’t even partially addressed by any of the articles we’ve discussed here, as is the use of MRI versus CT. Often MRI is an even better imaging modality, but it costs more, it takes longer to perform, and its actually sub-optimal for several important emergency diagnosis made via CT.

[beowulff]

@Eva_Luna

I had a deep vein thrombosis after leg surgery. The only symptom was that I was a bit sore behind my knee (nowehere near either the surgical site OR the clot). The physical therapist who had come to evaluate me, on a hunch, had my surgeon send me back to the hospital for doppeerizing, which revealed a huge clot near my hip joint. May well have saved my life.

Here’s a shout-out to all the intermediate medical professionals! You rock!

doppeerizing?

[Eva_Luna]

@beowulff

@Eva_Luna

I had a deep vein thrombosis after leg surgery. The only symptom was that I was a bit sore behind my knee (nowehere near either the surgical site OR the clot). The physical therapist who had come to evaluate me, on a hunch, had my surgeon send me back to the hospital for doppeerizing, which revealed a huge clot near my hip joint. May well have saved my life.

Here’s a shout-out to all the intermediate medical professionals! You rock!

doppeerizing?

I never claimed to be a fabulous typist.

[Nava]

@beowulff

@Eva_Luna

I had a deep vein thrombosis after leg surgery. The only symptom was that I was a bit sore behind my knee (nowehere near either the surgical site OR the clot). The physical therapist who had come to evaluate me, on a hunch, had my surgeon send me back to the hospital for doppeerizing, which revealed a huge clot near my hip joint. May well have saved my life.

Here’s a shout-out to all the intermediate medical professionals! You rock!

doppeerizing?

Dopplerizing. They can see whether the blood in a vein is running at the same speed all over (as it should) or it suddenly changes speeds. A sudden change of speed in a spot where there shouldn’t be one means there is something wrong.

[KarlGauss]

@threemae

KarlGauss, sorry to call you out like this, but you’ve completely misrepresented what was in that NEJM article and the AIM article it was based on. “A single unnecessary CT scan is estimated to lead to a one in eighty chance of cancer,” is more accurately stated by that article as, “the risk of cancer from a single CT scan could be as high as 1 in 80 .”

Well, I’m not sure that the two phrasings prove that I’ve “completely misrepresented” things, but will agree I should have been more circumspect in the way I stated the estimate.

That being said, given the frequency with which people come in and essentially demand CT scans for even the most trivial symptom, and the bourdgeoning use of CT scanning to look for coronary disease (i.e. CT angiography), I thought it was important to point out just how risky a proposition a CT scan may be. This concern is heightened when recognizes that there is a huge disparity among radiation dose delivered for a given type of CT scan (i.e. some centers’ machines are using WAY too much radiation - due to some combination of malfunction of the scanner and intentional, but misguided, settings chosen by the operator).

An article in the Archives of Internal Medicine (December 14/28, 2009) included most of these variables and came up with a figure of 29,000 additional cancers, with half of them fatal, attributable to CT scans undergone in the US in the year 2007 alone. The authors note that the figure could be as high as 45,000 extra cases of cancer.

In the same issue of Arch Int Med, a companion article estimated that there is a 1 in 270 chance of cancer developing in a 40-year-old woman who undergoes CT angiography (looking for coronary disease). Not 1 in 80, I agree, but unacceptably high for a screening procedure where it’s not even clear that intervention would subsequently be required or even be beneficial.