Increased number of CT scans cause for concern

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According to a June 13, 2012, story by Alice Park at’s Healthland, a study published in the Journal of the American Medical Association has found that the use of imaging tests, such as CT scans and MRIs, grew tremendously between 1996 and 2010, with the use of CT scans tripling and MRIs quadrupling per 1,000 patients.

Author of the study, Dr. Rebecca Smith-Bindman, who is a professor of radiology and biomedical imaging at the University of California San Francisco, is expressing her alarm over patients’ increased exposure to radiation, especially from CT scans that use the cancer-linked ionizing radiation.

Dr. Smith-Bindman’s study found that this pervasive use of CT scans has little to do with the financial incentives doctors receive for giving more tests, as previous studies have asserted, because CT scans have also increased within privately insured populations where doctors have little to no incentives for issuing numerous tests.

Testing has increased for several reasons. The first is obvious—medical reasons. Imaging devices help locate internal injuries, hidden causes of illnesses, etc. But the article reveals another, more potent reason for this increase—malpractice lawsuits. Doctors see tests as a back-up to their own diagnoses, and because imaging can locate issues a doctor cannot, tests protect them from missing something fatal and provoking a lawsuit.

Also listed as a reason–patient expectations. Patients expect these tests and think a doctor is being negligent if those tests aren’t issued.

Some experts have challenged these studies by saying radiation doses in CT scans have declined, but Dr. Smith-Bindman says there is not enough research to confirm this.

In fact, another study in The Lancet backs up Dr. Smith-Bindman’s concerns. In comparing children who had received numerous CT scans with children who had not, those who had received scans were at a three times greater risk for brain tumors and at a four times greater risk for leukemia.

Until healthcare organizations figure out a way to use CT scans and other tests in moderation, Dr. Smith-Bindman suggests that patients ask doctors if alternative tests can be performed. She also urges doctors to be vigilant about issuing repeat tests, something with which EHRs should help.

– by Pete Fernbaugh

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