Hospital Overuse of CT Scans | Natural Health Blog

Date: 07/16/2011    Written by: Beth Levine

Hospital Overuse of CT Scans

Hospital Overuse of CT Scans

Back-to-back mega-doses of radiation!  That sounds like something out of the "Incredible Hulk."  But unfortunately, this is not a scene from a comic book or movie.  It is taking place in hospitals all across the United States.

New research has found that it is a regularly occurring practice at hundreds of hospitals to allow chest CT scans, which typically dose out 45 millisieverts (mSv) of radiation -- and sometimes substantially more -- twice in the same day.1  In contrast, the average chest X-ray gives off 0.02 mSv of radiation.  The levels of radiation a patient is exposed to in one CT scan are only questionably safe -- now in all these instances, that amount is doubled.

The study, performed through the Center for Medicare and Medicaid Services, examined Medicare outpatient claims from 2008 and discovered wide variations in the use of CT scans.  Some hospitals will not perform two scans in a day on the same patient or do it less than 1 percent of the time.  Others, however, allow double scanning in a day to occur more than 80 percent of the time.

The data was broken down by state as well as by each individual hospital.  Overall, approximately 75,000 patients across the country received two CT scans in one day in 2008.  The scans are performed slightly differently, as one employs iodine contrast to monitor blood flow and the other does not.  But according to most radiologists, as well as common sense, they are almost never both necessary.  A physician should be choosing one method over the other, depending on what it is they are assessing.

One CT scan of the chest area is the equivalent of roughly 350 standard x-rays -- which is already a tremendous amount of radiation to subject a patient to.  So two scans is 700 chest x-rays worth of radiation…in one day.  Seems a little excessive in any possible scenario.

The research determined that the national average among Medicare patients receiving double scans is 5.4 percent.  However, there were over 200 hospitals that gave two scans in a day to more than 30 percent of their Medicare patients.  Of course, this study only focused on Medicare patients; double scanning was found to be just as common among privately insured patients of all ages.

The use of CT scans stems from their ability to provide three-dimensional images far more detailed and flexible than normal X-rays.  Since many doctors rely heavily on them for diagnoses, the number of CT scans performed in the United States has increased 23-fold from three million in 1980 to about 70 million by 2007.

Despite assurances from doctors that the benefits of getting such accurate diagnostic images outweigh the risks, there is evidence that indicates that the radiation received from CT scans increases cancer risk by a substantial margin.  A 2009 study at four San Francisco hospitals found the median doses of radiation delivered during CT scans was higher than previously thought.  Also, the radiation levels varied wildly for the same procedure from hospital to hospital and even within the same institution.

Another 2009 study, published in the Archives of Internal Medicine, concluded that approximately 4,100 new cancers would result from CT scans of the chest in 2007.2  How many of these might be avoided if double scanning was procedurally banned?

In fact, CT scans should probably not be used as a diagnostic tool option, except for the very sickest patients for whom no other diagnostic tool will work.  In those who are generally healthy, with only a mild form of illness, the risk of developing cancer should far outweigh the potential benefit provided when there are other methods of determining cause that are safer. And when it comes to double scans on the same day -- or during any contiguous time period, make sure your doctor provides a compelling reason. But again, remember that according to most radiologists, they are almost never both necessary. 

So go armed to your physician with the knowledge that CT scans are not usually your best option and double scans are almost never okay.  Be your own best advocate in the hospital and when obtaining medical services anywhere, because the medical system often will not take care of you the way it should.

 

1 Bogdanich, Walt and Craven McGinty, Jo. "Medicare Claims Show Overuse for CT Scanning." The New York Times. 17 June 2011.  The New York Times Company. 3 July 2011. <http://www.nytimes.com/2011/06/18/health/18radiation.html>.

2 Amy Berrington de González, DPhil; Mahadevappa Mahesh, MS, PhD; Kwang-Pyo Kim, PhD; Mythreyi Bhargavan, PhD; Rebecca Lewis, MPH; Fred Mettler, MD; Charles Land, PhD, "Projected Cancer Risks From Computed Tomographic Scans Performed in the United States in 2007." Archives of Internal Medicine. Vol. 169 No. 22, Dec 14/28, 2009 <http://archinte.ama-assn.org/cgi/content/abstract/169/22/2071>

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Comments

  •  
    Submitted by Guest on
    July 17, 2011 - 10:36am

    Hi - I was wondering how you got to the estimate of 45 mSv for one chest CT, as it is not mentioned in the article you cited.

  •  
    Submitted by BaselineFoundation on
    July 20, 2011 - 9:13am

    That came from the original paper “Cumulative Radiation Exposure and Cancer Risk from Diagnostic Imaging in Patients” presented at the at the 2008 meeting of the Society of Academic Emergency Medicine. You can read the abstract on page S58, item 135 at http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2008.00121.x/pdf

  •  
    Submitted by Tammy on
    October 23, 2018 - 11:54pm
    Monroe , North Carolina

    My dad has pneumonia and he is 76 years old. He fell at home and hit his head. The hospital did CT scans and found nothing wrong with his head but did find the pneumonia. I know of 4 scans they have done in a week since then on his head and found nothing. They come into his room and get him without family knowledge or consent, so I don't know how many he has really had. When I found out, I put a stop to it. He gets confused at night and I told them to stop frying his brain.

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