Doctors Suggest That We Are Scanning Ourselves To Death

By Alan Lyndon

“We are giving ourselves cancer.” That’s according to an article in today’s New York Times written by a radiologist and a cardiologist from the University of California, San Francisco. They are specifically referring to the exceedingly popular, and extremely dangerous, use of medical imaging.

“We are silently irradiating ourselves to death,” write Rita F. Redberg, cardiologist, and Rebecca Smith-Bindman, radiologist.

Every patient wants to know now if they have cancer.  And health care today encourages early detection.  Physicians are facing more and more pay-for-performance initiatives for chronic care management.  Those incentives — or threats of penalties — also encourage early diagnoses.

The computed tomography (CT) scan is like a super X-Ray that shows images of blood vessels, bones, internal organs, and tissue in much greater clarity and detail. A study published last year in JAMA showed that the use of CT exams in children under 14 more than doubled from 1996 to 2005. Redberg and Smith-Bindman report that the overall “resulting exposure to medical radiation has increased more than sixfold between the 1980s and 2006.”

Radiation is measured in millisieverts (mSv). The average person is exposed naturally to about 3 mSv each year, varying slightly upon altitude.  By comparison, one CT scan of the abdomen and pelvis, repeated with and without contrast, provides an effective radiation dose of 20 mSv. That’s the equivalent of up to seven years worth of natural radiation.

The concern is that while all parties involved are trying to identify and prevent cancers, we may be causing future cancers in the process.  Experts estimate that over 4,000 future cancers could result from the 4 million CT scans performed in children each year. The National Cancer Institute estimates a total of 29,000 future cancers overall.

Redberg and Smith-Bindman suggest better oversight by the FDA and physician restraint as possible solutions to over-radiation.  But patients can help themselves.  The authors suggest that “before agreeing to a CT scan, they should ask: Will it lead to a better treatment and outcome? Would they get that therapy without the test? Are there alternatives that don’t involve radiation, like ultrasound or M.R.I.?”

While they acknowledge the value of medical imaging, Redberg and Smith-Bindman want to find a way to use CT scans “without killing people in the process.”