We love technology in medicine like CT scans, however, it is replacing a well thought out diagnosis. But are CT scan side effects worth the information obtained?
Regardless of whether it is for a child or for yourself, going to the emergency is dangerous business. Not only is the ER a breeding ground for bacteria like MRSA and C. diff, but the risk of unnecessary procedures being done is ridiculously high. Some of these may be harmless like bloodwork (not considering the pain of the blood draw and the pain of the cost of labs being done in the hospital) or an ultrasound.
But some may be downright dangerous.
Several years ago someone raised a scary question. We know that the potential CT scan side effects from radiation (computerized tomography, also called a CAT scan) is very, very high. As an example, a single CT scan of the chest is equal to about 133 two-view xrays of the chest. I’ve had patients who had several CT scans done in a single ER visit. If you do the math, you’ll realize this becomes amazingly high.
And keep in mind that there is NO safe level of radiation. Radiation is cumulative. A single dose today can affect you decades down the road.
There are an overwhelmingly high number of CT scans done in the US every year. Approximately 70 million scans are done every year. Yup – 70 MILLION. I know that ERs use them because they are quick and very billable, as anyone who has looked at a hospital bill can affirm. MRIs have no radiation exposure but the turnover time is much, much longer.
A group of researchers back in 2009 estimated the number of cancers resulting from CT imaging in the United States. The number? A massive 29,000 cases that is produced as a result of the CT scans done in a single year. Half of these would be expected to be fatal, resulting in 14,500 cancer deaths per year as a result of an exceedingly high number of CT scans done per year.
So, the above study was done in 2009 and actually got quite a bit of press. So, hopefully, medical providers have learned from this and are ordering advanced imaging with care. The cynically part of me realizes how slow medicine is to adopt new research when money and dogma is involved. The hopeful part of me believes that studies like the CT radiation cancer study will cause drastic changes in the way we practice medicine.
It better. You see, prior to this study in 2009, CT rates were going anywhere but down. This particular study looked at abdominal CT scans (one of the higher radiation dose imaging scans) of children in the ER presenting for abdominal pain and how the number of CT scans changed from 1998 to 2008. The findings are a little scary:
- Of all pediatric ED visits, 6.0% were for abdominal pain
- The use of CT scans of the abdomen in these kids was 0.9% in 1998
- This skyrocketed to 15.4% in 2008 (an increase of over 1700%)
- There was no change in the use of ultrasounds or X-rays, which can be used to rule out many causes of abdominal pain in kids
- There was no increase in the diagnosis of appendicitis or in hospital admissions
- Older and male patients were more likely to have a CT scan
- Black children were one-half as likely to undergo a CT scan
In a nutshell, the number of kids getting CT scans of the abdomen went up exponentially in a decade, without any use of alternative imaging like an ultrasound (which does not give off radiation). These kids were no more likely to be diagnosed with appendicitis or be admitted to the hospital. In other words, there really was no rationale for the increased use of abdominal CT scans in these kids.
I can’t exactly explain why this number was on the rise (even though hopefully, after the 2009 study was released, this trend has been strongly reversed). Maybe as defensive medicine? Maybe relying less on a physician’s diagnostic skills and more on technology?
Either way, if your child has to go to the ER for abdominal pain, make sure you ask questions and ensure that every test being ordered is absolutely necessary.