Statistically, the answer is probably yes because we are handing these out like candy. Fill up at Quik Trip and you can have your windshield repaired and a CT scan ordered.
I recently had a patient with a headache that was not responding as expected. Her PCP ordered a CT scan. Not an MRI. When I told her she needed to get him to order a MRI instead, his office noted that they do not order MRIs. What???? For her situation, there was absolutely no reason for a CT scan over the MRI. As a matter of fact, the only reason to order a CT over the MRI is when we need rapid information, such as an intracranial hemorrhage after head trauma. Or maybe if some type of bone growth is suspected. Also, you can’t do an MRI when any type of metal is in the body such as a pacemaker or spinal fusion.
Other than these limited situations, MRI preferable to CT scans. Despite this, CT scans are now coming in cereal boxes and kid’s meals in the drive thru. In an ER setting the argument is usually that CT scanning is much quicker (read = you can make more money off of it), which is why ERs only use CT scanners. And some will say that the initial cost of purchasing the scanners is much cheaper for the CT scan over the MRI. This may be a good argument for a hospital, but NOT for a physician ordering from an imaging center with access to both.
So why all the frustration on my part?
Because the radiation associated with CT scans has been estimated to contribute to some TWENTY NINE THOUSAND cancers per year in the US alone.
That makes this discussion incredibly relevant to your long-term health, since it’s highly likely you’ve had a CT scan done before. The article noted above was published over 5 years ago, so this has been plenty of time for physicians to change their addiction to ordering CT scans. Heck, you could practically hear the screeching of the brakes immediately after this study was published.
Turns out that the screeching sound was actually the tires squealing as the number of orders for CT scans took off at full speed. Yup, according to this review article, there were just over one million CT scans order in England in 1996-97. By 2012-13 this number had jumped to a whopping five million. Even worse, for 2013-14, there was a 13% increase with no sign of “plateauing.”
How are these numbers even possible???
I know that I often complain that it seems like most physicians don’t keep up with medical literature, but geez-o-Pete. We’re talking 5 years since the concerns started to rise that one of the CT scan side effects included a large increase in cancer risk. Despite this, we still have physicians ordering these scans. Even worse, they are ordering them for situations where an MRI would be an even better choice or (even worse, in my opinion) they are ordering them for situations where they should not be ordered. This happens an awful lot for conditions like headaches, shoulder pain and back pain.
So what should you do?
- Avoid the ER if at all possible. Try urgent care or find a good chiropractor. If you do go, make sure they feel the CT scan is absolutely, positively needed and the benefits of obtaining the scan outweigh the increase in cancer risk from ionizing radiation.
- If your doctor is ordering a CT, have a discussion with him or her about ordering a MRI instead. There is no radiation with a MRI.
- Just like in the ER, if your doctor is ordering a CT scan, make darn sure the imaging itself is actually needed. All too often a CT scan is done as a shot in the dark. Imaging should be done to help confirm a diagnosis, NOT to fish around for ideas.
- If you have an ultrasound done, it many cases it is NOT necessary to order a CT scan on top of this just to confirm what the ultrasound found. It’s ridiculous.
- If a CT scan is absolutely determined to be the best option (if you have a pacemaker, for instance). then check with your doctor and the radiologist about ways to lower the radiation exposure for the test (such as imaging ONLY the area of concern).
For a full review of the Committee of Medical Aspects of Radiation’s 16th report you can click here to read more about it.