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Millions Exposed to High Radiation from Medical Tests

RadiationHere’s the latest reason to wonder whether you really need that CT scan the doctor’s ordering “just to be sure”:

In any given year, roughly four million Americans between the ages of 18 and 64 are exposed to “high” or “very high” doses of radiation as a result of medical testing, according to a study published today in the New England Journal of Medicine.

Estimating the risk of cancer from a given dose of radiation is notoriously difficult, and the authors of the study don’t quantify a specific cancer risk from a given dose of radiation. But the paper does note that the per capita dose of radiation Americans are exposed to because of medical testing has increased sixfold since the 1980s.

The study, which included funding from the NIH, looked at data on nearly one million people from 2005 to 2007.

While many medical tests are clearly necessary — and the benefits of the test outweigh the risk of the radiation — in other cases it’s less clear. A perspective piece that accompanies the study calls for a much more cautious approach, with more study of the benefits of imaging tests before they are put into widespread use.

“We have to think and talk explicitly about the elements of danger in exposing our patients to radiation,” writes the piece’s author, an NIH doc named Michael Lauer. What’s more, he argues, doctors should weigh a patient’s previous history of high-radiation tests and explain the possibility year after year of high-radiation testing could lead to cancer.

Radiation sign via iStockphoto

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    • Here is how it goes day after day, night after night:

      Doctor: Well Mr. Patient, I think your chest pain was probably indigestion. You can go home and follow up with your doctor on Monday.

      Patient: What else could it be?

      Doctor: Well, it could be a pulmonary embolism, or aoritc dissection, or pneumothorax, or spontaneous esophageal perforation, or a lung tumor, or more rare type of mediastinal tumor that has bled spontaneously, or a congenital cyst that has bled or a........

      Patient: Well how can we be sure before you send me home?

      Doctor: We can get a CT scan.

      Patient with Insurnce: lets get it.
      Patient without insurance: lets get it
      Patient with Medicaid: lets get the CT scan
      Patient with Medicare: lets get the CT scan
      Patient with high deductible: Well what are the chances its one of those things...Doctor says small, and patient decides not to get it.

      See the trend. Note there are 5 million visits a year in the ER for chest pain. Same story for head ache. Same story for Abdominal pain. The list goes on.

      This has nothing to do with doctor ownership of CT scan. And, there is a significant consumer driven component here: people want this. they want the reassurance. they want the CT.

      What would happen if the goverment decided to ration CT availablity (by cutting reimbursement so low its not worth it to have one or read one?)

    • ER doctors dont own CT scans and they order more than anyone. Its just a fact that its standard of care, and the standards are driven by defensive medicine principals. I can think of so many many, when a CT found things we didnt expect. They also find incidental nodules, but a good follow up doc can manage those without much difficulty. To say physician ownership is responsible is simply mis informative. Its standard of care that drives this. Want to change the standard, loosen up the tort......

    • Patient here who has seen all of the above from inside la machine.

    • Radiation is not the worst consequence of CAT scans. I suspect that nearly half of them are medically unnecessary and ordered by reflex or in an attempt to provide a shield against litigation. The biggest risk is all of the trivial and irrelevant abnormalites that they discover that then spawn more scans, consultations and biopsies, etc. Think of the cost and anxiety of this cascade of medical chaos. Why do MDs order so many CAT scans? For a candid MD answer, see

    • The radiation dose from a CT scan of the abdomen is 10 mSv which is the equivalent dose of background radiation we all get for 3 years. I'm not convinced that it's accurate to extrapolate exposure data from nuclear accidents downwards in a linear no-threshold manner to predict cancer risk from the doses in diagnostic imaging. There is data out there that would suggest small doses of radiation could be helpful. In the dish, it increases tissue production of DNA-repairing enzymes. So, it's controversial, but it's appropriate to be cautious. Actually, with head CT's, you'll have more significant risks of cataract formation. The brain is pretty radioresistant.

      We have had a PACS system for 4 years now, so I can quickly see how many CT scans the patient has had since then. Many are ER frequent fliers, head CT's etc. But some people with kidney stones get repeats each time they show up with flank pain, and some of those could be replaced with a simple xray or an ultrasound, if the person carries a known diagnosis of stone. I now state in my reports exactly how many scans that person has had in the last 4 years if it's more than a few just to make everyone aware of the cumulative dose.

      The posts above really highlight the need for tort reform. Experienced ER physicians shouldn't feel forced to order any test for fear of litigation. The practice of defensive medicine is estimated to represent 30% of all healthcare spending. That's outrageous!!!!

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