{"id":259,"date":"2014-02-03T01:30:17","date_gmt":"2014-02-03T01:30:17","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=259"},"modified":"2017-08-21T13:00:39","modified_gmt":"2017-08-21T13:00:39","slug":"pc-corner-with-dr-geoffrey-modest-ct-and-radiation-another-view","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2014\/02\/03\/pc-corner-with-dr-geoffrey-modest-ct-and-radiation-another-view\/","title":{"rendered":"PC Corner with Dr. Geoffrey Modest: CT and radiation–another view"},"content":{"rendered":"

i realize that i have spent a disproportionate amount of time writing about the risks of CT scan (and xray exposure in general). but there was a really good editorial in the NY times today by a cardiologist and radiologist (see\u00a0http:\/\/www.nytimes.com\/2014\/01\/31\/opinion\/we-are-giving-ourselves-cancer.html?ref=todayspaper<\/a>). their points:<\/p>\n

 <\/p>\n

–cancer deaths are increasing relatively, as heart disease (the major killer) mortality has decreased over the decades<\/p>\n

–medical radiation exposure has increased 6-fold from 1980s to 2006<\/p>\n

–one in 10 americans get a CT scan every year (and many more than 1\/yr), with radiation 100 to 1000 times higher than regular xray<\/p>\n

–british study of kids exposed to multiple CTs found 3x incidence of leukemia and brain cancer<\/p>\n

–? role of direct-to-consumer advertising or financial incentives of MDs. \u00a0though i would add here that xrays have become part of the “culture” and patient expectations: patients often come to me requesting an xray\/CT etc, and i often need to spend significant amounts of time dissuading them of the need.<\/p>\n

–Natl cancer institute in 2009 estimated that CT scans resulted in 29,000 excess cancer cases, and 14,500 excess cancer deaths. these editorialists estimate that 3-5% of all future cancers may be from medical imaging<\/p>\n

–there is large variance of dose\/xray from one institution to another<\/p>\n

–they promote using the Choosing Wisely website to help patients (and providers) decrease xray utilization<\/p>\n

 <\/p>\n

one particular concern, not mentioned above, is the new USPSTF recommendation to do annual low-dose CT screening of all current smokers aged 55-80 with smoking history of >30 pack-years, or those who stopped smoking within the past 15 year. this was based on the natl lung screening trial, which found that annual low dose CT screening (for only 3 years, but then followed another 3.5 yrs) in those aged 55-74 (for some reason USPSTF increased the age to 80!!) decreased mortality by 20% (which translated to absolute benefit of only 62 deaths\/100,000 person-years), but with a 25% false positive screening rate leading to more radiologic procedures (so that on average the low-dose CT was actually equal to that of a regular CT with 8mSv radiation exposure, and that this degree of radiation exposure would create one cancer in 2500 screening people. (see prior email\/blog for details)<\/p>\n

 <\/p>\n

and, the increased number of screens (up to 25 annual screens, if the person kept smoking), would undoubtedly augment many of these numbers (eg, adverse effects of continued screening, including psych; probably increased false positives with more biopsies and potential problems esp as people get older and likely have more COPD; and undoubtedly more iatrogenic cancers…..)<\/p>\n

 <\/p>\n

geoff<\/p>\n","protected":false},"excerpt":{"rendered":"

i realize that i have spent a disproportionate amount of time writing about the risks of CT scan (and xray exposure in general). but there was a really good editorial in the NY times today by a cardiologist and radiologist (see\u00a0http:\/\/www.nytimes.com\/2014\/01\/31\/opinion\/we-are-giving-ourselves-cancer.html?ref=todayspaper). their points:   –cancer deaths are increasing relatively, as heart disease (the major killer) […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-259","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/259","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=259"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/259\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=259"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=259"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=259"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}