Since the mid-90s, the use of CT scans in the ER has skyrocketed, according to a new study conducted by the University of Michigan Health System. The review of hospital data from 1996 through 2007 examined national trends in the use of CT scans and found that the use of computed tomography scans in emergency rooms increased a stunning 330 percent in just 12 years. “It’s enough so that these days -- and it’s even grown since 2007 -- about 1 in 7 patients in the ER get a CT scan,” says Keith Kocher, M.D., M.P.H., clinical lecturer at U of M’s Department of Emergency Medicine and first author on the study. “If you look at the number of scans [conducted] in the ER and compare [that] to the entire health care system, about a quarter of the scans [being done] are being done in the ER.”
Although the U of M study specifically focused on CT scans and emergency rooms, it seems that this trend is not limited to these conditions. A more generalized report was released by the National Council on Radiation Protection and Measurements (NCRP) in March 2009. It measured Americans’ total exposure to ionizing radiation by source. Ionizing radiation is defined by the American Cancer Society as “high frequency radiation.” This type of radiation has the power to do permanent damage to the DNA in your cells.
The NCRP report concluded that medical tests were responsible for almost 50 percent of all radiation exposure experienced by Americans. CT scans -- which use more radiation than other imaging procedures such as x-rays -- alone were responsible for half of this total. It is not altogether surprising, as imaging technology has become more widely available and physicians have been more universally trained to use these technologies over the last two decades. “It’s the way medicine is practiced these days,” says Kocher.
But what do these studies and statistics mean for patients in practical terms? And should we be concerned?
It’s A Mixed Bag
As with most medical issues, the question of “concern” is not easily answered. One positive that Dr. Kocher and his team discovered when studying ER statistics, was a possible association between scans and a decrease in unnecessary ER patient hospitalization. Although Kocher acknowledged the inherent limitations of a study that looks back at pre-existing, emergency room data, he felt that the point was worth mentioning.
“One of the main things that emergency physicians do is decide whether [a patient] can go home. With a rise in CT scans, [there seems to be] a fall in the number of patients that end up being admitted over time,” he told The Huffington Post. “There may be some benefits in the amount of scans over time because it may prevent people from being hospitalized [unnecessarily].”
It’s also important to note that imaging procedures can be lifesaving. CT scans and x-rays allow physicians to see inside of their patients, which means that these procedure are pretty invaluable diagnostic tools. Not only do these technologies allow physicians to gather a lot of information, but to do so in a time-effective manner -- which is especially key in emergency situations. According to RadiologyInfo.org, imaging procedures help physicians cut down on invasive, exploratory surgeries, determine more accurately when surgical procedures are necessary and more accurately diagnosis serious conditions such as cancer.
However, these scans are by no means all good. To begin with, ionizing radiation is classified as a known carcinogen by the CDC. Although one scan is not going to cause you to develop cancer, over time radiation exposure can build up. Additional side effects from ionizing radiation exposure include cataracts and skin burns. “The truth is that we are probably causing future cancers as a result of the scans that we’re doing today,” says Kocher. He also acknowledged the importance of conducting these scans only when they are medically necessary -- and expressed that they are probably overused.
New technologies also inherently bring about new -- and dangerous -- margins of error when they are used. And when it comes to technologies that expose patients to ionizing radiation, errors can be life threatening. Walt Bogdanich’s “Radiation Boom” series for The New York Times has exposed countless errors in the way that technicians sometimes operate these powerful machines. For example, in 2009, more than 300 patients received unnecessarily high radiation exposure while being administered CT scans at Los Angeles’ Cedars-Sinai Medical Center alone. This past February, the FDA unveiled an Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging to address these issues.
In addition to issues of patient safety, unnecessary imaging procedures also exert a high cost on our health care system. In 2008, The New York Times reported that in 2007, over 150,000 CT scans were conducted -- costing in excess of $100 million.
How To Be Savvy
The key to being scan-savvy is education and dialogue. “It’s OK to talk to your provider … about why they think a CT scan is necessary or indicated,” says Kocher. “A lot of times doctors come in with this perception that this [procedure] is what patients want. Sometimes this is an unfair perception.”
Image Wisely, an organization sponsored by the ACR and RSNA that aims to eliminate unnecessary ionizing radiation exposure, recommends that all patients ask their physicians the following questions before receiving a scan:
-How will this exam improve my care?
-Are there alternative imaging exams that don’t use radiation?
The Bottom Line
The bottom line is that when it comes to radiation exposure from medical procedures, there is both good and bad. Often times, these procedures are quite necessary -- and allow physicians to make life-saving diagnoses. However, it’s important for patients to educate themselves and begin dialogues with their physicians. Ultimately, an informed patient is a safer patient.
Kocher believes that patients and doctors should move past a paternalistic model of care. “This is an older model [of care],” he says. “I think that having a shared decision-making discussion -- in particular [when it comes to scans] is really helpful.” Let’s start discussing.
Below we've gathered a list of some of the most common imaging procedures and their respective radiation doses (all measurements are based on a full-sized adult):
