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Subscribe to RSSThe latest medical images can provide spectacular pictures, giving doctors and patients enormous amounts of information about a wide range of medical conditions. But doctors may have gotten overly enthusiastic about using them.
A study out Tuesday in the Journal of the American Medical Association found that the number of MRIs quadrupled, CT scans tripled and PET scans went up 57 percent between 1996 and 2010. The researchers tracked up to 2 million members of six large health systems in the U.S.
There is no question that before performing a surgery, for example, a doctor wants to see as much as possible. Magnetic Resonance Imaging (MRI) uses magnets and radio frequency fields to scan the body and help doctors make diagnoses of tumors, torn ligaments or strokes without surgery. A PET, or positron emission tomography, scan can be conducted alone or combined with MRI with radioactive isotopes to show metabolic activity in the body such as cancer.
The images help; the question is just how much.
“The increase in use of advanced diagnostic images has almost certainly contributed to both improved patient care procedures and outcomes, but there are remarkably few data to quantify the benefits of imaging,” radiology professor and lead author Dr. Rebecca Smith-Bindman from the University of California, San Francisco, and her colleagues write.
Why does it matter? The biggest reason is cost. Americans now spend an estimated $100 billion a year on medical imaging. For each patient, each procedure can cost between a few hundred and several thousand dollars. Usually doctors order them for the best of reasons, but sometimes it is defensive medicine based on the fear of lawsuits or, even worse, the need to amortize the huge cost of a piece of equipment the practice has purchased.
Another major downside of increased imaging is the “false positive,” which is the discovery of a growth or other apparent problem that presents no danger but needs to be removed -- with additional cost and anxiety.
The biggest danger with scanning comes from CT, or computed tomography. A CT scan exposes the patient to huge amounts of X-rays. One CT scan of the chest, for example, zaps a patient with the same amount of radiation as 150 old-fashioned X-rays. In their survey of medical records, the authors of the latest study found that 3.9 percent of patients were receiving an exposure or more than 50 millisieverts every year. In comparison, that is about the equivalent of the one-time amount that the Japanese government estimates that the nearby residents of the Fukushima power plant got in the hours before they evacuated.
A recent Institute of Medicine report on risk factors for breast cancer listed chest CT scans high on the list. Last week, an international study found that children who get CT scans have a slightly higher risk of later developing leukemia and brain cancer. While the absolute risk of cancer is still small, the British researchers suggested minimizing radiation exposure as much as possible.
In a separate report released by the UCSF researchers Monday, Smith-Bindman said a woman should ask her doctor these questions before getting a CT scan:
- Is this scan absolutely necessary?
- Is it necessary to do it now?
- Are there alternative tests?
- How can I be sure the test will be done in the safest way possible?
- Will having the scan information change the management of my disease?
For the sake of our pocketbooks and peace of mind, we all might be well advised to ask our doctors the same questions about any medical scan we receive.
Robert Bazell is NBC's chief science and medical correspondent. Follow him on Facebook and on Twitter @RobertBazellNBC
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This is the most important (and, judging by other comments here) overlooked phrase in this story.
I always question the why when a physician orders a test for me.Often tests are ordered for things that are not at all medical in nature as desribed by a few of the commentors. I was seeing a urologist at the request of my primary physician for a reoccurring urinary tract infection. I saw him three times and he conducted two in office tests of which the last one failed. Instead of repeating the failed test he wanted to scope me. I told him without taking a breath, not on my watch. I told him anytime there is an invasive test done in the hospital or in the office the risk of complications is greater than 50%. Boy did he get up tight with me that I questioned him. To make a long story short, the infection went away on its own and the urologist is on my do-not-call list and he knows it.
Wow good for you, you refused a minimally invasive test that was probably indicated, but your problem went away on it's own any way.
If you honestly think your urologist is sitting at home worrying about you being on his do-not-call list, that's just laughable.
He's back in his office doing cystoscopies on people who actually do want help and a diagnosis.
Please do a little more research on cystoscopy - the complication rate is well below 5%.
I am very grateful for MRIs. It is hard to see cervical disc ruptures and narrowing of the spinal channel. The first cervical spine surgery was kinda poke and hope and don't know until we get it open affair. The second one with a more modern MRI, they knew exactly what they were going to do. Before the surgery I could not raise my arms above chest level and could not turn or tilt my head without narcotics. There is a flip side to every coin but from my perspective I am very glad to have the technology
I did CT scan from 1996-2003 and it was a human mill. Now days, doctors don't make an educated diagnosis, it has become routine to just scan everyone that comes into the ER. Have a headache? CT brain. Have a stomatch ache? CT abdomin/pelvis. Chest pain? CT chest to R/O pulminary embolism. Low flank pain? you have a kidney stone, so lets get a CT scan so we can see it. Even when it's real simple to diagnose something, a CT is needed to cover the doctosr ass at your expense. It's become just like the movie "Idiacracy" where the human race has been dumbed down and depends on button pushing technology to think for us.
You're about the 20th CT tech to comment on this article saying the same thing.
1) "Even when it's real simple to diagnose something". So a subarachnoid hemorrhage, PE, mesenteric ischemia - these are all real simple to diagnose, right? Real easy to say from the scanner room.
2) Of course it seems like "everyone" gets a CT when all you do all day is load people in the scanner, and push a button. You don't see the countless headaches, abd pains, ect who don't get a CT scan.
14% of ER patients get a CT scan - would you consider that "everyone?"
Do some actual, intelligent research before commenting.
It didn't take very long to know what I will or won't see before "pushing the button" There are very few surprises. If they don't get a CT, they get and ultrasound, or an MRI, or a Nuc scan, or at least a butt ton of X-rays. Doctors are nothing more than technology expeditors these days, not worth their pay or the papers they hold.
Keep convincing yourself that
Also, keep telling yourself 14% = "everyone"
Good job.
As a parent of a 9-year old that had a brain aneurysm, I will say that we had a CT scan done and that idiot that read his CT scan sucks. He said there was nothing wrong with our son and just blew it off as migraine headaches. They continued and 4 months later we pressured our pediatrician to do an MRI and low and behold we had a 26mm brain aneurysm. We took the CD of the CT scan to our MRI doctor and he put it in the computer and it comes up and within 5 seconds he says "can you see it right there?" pointing to it on the screen. We are so glad to have done the MRI as our son most likely would have died from it. He had 3 other foloow up MRI's to see if it was still truly gone. No regrets, especially with the other alternative that we could have had.
I am an MRI Technologist and I have worked as an Applications Specialist as well. I have noticed the spike firsthand especially the last 3-5 years as CT continually gets negative press, there is a huge push into the modalities with no ionizing radiation involved (Ultrasound and MRI) both in sales and exam requests. Even though we are swamped with nearly a month backlog where I work now, we are fortunate that the Radiologists actually screen and protocol these procedures that are ordered by the providers. They are very good at identifying the BS from the clinically warranted exams and they call the providers to the carpet about it.
Solution: Tort Reform
Isn't it amazing that all of the people who don't want Obama care have no answer to the problem themselves. Health care cost have been climbing at double digit rates for 20 yrs. and it will excuse the pun bury us all. This is one of the leading causes for the decline of the middle class. Peoples wages are stagnate because raises that could be givin are eaten away by medical costs for companies. We always seem to have enough money in this country to give away to other countries or to blow someone up but we can't provide for our own people. To make matters worse we are borrowing money to give away. We as a nation have the I.Q of aquarium gravel.
your statement that there is no other answer to the problem is unsupportable.
Here is the answer, since you asked:
The ACA is NOT a piece of legislation that addresses costs, it addresses how to pay for those costs.
Here is a shortened list of opportunities and the amount that they would save.
1) malpractice/defensive medicine - easily responsible for 30% of our health care costs. Of all the tests I see, 30% are clearly worthless except as protection for the doctor. (one ER doc told me: the cheapest malpractice insurance I can get is to order a CT)
2)Misguided hospital competition and profits: every medium sized city does NOT need 4 heart centers. Many large hospitals are making huge profits. One system in Ohio has a cash reserve of 1.9 Billion dollars. Save 15-20% here
3)Physician self - referral - Physicians, in order to stay solvent after fee reductions in the past by the govt, sought other ways to generate income. Prime among these was milking their patients for profits by referring to centers that they owned. An odious and unethical practice which could be eliminated immediately with a small piece of legislation - could save 10% here
4)Hospital advertising - unnecessary, misleading, and a waste. Every dollar spent advertising comes from patient care dollars. Small potatoes, though, maybe 1-2%
5)Patient expectations - patients DEMAND high cost care, physicians can't easily resist, and have no motivation to control this
6)Insurance company profits: 15-20% - in Germany, insurance companies must offer health insurance at 1-2% profit if they want to offer any other kind of insurance. Why not here?
7) Overtreatment of everyone, but especially the terminally ill. It has been said that 50% of your health care costs are in the last 3 months of your life.
Addressing these items could theoretically (important word - theoretically) produce about 50% savings or more. NONE of these was addressed by the ACA, though. Not one.
These ideas, and a few more, are discussed in more depth on my blog:
Doctors nowadays are nothing but test prescription writers...MRI/CT scan can cost up $2000 a pop! Great ways to stay rich with this economy!
Health care in this country is a shame, like an blank check that service providers charge whatever they want.
You can charge whatever you want, but you only get paid the contracted insurance amount which can be ridiculously low.
Not everyone has insurance. In the poor areas of the USA many have little or no insurance.
If you don't have cash or insurance: The doctor may not treat you and you will be charged the full retail price. Then you may not pay the doctor. Some people don't even pay their Co-Pays. In pharmacy it is no problem for the business because if no insurance or cash you don't get the medication (treated).
I know a person who has a "bad" back. The doctor suggested a CAT scan but when he found out the patient had no insurance and little money he gave him a Rx for Soma (muscle relaxer).
Our kid with epilepsy gets an MRI every two years. I think she's had four to date, since it's been eight years since her first seizure. So far, her brain appears perfect in all the scans but as long as she still has seizures and/or is on anti-seizure meds, we'll stick with the MRIs. She's 19 and a full-time college student, so is still covered by our insurance.
OK, if you want to get technical... referring to "everyone" is a common exaggeration for "a lot more people than you would expect". I don't work in CT scan anymore, I work in regular X-ray. We have 50 beds in our ER and they're always full. Realistically, at least 20% of those Pt's get a CT scan. Together with X-ray, U/S abd MRI... between 65-75% of the roster is booked for diagnostic imaging. The other 25-35% are either Psych, or cream puff cases. It's only more job security for me, but also a huge expense and/or radiation dose for everyone else. On a positive note, most surguries and procedures would not be possible or go nearly as well if it weren't for med imaging.
If we can make computers,cell phones & DVD,s faster ,smaller & cheaper, why not medical equipment ?
I think companies do make medical equipment that is cheaper but they sell it in China or India.
The spike in tests could be explained by the rise in sickness, tumors and serious health problems; where these tests are required for diagnoses.
Seems to me like it’s a double-edged sword. The more exams that are ordered, the more imaging facilities become available thus assuring you that you get your exam done in a timely manner...usually in the next day or two. If the number of exams drop, it would not be profitable for the centers currently open to remain in business. The result might be that when an exam is urgently needed, there might be a long waiting list, possibly being months in length since hospital in-patients would take priority. Then there would be an outcry that there are not enough outpatient imaging centers open and people are dropping dead left and right while waiting for their exam. This of coarse would be president Obama's fault. If there are too many centers open then it would be president Obama's fault...him and his Obama-care wasting money. Either way, it’s his fault.
Maybe use is up because the stress of this lousy economy is giving everyone symptoms.
In my life time (47yrs) I have had 3-brain tumors. The first at the age of 12, I had several painful headaches so bad I could not even open my eyes even with meds. I was taken to several doctors. Diagnose #1 solution = remove …..Diagnose #2 solution = awareness of body changes (puberty /(menstrual). Other Dr's approx 5, found nothing . Final of these Drs’ even had the Gall to actually tell my mother Nothing found and “ that she’s spoiled and just trying to get attention,” of course, my mother didn’t know to approach. She saw my pain and how much it stopped me in every aspect of my daily life. Bur Could there be any truth to this Drs’ words? A week later my mother received a phone call from an associated Dr who requested to bring me in to do a test. The test was a CT. This was new technology . Result: Malign it Tumor found (L) lower cerebral area solution = sugary. My mother received a phone call from a second Dr. Yes… the same Dr who stated “she’s just trying to get attention” He Apologized. And no action taken. My mother should of sued his ass along with all the others who found nothing by only using assumptions. At leased there was one Dr who was willing to step up and take the heat. He saved my life. Since then I have had two other tumors 2nd benign and 3rd was not seen (MRI) 9mon. Prior to PCP appt visit due to lost / mumbled words solution = order to draw blood and see you in 2-wks. Parking lot from this visit Directly ER . Here a CT was done New Malign it Tumor found and I was admitted and surgery 3-days later. I should of sued PCP. I could of… well The question is, how many Dr's out there, are actually doing there job and willing to step up and take the heat when needed either to the patient or to anyone controlling the game? MRI, CT, EEG, EKG’s and any other tool to heal or save a life. I tip my hat to those who are wiling to take that extra step of what they truly feel is true even if it is just to R/O. Shame on those who do test or do not do test just to relieve themselves from the heat
As a medical train wreck of a patient, with longstanding cancer as well as a number of other serious co-morbidities, I have been scanned often enough I should be able to be my own night light by now. I have had numerous CT scans, PET/CT scans, Bone Scans, MRI's and Ultrasounds, to say nothing of Nuclear Cardiac Stress Tests, Chest X-rays, and eight weeks of Tomotherapy. Since I will probably die from the cancer before anything else, I am not too concerned about long term effects. If i were in my thirties, I probably would be, and should be.
Since a good number of the scans were negative, some would make the argument that I was an example of overuse of the technology, but I don't think that you need to have a positive diagnostic finding to justify scans. I have had stroke-like symptoms several times, and all of the scans were negative, and I eventually recovered, still not knowing to this day what the root cause was. Does that make the scan unnecessary? Not to me, it doesn't. I know there is a lot of overuse of these technologies, but painting all scans, doctors and patients with the same broad brush is pretty stupid.
When you have strange neurological symptoms, and the standard manual workups and labs yield nothing, then the scan is usually the last chance to get to the bottom of it. The one thing people need to understand is that not every bad thing will image on a scan, usually due to small size, or inadequate tracer uptake, and some benign things look very bad on scans. The tendency nowadays seems to be to treat the imaging result, instead of the whole patient, and the fault for that lies squarely on the doctor, albeit often abetted by the patient.
Things are never as simple as they seem, but there is no shortage of people who will try to do just that.
CT scans are a lot easier to endure but an MRI is horrible, sticking you head first inside a narrow tube. And the noise is awful too. Good thing though is that the procedure takes only 20 minutes nowadays
A patient may have no obvious indicators that a CT or MRI scan is necessary. If the physician does not order one and later it is found out that the patient has some condition that may have been caught, even if it is a million to one shot, you can bet that the lawyers will be lining up to represent that patient and say that a study should have been done. Doctors never get sued for ever testing. On the other side you can bet that many physicians see that a study will bring thousands of dollars to their bottom line with almost no time invested on their part.
Demanding patients and bloodsucking lawyers are the reason for rising healthcare costs. They DO seem to think people in the healthcare profession should work for free, just like Randy. He'll happily go out and pay $50,000 for a new SUV but balk at having to pay to get his hand "fixed". I'm an MRI tech and I've been told by patients that I should work for free, like a Red Cross worker. This is after they've visited the ER demanding an MRI for a back pain they've had since last week, or their shoulder hurts when they do "this" And you morons screaming for socialized medicine, be careful what you ask for. If you happen to herniate a disc in your spine, you're not going to want to wait 4 months to get your MRI, but that's EXACTLY what happens. You think a herniated disc is an emergency, and you'll get treatment right away. WRONG! Only under certain circumstances is it an emergency and ecruciating pain is not one of them. Randy, you want costs cut for your surgery. Find someone who hasn't spent at least 20 years in school, will do it without numbing and pain medication, equipment used yesterday on someone else and washed in the bathroom sinks. Using yesterday's newspapers to set up a surgery field and forget any pain or antibiotic medication afterwards. You should be all set. Or just live with it.
In the USA, we don't have the best health care, only the most expensive health care. Other questions for you and the ordering doctor to ask:
That is my approach. It is customary to image a whole area, like the chest or abdomen or skull, not just the local area in question, because it is easier for the radiologist, who then doesn't have to monitor the study. But this leads to many more pictures, thus more expense and radiation dose (CT). This has been recommended many times in the literature, but no one seems to follow this course.
I'm gonna say, regardless of your point of view and if I agree with you (at least at this point) this is the BEST discussion I have seen or been a part of. A FEW random posters have said thier piece, but for the most part it's been people in their professions with a few patients added in having an INTELEGENT AND HONEST discussion about radiology. These are the the kind of discussions that on the internet can open thought process. We should all feel proud about having a high-level discussion, the likes of what we all hope to be a part of. If we can keep this kind and level of discourse up, we have a better future ahead!
"One CT scan of the chest, for example, zaps a patient with the same amount of radiation as 150 old-fashioned X-rays"
I think I'll take a pass on the CAT scan......