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June 6th, 2012
06:30 PM ET
CT scans for children linked to increased cancer riskCT scans expose children to radiation that could give them cancer, according to a review of children’s imaging data published Wednesday in the British medical journal Lancet. The researchers estimate that for every 10,000 computed tomography scans performed on children aged 10 or younger, one additional child will get a brain tumor and another additional child will get leukemia within a decade of the first scan. These cancers wouldn’t otherwise be expected, even if none of the imaging was done. Researchers at the National Cancer Institute and Institute of Health and Society at Newcastle University in England say their investigation is the first direct evidence of such a link. They reviewed 175,000 cases. Multiple CT scans increase a child’s risk. The researchers found radiation exposure from two to three scans can triple the risk of brain cancer and five to ten scans can triple the risk of leukemia. Radiation experts say the increased cancer risk of the CT scans should not dissuade parents from getting the scans for their children when medically necessary. The tests often produce life-saving images of head injuries, complicated pneumonia and chest infections. “If an imaging scan is warranted, the immediate benefits outweigh what is still a very small long-term risk,” said Dr. Marta Schulman, a pediatric radiologist and chair of the American College of Radiology’s Pediatric Imaging Commission, in a statement to CNN. “Parents should certainly discuss risk with their provider, but not refuse care that may save and extend their child’s life.” A study last year found 1.65 million children got a CT scan during their visits to emergency rooms in 2008, a fivefold increase in 14 years. Before you agree to a CT scan for your child, here’s some advice from the study’s authors and pediatricians at Cincinnati Children’s Hospital:
The Alliance for Radiation Safety in Pediatric Imaging also has information on how you can decide on scans for your children.
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love. Recent Comments
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Docs need to be more prudent with this type of testing.
Agreed. But there's a lot of money involved here, which is really why so many of these tests are ordered in the first place, not because patients truly need them. Very disturbing.
Tell the lawyers. "Doctor, there was a simple test that could have diagnosed this child's problem, please tell the jury why you didn't order it."
My medical school teacher used to say everything under the Sun including the sun can be allergic to the human body.
I suppose it is true of technological devices. CT scan has its own significant indications. MRI, when can be done is superior. In practice, actually we have cut down remarkably on CT scan use in neonates but there are significant indications for CT scans. I suppose, doing CT scan once to rule out a condition is still worthwhile. After all, nothing is totally and absolutely safe in this world.
Also just for completion, I want to register a comment. Just because lives are lost in a war does not mean that there is no need to go to war. One has to choose one's battles.
These comments are idiotic.
(1) Docs do not make money by ordering CT scans (radiologists and the owners of the scans, perhaps).
(2) 1 in 10,000 children having a CT will get a brain tumor. How many of those 10,000 children have their lives saved by what is found on the scan? If the answer is greater than 1, the test is beneficial–and obviously if there were no useful answers derived from CT it wouldn't be used.
(3) It is true that a portion of these tests are driven by the practice of defensive medicine. The problem here lawyers and a litigious public, not doctors
(4) for some issues, an MRI scan would work. It involves no radiation. But it is not useful for all problems, frequently requires sedation for young children–and that sedation has a higher risk than the CT–and it is much more expensive.
This is a good study in allowing us to understand relative risk when ordering a test. Assuming that the ordering of CT tests for children is motivated by physician greed is just absurd.
Well with the growing majority of scan centers being partially owned by the doctors themselves I don't see that happening anytime soon.
Dentate your logic is idiotic and naive
It has nothing to do with money or insurance, maestra and everything to do with lets order all the possible tests we can to cover our A$$ in case this goes to court.
DOES BIEBER KNOW ABOUT THIS?
I have worked in the ER for 20 years, it is all about avoiding a malpractice suit, the ER doctors do not get any "extra" money for tests they order
If you are going to ban this type of testing, at least advocate increased research into altrnate methods of tumor detection such as terahertz scans, high resolution MRI, or blood tests. Instead what we'll have is CT tests banned even for people who need it and no alternatives either. We'll be back to 1700s level of health care (average life expectancy was in the 60s ..assuming they could survive past age 5 which was the hardest).
These data are not new. There have been estimates that 2% of all cancers in the next 20 years will be the result of medical imaging. A recent article in the Canadian Medical Journal (Eisenberg, M.J., et al, Can Med Assoc J 183(4):430, March 8, 2011) indicated that 20 mSv of exposure (typical for a CT scan) will increase your risk of developing cancer in the next 5 years by 3%.
Until recently, physicians have NOT been explaining the probability of harm vs benefit for imaging procedures. The next time any doctor is considering ordering an imaging test for you (including things like nuclear stress tests, etc.) You should DEMAND a discussion of harms and benefits.
Ok, lets say a child, falls hits head gets a concussion has nausea and vomiting. Would you not agree with the test being ordered. Lets say you didnt, what happens to the doc and the child child if he or she has a subdural hematoma. The child could suffer further brain injury and be dead in a few hours. The doc could be out millions and his medical career would be over. Things are not just ordered for no reason. Every time we order a test it has to be justified to an insurance company. But we also do worry about missing something for obvious reasons.
My daughter had two CT scans at a few months, because of a brain bleed (she was born early). Giving a child a CT scan should never be done casually or without consideration for the consequences, but I have to be honest: an increased risk of 0.02% of cancer was a fair trade for the information about whether she would survive the next 48 hours - and what medical intervention was necessary to keep her alive. Because of the scans, we were able to determine that no surgical treatments were necessary. Imagine how much riskier brain surgery would have been (compared to the scans).
Doctors should be able to use life-saving tests that carry risks (like a CT scan). Some may abuse it, and all should carefully explain the risks. But anyone who wants to ban or significantly restrict scans on children should understand that more kids will probably die from brain injuries because of the restrictions than would have died from cancer.
ASK for M.R.I
dont do C.T !
the radiation is just crazy
M.R.I is magnetic no radiation.
While it is true an MRI does not use radiation it is not an obvious improvement and replacement of CT. MRI's are designed for imaging of the soft tissues of specific organs while CT scans are better for bones and general scanning of the body. In addition MRI machines are significantly costlier than CT's, with MRI's costing in the $3000's while CT's cost around $1000. MRI's also on average take ~1hour in the scanner to produce an image while a CT takes ~30 seconds. The MRI's also induce claustrophobia in some patient's (more in children) and the patient must also lie perfectly still for the 1hr scan time. If the child is sick or otherwise unable to remain still for that period of time an MRI's image quality suffers greatly an in most cases is unusable.
As such, there are many obvious advantages to using CT's over MRI's and it is not a simple problem to solve. As others have said though in certain cases where there are other options, such as when an MRI or Ultrasound might be possible, or when observation of the patient is possible, these are things to be considered in order to limit the dose to the patient.
On another but related matter, how dangerous are full mouth panoramic x-rays ?
Greg hit the nail on the head. The tests take much longer, costs more, patient has to stay still...
A dental x-ray has about 0.5mrem of radiation compared to a CT scan of the head with about 200mrem, so it is several orders of magnitude less. A full mouth panoramic x-ray uses a number of individual films, but not enough to even approach the amount of radiation in a CT scan. In general most radiologists are not very concerned about the radiation exposure of 'plain films' ex. chest, bone, or mouth x-rays. More concerning, as evidenced by the article, is the rapidly increasing use of CT scanning. In addition there is some concern about angiography, the use of a fluoroscope for real time imaging during certain procedures, particularly cardiac catheterization.
GReg- There was an article in April? That bitewing x-rays have also been linked to brain tumors and they are urging Dentist to stop doing the x-rays annually and only do that 2-3years unless there is a specific "medical" reason.And regardless of the age when the bitewings were taken, those who had them yearly or more frequently were at between 40 percent and 90 percent higher risk at all ages to be diagnosed with a brain tumor. Panoramic X-rays taken at a young age, especially if done yearly or more often before age 10, also raised the risk of meningiomas by up to five times.
Full mouth "panoramic" x-rays....oh brother.
Thanks for mentioning that article. That article specifically addresses the risk of developing a meningioma, a benign tumor of the covering of the brain. Certainly, if true, that would be an argument for limiting dental x-rays that apparently, according to the dentists, have limited usefulness taken so often. In general though the amount of radiation in those x-rays is much less than a CT scan, and personally I am not yet convinced of the conclusions of that study.
MRIs use magnetic resonance, which though not radiation, is a different form of unnatural bombardment of the human body and long term effects are still being discussed. MRIs are a lot more expensive and in some areas, much more difficult to get. Rural areas may have CT scans handy, while the one MRI travels from place to place and has a long waiting list. Insurance companies can and do step in and say they will cover MRIs only is the CT is done first, or they will cover only a portion of the MRI, especially if they decide it's not necessary since a CT is cheaper.
I agree with someone else on this forum – saying one in ten thousand children may develop cancer as a possible result of having had a CT scan within the last ten years is meaningless compared to how many children receive a diagnosis and proper treatment because of the CT.
Sorry we do not know what MRI does to the human body. It is radio frequency radiation. It has not been around long enough to know what it does. We do know that it causes short term memory loss. Also US is a radio frequency wave that is introduced into the body and has not been tested on how the human cells react to this vibration introduced to the body.Also to let you know over the years CT scanners and radiation doses have gotten better and less dosses are needed to perform diagnostic exams. All exams are dose monitored by the scanners by the size and density of the object/body part being scanned. Also on the GE CT scanners we have specified dosese for children by wieght and size. Detectors used in the scanners have improved in detecion of the radiation that passes thru the body part. Being that the information came from the 80's and the changes over the last 30years this article is not correct for todays standards. Please people do not be alarmed. listen to common sense. Trauma, bleed,tumor is more important to detect then to live and or die with.
Fivefold increase in 14 yrs. Why? Scary to think of what the future increase could be when EHR is in full effect and tests will be ordered at the push of a button.
The docs are ordering more tests in an effort to avoid malpractice...EHR will (and has) greatly reduce the # of tests run because doctor's can already get a more accurate assessment of the big picture of what's going on with a patient and also can already view tests that their partners or cooperating practices have run instead of rerunning them. Questionable logic at best....
EHR would increae testing, but decrease it. Can't tell you how many time in the ER somehting is duplicated because there is no way to get to the records. I can look up every baseball game ever played on the internet, but not if someone has had an important screening test.
The increase is because CT's become more and more usefull and precise. Many older examination methods are no longer the golden standard, the CT is. With serious accidents partial or full body scans are now normal, its a precise and fast way to detect life threatening problems. So yes we do more CT scans because more and more problems are effectively diagnosed with them, saving more lives and improving people's health.
MRI and Ultrasound are always considered if applicable, either is preferable for example an appendicitis, however 1 out of 3 ultrasounds may not give the needed information and a CT scan is needed, and you dont want to waste time in an MRI with a potentially burst appendix. Also neither MRI nor ultrasound is of much use when looking at the lungs (air doesnt register (MRI) or blocks the signal(US)).
When the radiologist decides a CT is in order its because (s)he has weighed the alternatives. I've heard plenty of times where one suggested an alternative to CT, especially in the case of children/pregnant women.
Radiation safety is way more important than fear of malpractise over here.
What, radiation causes cancer?? No way....... What a dumb article, it has been known for over 100 years that radiation causes cancer... DUH!!!
That's what I was thinking...people are idiots.
The question being studied, is how little radiation causes an increased risk. It's more complicated than your Seasame street science.
Explain, Doc.
Don't worry about it.
These people don't really care.
They're just desperate to post....anything...anywhere...since Fox closed down their comments.
Actually, I _am_ a bit surprised that this is getting the mention it is. This is almost exactly what you would predict. A typical CT scan gives between 1 and 10 mSv of radiation(depending on the scan type). That puts the cancer risk for somebody about 30 at between 1 in 25000 and 1 in 2500. Children receive somewhat weaker scans, but while an adult has a 4%(age dependent) risk, a child under 10 might have twice that or more. Infants are much more. So we expect it to still be in that ball park. That they found it was 1/5000 is more or less exactly what is expected. Turned out that all that other science people already did told you the answer to this already.
The flip side of this is that the numbers have always been rather tenuous – there are very few large studies which could know the exact radiation well for these levels. Hiroshima provides a lot of the data, as do radiologist studies and a few other oddball things. So this is a nice confirmation, but still no surprise.
Simon, I think this is getting press over the HP scientific prediction of low dose since the general public probably couldn't follow it and media generally hates it when everyone is saying "assumptions." This study actually followed low dose cases and removed some assumptions (however, it still had a few), and is much easier to make a news story out of than scientific theory based on the bomb data. But just my thought of why the media publishes what they publish.
I guess CTs need to be adjusted with young patients and to pass regulations.
Child/baby protocols are in place and do indeed reduce the dose recieved (as well as 'smart' programs that automaticly reduce (or increase) the dose based on bodysize and location (slim/fat, lungs/pelvis)). We still have to walk a fine line between patient dose reduction and maintaining a good enough quality scan.
Just my impression is that we have to sacrifice the high quality scan for more comfortable X-ray radiation examination. The doctors need to be more skilled for diagnosis and work harder.
Totally agree with Zoo.. These new CT machines can produce really high resolution images, but at the cost of higher doses. Sometimes, these types of images are necessary... but not always. The problem is, generally the prescribing doctor in the ER is not a radiologist and they do not know exactly what will be needed for the radialogist and they just order the best (which is probably better than getting 2), SOME radialogists still just want the pretty picture on all images, and some techs are not trained to know when to turn down the radiation and produce standard images. This is what this study needs to be addressing... radiaiton saving mechanisms... not stop all CT's. For now, patients should be informed to ask the doctor once a CT has been agreed on, "are you doing this in the most dose saving way?"
Isn't it possible that the kids who need multiple CT scans are kids who are already showing signs of having a brain tumor? So the multiple scans aren't really what's causing the cancer?
It's like saying that kids with fewer televisions are more likely to have lower-paying jobs as adults. Does that mean all poor people should go out and buy TVs??!?!?
Correlation vs. Causation. I don't think the author of this article has proven that the CT scans are a CAUSE of cancer, and not just a correlation.
The study excluded cancer patients. Most childhood head CT's are for trauma.
So what exactly on this planet doesn't cause cancer?
Cancer does have a cure.
The medical profession and drug companies will never release it.
They would lose too much money.
Berries.. organic berries
They are actually cancer fighting
Norm, do you know what an "urban legend" is? No? Please look it up. You are propagating one.
Marijuana has chemicals in it that can help in the fight against cancer. In some cases, it was even a direct cause of it being cured.
Red wine!!!! (I'm going to be very sad the day they find out that study was false)
As a radiologist at a major hospital in Northern VA, we strive to use low dose technique on children in the hospital and only have low-dose CT in our private practice. The ACR has been encouraging the "Image Gently" campaign to reduce radiation exposure in children for several years. Our goal as radiologists is to keep radiation as low as reasonably possible while producing a diagnostically acceptable exam for our patients and the clinicians who need the answer the tests provide.
ER docs are under time pressure because patients/customers often want to get in, get an answer and get out as quickly as possible, CT is fast. MRI machines are less numerous than CT and can therefore have a backlog of critical patients. MRI scan times are much, much longer than CT. Additionally, MRI is extremely susceptible to patient motion- squirmy kids often give unreadable exams, so MRI often requires sedation, a procedure that carries its own risks.
Ultrasound's effectiveness is limited in obese patients, gassy patients, patients who cannot tolerate us pushing on their bellies, patients without a specific physical exam finding and is more dependent on the person actually doing the scan than MR or CT. My group ultrasounds a lot of kids and thin adults for appendicitis, this adds time and if the doc is really concerned about appendicitis, the patient may still need to be evaluated by CT or MR.
As to the issue of the EHR, our group can view images online from our outpatient practice as well as the other hospitals and is often asked to review such cases but patient symptoms change, and what was not at issue last week could have developed additional findings of concern in the interim. Sometimes you do have to scan the patient again in some way.
We the doctors need several things to be able to take the best care of patients. Patients and hospital administrators must understand that the ER is not a McDonalds drive through. You want the best care as quickly as you can get it, not the fastest "care" and hope it is good. Some diagnostic workups take time to do right-giving oral contrast if you need an abdomen/pelvic CT in particular. ER docs especially need malpractice reform, bad outcomes happen, and when the possibility of missing the smallest thing drives them to aggressively order additional, potentially unnecessary tests on a much larger number of patients, it drives up costs and ER wait times.
Anyway, we radiologists want to give good answers to you, the patient, and your doctors. We want to limit your radiation dose as much as reasonably possible. We want to consult with your physicians to collaborate in getting you the best and most efficient care. Stay safe.
Did anyone actually read all of Gretta's book?
Greta, can we can cliff notes on the essay you wrote?
Gretta,
most people just skip comments that long.
Your effort has been wasted.
Well I for one have appreciated the thorough explanation. Thank you for taking the time Greta.
You are right. But we need to train technologist to apply "low dose"... we need Congress to pass the CARE Bill. So sad that many states doesn't require accreditation for medical imaging and radiation therapy technologists. How is possible to protect patients when technologist are not properly trained?
Greta,
Unlike some others I was able to read your entire post, and appreciate the perspective of a radiologist... thanks.
Thanks, Greta. Perhaps you should have written the article. Then it would have been educational instead of sensational. Nah...it would never sell.
Greta, thank you for the detailed information. People like Norm have the attention span, and reading comprehension, of a gnat. Question: how often do E.R. patients NOT have blood drawn for testing? One way to speed up the time people spend in the E.R. is that, upon initial assessment, blood be drawn and be sent to the lab with the basic, always-ordered CBC etc. Shortly thereafter, the expanded test orders can be sent the lab via computer. Most likely these additional orders will be timely because the labs are most often have a backlog of testing to be done and tubes are refrigerated.
To Monica, the problem with that, is the operators do not set techniques. The manufacturers are responsible for that portion of the machine. Now, that being said, it is the tech's responsibility to monitor dosage and to notify the manufacturer that the techniques need to be adjusted. Also, shielding is the best way (after setting proper techniques) to reduce dosage for necessary scans. If your child hit their head and is getting a CT, there is no reason why they cannot have a lead shield around their chest/abdomen. Do not be afraid to ask questions, this is your child's well-being at stake, and we understand that.
I for one, greatly appreciate Greta's comment. As a Radiologic Technologist (R.T. (R)) I've worked in several EDs. I can't tell you how many times I've had parents try to rush me through exams or to give answers I can't (legally or I don't have the information) give. I understand your child is sick, it's 2 AM and that you have to work in the morning. But, my concern is your child and I will do everything as quickly as safety allows and not a hair more.
This is precisely why Norm believes in the magic Cure that physicians are witholding to make more money, or
– the magic 200 mile/gallon engine petroleum companies have destroyed the plans for, or
– the lost alien civilization "the government" has hushed up, or
– the Faux News 1 h special explaining how the 1969 moon landing was a hoax.
Norm, read more, complain less. You might learn something.
Thank you, Gretta, for your time and your sincerity. I apologize for all the people who have attention spans of 40 characters or less.
For those of you who do not actually read this study and do not understand the importance of the findings:
The authors do not say CT is bad, but they do highlight that the radiation associated with the protocols has the potential to damage DNA molecules and cause cancer. Doses can be lowered in the majority of patient cases. IF by lowering radiation, we can prevent future cancers in the process, THEN we should strive to establish CT radiation doses that are as low as reasonably achievable.
This is a great study because it is putting more pressure on radiologists, ordering physicians, and technologists to reduce medical imaging radiation exposure to the patient population- preventing future cancers=saving lives=good medicine.
Thanks I am a ARRT (R) (CT) (MRI) you answered appropriatly. The stupidity comes from the news without really investigating what really happens in our career field. We as radiology professionals do screen all exams ordered by physicians for correct exams for a correct diagnosis.
The author assumes everyone knows what a CT scan is.
Maybe a better journalist would have explained or at least written the name out instead of using an acronym.
They have this 'internet.'
Completely agree
Agree. Poor journalism. What was the dose? What type of CT? Where was the CT given? What part of the body was the CT performed on? How many lives were saved by ordering the CT?
This is the same medical journal that published an article about there being a link between vaccinations and autism after all!
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I always want a stick-up, never a hold-up. My young, bodacious body is appreciated by someone near my own age and that's the way I like it.
Hopefully CT's are being done for a more urgent or pressing reason to offset this 1 in 10000 risk.
What? X-rays cause cancer and leukemia? Who knew? No more Chernobyl, no more Fukushima. Stop all radiation and outlaw CT scans and X-rays.
You do realize all electronics emit radiation and thus increase your chance of getting cancer? Your computer screen, your cell phone, your car. Also, you are exposed to radiation every day from the sun, breathing in things from the atmosphere, etc. Radiation is always around you and you can't get away from everything.
How's your sun tan, Simon? Do you appreciate a nice tan? That's caused by solar radiation. Get too much and your skin literally burns.
Simon was being sarcastic about getting rid of all radiation.
This, as a parent, is scary. My daughter jumped out of her crib when she was a little over one, and when I say jumped i mean jumped. She had bruises on her face and forehead that were so awful, i was almost given no choice but to have a ct scan done. What are you suppose to do in those types of situations? I couldn't just take her home thinking she could have a concussion.
hmmm...Lauren, I'm Lauren and my daughter climbed out of her crib at 11 months. I can imagine your terror was mine times at least ten. I think in your case, a CT scan might have been appropriate, if for no other reason than to cover your six in the case of a child abuse allegation (I know the latter sounds harsh, but you know how crazy CPS can be sometimes). I think they're talking more about the ER frequent flyers and folks who rush their kids to the doc when they have a temperature of 99.3.
I am an ER physician. I have parents who DEMAND CT's all of the time, because their kid bonked their head. I guarantee you, if I don't do it they will sue, even though I discuss the risks and benefits all of the time. It is usually the same parents who don't immunize their kids, then let their kids ride their bikes with no helmet, then the minute they fall they want a huge crazy workup that isn't indicated. And as far as requesting an MRI or Ultrasound, if you MRI your kid they will have to get conscious sedation which is an airway risk, and ultrasounds don't show brain bleeds on anyone older than a few months.
It's called a guilty conscience: I screwed up; now fix it, fix it!! Have you told them that if it's not medically necessary the insurance won't pay for it, and how much that will run them...especially from an ER perspective? Of course, I usually try to go to an ER at a hospital where I trust I will get good care (even moreso when my kids were involved), so I kinda trust the doctors' judgement. Also – just for the record – I loved "Trauma in the ER", so I appreciate that ER docs see a steady stream of all kinds of stuff. I tend to trust hospital nurses and ER docs more than physicians in private practice.
My six year old had an MRI and I had to argue with them about the conscious sedation. He didn't need it and we didn't want it. They were so insistent about it, laying on this big guilt trip about how we came to them for help, blah blah blah. I called in the supervisor and finally asked for an administrator. We got our way – no conscious sedation. It went smoothly – my son laid still the entire time – and it took less time for the test than it did to get it done our way. When we got the bill, we found they had tacked on charges for "extra time" in addition to the "routine" conscious sedation and recovery time. I paid the charge for the MRI only (we had insurance, but it didn't cover this) and when they sent a collection agency to us for the rest, I wrote up a notarized statement detailing what had happened and why I wouldn't pay, especially saying why I wouldn't pay for conscious sedation. The collection agency sent the hospital a warning about over-billing and declared our matter settled. If you know your own child can tolerate laying still, you have the right to refuse the conscious sedation and the right not to pay for it.
Our 6-year-old daughter fell off a platform and smacked the back of her head on a metal pipe. We don't know if she ever lost consciousness, but afterwards she had lots of crying, multiple episodes of vomiting, a dazed appearance, and wouldn't move. By the time we got her to an ER 16 hours later, they would not do a CT saying that too much time had passed to warrant the risk (they told us that "no CT" was the "standard of care" for that amount of elapsed time). She did recover, but for a couple weeks afterwards she would scream, hold her head, and vomit every time she rose from a sleeping to an upright position. I don't know if a CT would have made any difference in her treatment (watchful waiting) in this case.
I found this very interesting, especially the part about an X-ray using less radiation than a CT Scan. I imagine I'm not the only one who assumed that a CT Scan, being a newer technology, would be safer than an X-ray.
An x-ray is lower than a CT scan because it is just a one direction CT scan. X-rays don't give you near the detail a CT could or image organs or anything other than bones. CT's are 360 degree x-rays, of course they are going to have lots more radiation, but they also give you a lot more picture/clarity and gives you the ability to image everything.
And dental x-rays and orthodontic x-rays. The cure is worse than the disease.
The caption is a bit over the top!
Great, I just had two CT scans to check for cancer. Go figure.
There is no direct correlation between receiving ionizing radiation and the instances of cancer (Yes, radiation CAN cause cancer, what I'm saying is there is no way to predict IF you will develop cancer or your risk factor; i.e. any amount of radiation can cause cancer, but we can't say after 3 scans you WILL get cancer). That is because everyone's body responds differently to stimuli. One person could develop cataracts after getting just 2 or 3 x-rays of their skull. Another person could have developed cancer, undergone screening and treatment planning (receiving multiple scans in a short time) and never develop any issue from it. The trade off is risk vs benefit. While I agree, yours might have been unwarranted, did the doctor do any bloodwork to look for cancer markers? A health screening including your family history of cancer? Obviously I don't know your medical history, but your doctor (if they are even remotely responsible) will have weighed any number of factors before sending you to CT for a cancer screening.
Gives a whole new meaning to being "TESTED" to DEATH
I think the real news would be a link to something that doesn't cause cancer.
Dihydrogen monoxide is present in over 95% of known carcinogens, but the government refuses to ban it. It's been directly linked to millions of deaths in the last 2000 years alone. ; D
Well we ought to ban dihydrogen monoxide then! Is there a pet-ition I can sign?
We have to find new ways to diagnose people that are not so dangerous. How about talking more to patients and looking at them rather than trying to see through them. The outer persons tells what is going on in the inner. We have lost the knowledge of making diagnosis by talking and looking at the patient and want to play with the new toy of x-rays despite the knowledge that x-rays harm people. We as always are our own worst enemies and are harming the children who trust us.
The sun "harms" your skin, but you need sunlight to process Vitamin D (and other reasons). Now, I don't argue that ionizing radiation can be harmful (there are some studies saying small amounts of radiation can actually be beneficial), but having dealt with thousands of patients, I can tell you talking does not always work. People lie, for whatever reason, and that is something you have to consider. People also have different pain tolerance levels. I regularly have patients swear up and down that something is broke, and the results will be completely negative. The reverse is also true, I had a young patient with a broken cervical vertebrae that presented no pain in the neck. Also, when a patient comes in with LOC (loss of conciousness), you can't talk with the patient. While I fully support talking to patients (it is a key portion of medicine), don't devalue the forms of medical imaging we have. They provide great insight (no pun intended) into our patients' health. When used properly (meeting the necessary criteria and completing any non or minorly invasive testing) it is a powerful tool that has potentially saved millions of lives. It is also crucial for such things as alignment of bones after a fracture, to ensure the best possible outcome for the patient. A responsible, knowledgable doctor knows all of this, but again, when you have near hysterical parents (or extremely irate) who won't take no for an answer, it greatly complicates matters.
Doctors are trained in medicine and healthcare. They know pathology and etiology. They know prescription drugs and have vast amounts of knowledge and experience to offer, but it is YOUR health, and no one can force you to do anything in regards to it, short of a court order. The reverse is true as well, if you won't take initiative, the doctor cannot help you.
Primordial Dwarfs need to be scaned twice annually since they are genetically disposed to strokes and other vascular problems. What of others who rely on these scans for similar problems?
A substantial number of these ct scans are ordered "by protocol" often as part of a clinical trial or hospital policy or guideline. The individual child does not need the scan nor will they benefit but a researcher or society in general might and the hospital definitely does $$$.
Also, a substantial portion of a hospital's revenue is not from hospital beds (often a loss leader) but from what they call "ancillary services" like CT scans. The hospital absolutely wants these services delivered. Listen to hospital ads they almost never speak about the great beds they have only about their great diagnostics or procedures.
Poor kids, they are our new lab mice! A good and experienced doctor does not need to rush to CT and other tests. They use their knowledge first.
Not to worry. I'm sure the insurance companies will no longer authorize CT scans for children, for fear of future reprisal. The fact that it might save a child's life in the short term will not dissuade their zealous desire to save money in the long term.
Most of the replies here by docs seem to justify CAT scans based on the fact that they're quicker than MRIs and patients are in a hurry to get out of the ER. Which medical school course teaches to rush a diagnosis or order a procedure while knowing that a safer alternataive diagnostice procedure is available?
No medical school or residency program trains us to rush. If only it were that simple.
Practicing medicine is often a very complex balance between diagnostic accuracy, patient safety, and patient/customer satisfaction (you may have no idea how big a driver that is) and availability of a service. MRI is ideal for some things, CT is better for others. It is often a big, complex picture. Talk to your doctors.
If a kid is getting multiple CT scans, there's something wrong to begin with.
We are over doctoring ourselves and we're throwing a fit about a healthcare plan that might exclude lifesaving treatments for an elderly person just diagnosed with cancer who's already dying of emphasema (sp?). I just don't get it. I work with some people who have had their kids in/out of doctors for all sorts of testing...way too much testing. There's two who will only take their kids to specialists in Dallas (40 miles away). That's way over the top. It's like they get off on it or something. I can't figure it out nor do I get it. We have a great D.O. who will always weigh the invasiveness/cost of every test/treatment first and explain everything in great detail. He will also suggest second opinions when he thinks it neccessary. Common sense needs to come first folks.
I am a nurse. I totally agree with you !
Medical professionals need to limit the use of CAT scans to situations where the information that can be gained is absolutely necessary, and to give patients the opportunity to know the risks. If my kid gets bumped on the head but doesn't have obvious signs of trauma, I'm not going to increase her chances of getting leukemia or mengionomas by agreeing to a rule-out CAT scan. I hope the docs ensure that all patients are aware of the risks.
Here is my big question ! What did the doctors do 25 years ago when there wasn't fancy helical CT Scanning ? They were actually doctors who knew what they were doing! Now these ER physicians are mindless ordering robots. Gone are the days when doctors would give you a good hands on physical. Tort reform would also help. Alot of doctors practice defensive medicine.
MRI scans use radiation: look up "radiation" on the internet or ask any engineer or person who understands the words "electromagnetic radiation". MRI and ultrasound do not use ionizing radiation.
It seems to be CT scans are the new lucrative X-ray. It used to be that routine x-rays we're ordered as part of an examination until it was determined there was a link between their proliferation and cancer cases. They finally cut back, but it sounds like they're at it again.
Our 5-year-old had an abdominal CT prior to surgery for congenital diaphragmatic hernia (intestines, spleen were up in left chest). When a surgeon tells you she wants to do a CT, it's hard to argue and advocate properly for your child in the moment. In retrospect, the CT for our child was unnecessary, and if my daughter gets cancer from it, I'm not sure if I'll ever be able to forgive myself.
I would disagree that the scan was unnecessary. The surgeons need to plan, and they need to know the body habitus before they make an incision (also to make the smallest incision possible). This greatly reduces the risk of complications during the surgery, again you have to weigh risk vs gain. Obviously her organs were not in the "normal" spot, or she wouldn't have had the surgery, and the surgeon would have a much harder time using other methods (X-ray or Ultrasound) to get precise locations. MRI would be a great option (especially for soft tissues like spleen and intestines), but most 5 yr olds won't hold still in a tube, with loud noises, in a cold room, in a hospital, for twenty plus minutes and without a parent holding their hand. Then you have to talk about sedation, which is another issue in and of itself.
Karl, you did the right thing!!!!! If your child needed surgery, images can greatly reduce the risk of complications. Notice that the study does not meantion anything about 1 CT scan increasing the risk... it has to go out to 2-3 scans. That is because the risk is so small, that the researchers could not actually show that there is an increase. Now common sense tells us that if 2 are bad, then 1 would be... but it is so small that these researchers could not find it even after studying thousands of patients. However, blind surgery... that is a huge risk and we don't need complex studies to tell us that.
Children have no need for multiple CT scans unless there is a major medical concern going on. If that is the case then the risks are necessary and a more pressing concern than the rare risk of cancer in the future. I would think most Doctors are already aware of this....parents should be too.
A machine doesn't necessarily have to juggle electrons to be dangerous. They now suspect prenatal ultrasounds may be a cause of autism. I would hate to think a doctor would use fancy machines just to process patients faster, to impress themselves with digital images or to rack up usage logs for tax purposes. We need more naturopathic doctors and the insurance companies to cover them.
MRI does in fact use radiation. It uses electromagnetic radiation to detect protons' energies in the magnetic field. The correct name of the technique is, Nuclear Magnetic Resonance or NMR, long-used in Chemistry to study molecules. The term, Magnetic Resonance Imaging is used because the public is afraid of the term, "nuclear." It simply refers to a (hydrogen) nucleus, or proton. But, back to the main point: there is radiation of the same family as X-rays, but much more benign, used in MRI. Please correct this in your original post.
This isn't true. MRI does not use ionizing radiation. The radiation emitted has about the same energy as radio waves which are omnipresent and generally considered harmless.
Both are radiation, but like Greg says, x-ray is ionizing, MR is electromagnetic (on par with radio waves). The key factor is the biological damage they can cause. Ionizing can cause stochastic effects at ANY level. EM on the other hand, needs to be administered in EXTREMELY high doses to produce a biological effect. The poster states the difference is ionizing vs non-ionizng, which is correct.
Sorry, I didn't realize the reference was to the author, yes, what she said is technically inaccurate. But Joe Schmo hears radiation and thinks x-ray, not microwave, and 90% of the people out there couldn't tell you the difference. My comment was about a previous post, where someone does mention that MR uses radiation, but not ionizing radiation. It's akin to you saying people are afraid of the word "nuclear", they also have a similar response to the word "radiation," so I think her intention was to use it more as a laymen's term.
Man, now I'm freaked out. My 7-year old has had at least 2 (maybe 3) CT scans, the two for massive sinus infections (and I can't remember if she had a CT scan when she fell and hit her head).
Again, you have to weigh risk vs benefit. The reason for doing CTs for sinuses instead of x-ray, is they obtain a much clearer image, and it is easier to visualize fluid/mucus. Left untreated sinus infections could cause any number of more sever issues including hearing loss or meningitis. I doubt you have much cause for concern. If you are truly worried, they should have a dose summary report from the exams, this can give you an idea of the level of exposure she received. While this may not tell you much, you can compare it to say, natural exposure rates due to Radon, sunlight, air travel etc. If the rate of occurence was 1 additional tumor and 1 additional leukemia (which is one of the most treatable cancers, if not the most) per 10,000 children, that equates to a 0.01% chance of developing either. She has a similar chance of being stuck by lightning in her lifetime. As a parent however, I do understand your concern for your child's well-being, and fully agree (as a person in the Radiologic Technology profession) that these exams are limited to when necessary.
you all are not doctors. i'd rather get a test. if you come in with a pain or discharge from somewhere, how can the doctor figure out what it is? they can't tell by just looking at you. these test save lives that's all there is too it. now go away.
Only a couple people have claimed to be doctors, but as an RT(R) I'm very concerned about dosage rates, especially among pediatrics. Yes, these tests provide a wealth of information we couldn't obtain any other way. The issue presented here, is are the doctors following the proper procedures (i.e. ordering the proper bloodwork and other non-invasive testing methods) before ordering a CT scan. The other issue with exposing peds, is they are much more susceptible to radiation. The author (and most posters) aren't saying, don't get the scans. We're saying, don't get them unnecessarily. It's your health, take a role, ask questions.
I'd be interested to see the source for this. I work in Radiology and have an US tech under my supervision, but I'm not academically trained in the field of sonography.
This was supposed to be in reply to the post about prenatal ultrasounds being linked to autism.
Rombolio, thanks for putting sensible comments out there.
Most patients would elect to take a high probability diagnostic "save" today, as provided by a valid dagnostic test and result as opposed to maybe avoiding a potential small risk later.
To the public, educate yourselves when practicable with reputable sites on the net. Ask questions. But still it can be complicated. Even for us medical professionals.
greg you are a complete idiot. i dont know where you get your information but its flat out wrong. an mri is about 1750 to 2000. and it only takes 15 minutes. i have recently gotten an mri and i paid 1750 for the mri then another 200 for the reading. yes you have to be still but that is only during the imaging, which is about 30 seconds then a 5 to 10 second break and the pattern repeats for about 15 mins.
Your statement about your MR holds true for you, but the price varies from place to place for a number of reasons. Cost of equipment, type of exam, if insurance is involved etc. 15 minutes is on the short end of MR exams. The length of the exam is determined by a number of factors including: body part being imaged, size of the patient, fat content, body habitus (physical layout of organs and bony structure), and the machine doing the imaging. More factors regarding time include screening patients to make sure they can have an MR (i.e. no non-MR safe implants such as pacemakers), possibly injecting/ingesting contrast solution (and bloodwork associated with that), reconstructing the images into a 3D format, explaining the exam to the patient, if the patient needs some concious sedation (i.e. Ativan or similar) etc. I've been in the MR scanner for over 30 minutes, and the scanning was continuous for minutes at a time, not just seconds (a cardiac scan). Different scans will require different scanning modes and times. It's not unheard of for a scan to take an hour. What Greg stated about the cost is accurate, in the sense that usually a CT is going to be 1/2, or less, the cost of a similar MR scan. What holds true for you doesn't necessarily hold true for everyone else.
I apologize if the fact my approximate numbers were different than the ones you personally experienced upset you. Cost and time vary on the body part being scanned, the number of sequences run, the use of contrast, and the strength of the magnet, and variety in individual practices. A full brain MRI compared to a head CT is most similar the approximate times I gave.
MRI needs to become accessibe to every radiology practice so that excess ionizing radiation can be avoided. It will also take more people trained in anesthesia so patients can be put to sleep in a completely secure environment.
If ct scans increase incidence of tumors in children they could also increase tumors in adults and we dont know it. the health of the entire nation is at stake. this is a matter for Congress since it affects all Americans. It is wiser to go the safe way and avoid Ct scans as much as possible. The members of Congress after all are also exposed to radiation. What about the airport massive Xray machines.
This is not a matter for Congress, there are regulating bodies established to govern the use of ionizing radiation (FDA, EPA, NCRP etc) already in place. Yes, CT scans can produce the same results in adults, but children's bodies are more radiosensitive. Anesthesia is extremely complicated and presents its own set of risks, especially for young or elderly patients. The problem with MR is that many people cannot have scans (due to implants like pacemakers, being on a ventilator, claustrophobia etc) for dozens of reasons. MR does not show the bony structures of the body nearly as well as CT or x-ray, so there are reasons for both. MR is also very expensive, yes making it more accessible will drop the prices, but CT is already available at places where MR is not. The moral of the story is, if you don't NEED it, don't get it.
The risk of something bad is 1 in 10000! If your child is sick and the doctors have no clue and want a CT scan, you have a decision to make. Let your child die because no one can diagnose the problem, or let the CT scan be performed so that the immediate problem can be diagnosed and addressed. The 1 in 10000 risk is better than letting the kid die tomorrow. Why doesn't the news media state the obvious intelligent issue? Risk is risk! Every US public school student should have been taught risk analysis in high school but I doubt many teachers are qualified. Risk analysis is like check book balancing. If you don't know how to do it, you will destroy your life and the life of your family. Journalists seem to be pretty ignorant of basic math and risk analysis is something strange to them. That is scary! Risk analysis is something you do every day! Should I do a rolling stop and the stop sign? Tort law to fight stupid advice in the news is now necessary. Journalists have become the most ignorant profession. They are trained to stretch the truth and lie!
Cigarettes and cigarette smoke are known to cause cancer but you don't see too many people going ballistic because they end up breathing some smoker's cast-off air as they lounge in doorways and on sidewalks, even if it means having to expose your children to it as you run the gauntlet. I'd worry more about that than I would about one CT scan that might help my child.
Actually, you do see this. I've yelled at plenty of people for smoking near doorways myself. Also, this is evident because of laws concerning smoking indoors, near entrances to government buildings, hospitals and schools.I distinctly remember "Second hand smoke kills" commercials in the 90s and 2000s. So yeah, there is/has been lots of concern regarding second hand smoke.
Well that's it. I guess it's time to hide underneath my bed and never come out. Does anybody have any jars I can use to collect my own urine?
Yes, but they all contain bpa, sorry!
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Cancer research is the most corrupted industry in the world ... who would want to find a cure when there is billions of $$ to be made treating the disease?
Nah, that's still politics. I don't buy this whole conspiracy of "cure vs treatment." A cure for cancer would result in a drug patent potentially worth trillions of dollars. How would that not be easier than doing CTs, planning chemotherapy, radiation therapy? They could charge what they want (big pharm does now anyways) and people would buy it. You can't eradicate cancer entirely, it's a mutation. It will keep popping up no matter what, so people would continue to need the cure for years and years. That's why they say remission instead of cured, once you're cancer-free.
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Not only is the incidental significance way under the noise level, but there's also no causality involved. This study, on its own, tells us nothing except we probably should look a bit more.... Oh yes, and that the risks, if they are ultimately determined to exist at all, are at most minimal. So all-in-all I'd say this is more a verification of the likely very low risk character of the procedure, in world where we know that nothing is without at least some risk, even if it's just that involved in walking across the street.
I recently had two CT scans and the doctors never mentioned the risks involved. Had they told me, I would have refused the scans. It should be mandatory that people should be told. This is a life-threatening test. Thanks to the internet, I now know. CT scans should be banned except dfor people who are in a life threatening situation.
The risks posed to a full grown adul are minimal compared to those of pediatrics. Their tissues are much more sensitive to radiation due to the fact that they are still growing (scientific explanation has to do with cell mitosis, and oxygenation also affects radiosensitivity). From your name, I'm assuming you're male. Because the rate of occurence of stochastic effects is low in adults, and extremely difficult to correlate directly to radiation due to so many risk factors in volved in cancer susceptability, the main areas of concern are pedatrics and pregnant/nursing women. The reason you weren't "warned" is because you aren't in a high risk category.
The same goes for getting your vaccinations or flu shots etc, they don't explain risks to someone who is at little risk. If we Radilogic Technologists had to explain the full scope or potential hazards to radiation exposure, no one would ever get x-rays due to either paranoia (it is a rather long list of hazards) or just because it would take us 30 minutes to get near explaining it all. There are hazards associated with any medical treatment, but you have to factor in the risk versus the benefit. Curiously, what indications brought about the ordering of a CT? And were other tests (Ultrasound, general x-ray, blood test etc) performed before ordering the CT? The exam isn't "life-threatening." Life-threatening presents an IMMEDIATE risk to your life. The effects of radiation are not instant and can take years to develop, if they do at all.