and must be employed very, very carefully.
If it's not absolutely necessary, don't.
Anyone familiar with nuclear physics, engineering, or medicine knows that it only takes one ionizing radiation event to damage one single cell's DNA such that the cell becomes malignantly cancerous to start a life-threatening illness.
Any patient recommended for an x-ray or CT scan - especially with contrast - should ask "Is this test really necessary? Or can you draw logical conclusions using methods that don't expose me to ionizing radiation?"
One of the most intense aspects of the current health reform debate involves conservatives charging that reform will “get between you and your doctor” and “cut needed tests.”
A New England Journal of Medicine article this week says an attitude of thrift regarding scans may not only save money, but save patients from radiation-related illness.
As lead author Reza Fazel told The Baltimore Sun, “There’s a cost with these tests, and it’s not just dollars but radiation risk.”
The problem is there is an economic incentive to do more scans. More scans mean more money. When doctors have bought a scanner, that is money going directly to the doctor.
Tests designed to check for heart problems are increasing fastest, the NEJM study said, and 2% of cancers in a recent study were the result of CT scan exposure. So difficult-to-diagnose heart problems could be resulting in patients getting cancer.
An NEJM perspective by Michael Lauer with the National Heart Lung and Blood Institute argues that the heart tests, called nuclear stress tests, may actually have more risks than benefits.
The cure for this disease, ironically, turns out to be economic, changing market incentives that now favor extra tests.
