Tuesday, January 4, 2011

Overtreat Me

MSNBC reported yesterday on yet another overused medical intervention that may be putting our children at risk. The headline read “kid's radiation exposure is common and dangerous” while the story reported


The first large study to examine the use of X-rays, CT scans and other medical radiation in children estimates the average child will get more than seven radiation scans by age 18, a potentially worrisome trend.

More troubling is a child’s unique vulnerability to these tests

Children's developing tissues are more sensitive to radiation and their longer life spans allow more time for risk to build up. 

The main source of concern emerging from the study was the use of CT scans

And while the MSNBC piece does not state directly that these tests are being over-performed other sources have addressed the issue. In 2007 USA Today quoted the author of a study examining the necessity of these tests: 

About one-third of all CT scans that are done right now are medically unnecessary," says David Brenner of Columbia University, lead author of the study reported in today's New England Journal of Medicine.

As to the possible consequences, the paper went on:

Overuse of diagnostic CT scans may cause as many as 3 million excess cancers in the USA over the next two to three decades, doctors report...
  
Further, in August of last year, Fierce Health care reported on a story appearing in the Chicago Tribune quoting doctors expressing their concerns over excess radiation attributable to CT scan overuse:

Children often have scans at other hospitals that were not needed or the right area wasn't imaged, said Dr. James Donaldson, chairman of medical imaging at Children's Memorial. Worse yet, many scans involve high radiation doses that weren't adjusted for a child's size or weight.
  
This in not to say CT scans and other radiation-emitting procedures should always be avoided. Time magazine’s Dr. Scott Haig, in 2007, examined the radiation issue in its entirety and in regards to evaluating the appropriateness of CT scanning had this to say:
  
CT is absolutely necessary with head trauma and acute abdominal conditions. Minutes can make a difference in these cases — if, say, there's bleeding around your brain and you can't get an MRI — and the speed of a CT scan makes it worth the risk. But in most other situations, it's wise to let the doctor convince you it's worth it, before consenting to the scan
 
The wheels of medicine turn slowly so institutional change is unlikely to arrive anytime soon. Therefore if you find yourself in a situation that my require radiation exposure, make the medical professionals with whom you deal aware of your concerns regarding the capricious and improper use of radiation-emitting devices. After all, the more informed and aware we are as patients the better we can navigate a medical system that does not always act either rationally or in our best interests.

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