Attention radiologists: First do no harm

CT scans are lucrative for physicians and the owners of the machines. They produce cool-looking images. And they can be at least modestly useful in a variety of clinical situations. All of these factors lead to high and rising utilization, higher costs for health care payers, and a lot of radiation exposure. Even if we accept that the level of utilization is appropriate --which I don't-- this article from JAMA (Estimated Radiation Dose Associated With Cardiac CT Angiography) is concerning. Turns out that patients receive a wide range of radiation doses depending on where they go for their scans. That's particularly alarming in the case of CTA, a high-radiation scan even when done properly.From AuntMinnie (JAMA study finds wide variation in cardiac CTA dose)

Many facilities that perform coronary CT angiography (CTA) are failing to protect their patients from high radiation doses -- even centers that scan large numbers of patients -- according to new data from sites throughout the U.S. and Europe, published in the February 4 Journal of the American Medical Association.The study involved nearly 2,000 subjects undergoing coronary CTA, who received a median radiation dose equivalent to 600 chest x-rays. Some sites reported radiation dose levels six times higher than at other facilities. And although effective techniques exist to reduce patient doses substantially, many clinicians have not yet succeeded in implementing them, leading to wide variations in radiation dose, the authors reported in JAMA.

It's not an easy thing to do, but patients and their families should try to ascertain whether the facility where they are being scanned uses techniques to reduce exposure. And they should ask hard questions about whether the scan is really needed. Ideally it shouldn't be up to the patient to do this. We wouldn't expect to ask analogous questions when we get on an airplane or eat at a restaurant. Alas, despite all the talk about defensive medicine, it seems that dangerous practices are alive and well.