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The increasing use of CT and its risks.

Article Excerpt
Computed tomography (CT) is one of the most powerful diagnostic tools available to physicians. Rapidly developing technology has enabled visualization of smaller structures with ever-increasing detail. Results are available quickly, and there seem to be no visible side effects. Recently, these benefits have overshadowed the risk inherent in any examination involving exposure to ionizing radiation. Physicians and patients often are not aware of the elevated radiation dose associated with CT or the related risk of long-term biological effects. This paper addresses the risks associated with CT examinations, as well as avenues for minimizing these risks.

Benefits of CT

CT has many advantages over other diagnostic imaging modalities. It is used widely in the emergency department (ED) to quickly and accurately diagnose a variety of pathologies and injuries that often are not visualized with conventional radiographs. Multislice CT also has found use in coronary angiography. It is a noninvasive procedure with fast enough acquisition times that patients do not need to be medicated to slow their heartbeat. (1,2)

In some instances CT has decreased the cost of medical imaging. Insured patients often do not have to pay out of pocket for a CT scan, and other options, such as magnetic resonance, can be much more expensive. (1) Hospitals benefit economically from increased CT use as well, as reported by a level-I trauma center that studied costs associated with imaging facial traumas. In 2002 a CT head examination was estimated to cost the hospital $121 per patient, while performing the same examination with conventional radiographs cost $154 per patient. Using CT alone saved 22% in imaging costs, primarily due to the shorter time necessary for the CT scan. (3)

Trends in Use

Use of CT has increased steadily during the past 2 decades. Between the mid-1980s and the mid-1990s, CT use grew by more than 500%. (4,5) CT now accounts for approximately 13% of all diagnostic imaging procedures in the United States. Sixtyfive million scans were performed in 2002, compared with 33 million in 1998. (5,6)

Emergency Department Use

The use of CT has increased at an even higher rate in many EDs. One ED reported a patient increase of 13% between 2000 and 2005, with a disproportionately higher increase in the use of CT over the same period (see Table 1). The increase in CT use is driven by ever-increasing detection capabilities, as well as by the increasing availability of CT scanners. Additionally, many departments consider CT the first test for many conditions. Physicians might be replacing clinical judgment and time-consuming physical examinations with a "let's do a quick CT" approach to emergency medicine. (1,5) A trauma patient in the Yale University Medical Center ED might have his of her entire body scanned. (5)

Defensive Medicine

Perhaps one of the greatest factors contributing to the rise in CT...