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Entries in CT Scan (9)

Wednesday
Aug222012

CT Scan for Heart Risk Splits Doctors

Hemera Technologies/Thinkstock(NEW YORK) -- For hundreds of thousands of Americans, the first sign of heart disease is when their heart stops.  It's a situation that has cardiologists constantly searching for better ways to detect heart problems sooner.

On Tuesday, a study published in the Journal of the American Medical Association suggested that a test using a CT scan could lead to answers for many of the 33.5 million Americans deemed to be at intermediate risk of heart problems.

Yet, the scan is not without its drawbacks -- a fact that has some doctors skeptical as to whether this test should be offered more widely.

The test -- known as a coronary artery calcium score, or CAC -- is found by evaluating the amount of calcium in blood vessels around the heart.  Doctors accomplish this through a CT scan of the chest.

In the new study, a team led by Dr. Joseph Yeboah, assistant professor of internal medicine-cardiology at Wake Forest Baptist Medical Center, found that this test was the most effective of the six different methods to determine someone's risk of future heart problems if they happened to be classified as having an "intermediate" risk of heart disease.

Doctors can tell patients whether they are at high, low or intermediate risk of developing heart disease by using what is known as the Framingham score -- a tool that looks at age, cholesterol, blood pressure, smoking history and gender.  A high-risk patient will likely be treated more aggressively with blood pressure and cholesterol medications than their low-risk counterparts.

But while this approach works well when it comes to high or low risk patients, for the 16 percent of Americans in the intermediate risk category the lines are fuzzier as to when they should start taking these medications.

While the CAC is not currently in wide use, the study authors argue that expanding its use could help guide treatment for these millions of patients.

"The present study provides additional support for the use of CAC as a tool for refining cardiovascular risk prediction in individuals classified as intermediate risk by the [Framingham risk score]," the study authors write.

Specifically, the coronary artery calcium score would have accurately "reclassified" 25 percent of individuals from intermediate to high risk, and another 40 percent to low risk.  This means more than half of the people previously labeled ambiguously as having intermediate risk would now be considered to be at either high or low risk, which would ideally lead to more appropriate care.

The implications of such an adjustment would be considerable.  Heart disease remains the leading cause of deaths worldwide.  Blockage of the arteries of the heart, or coronary heart disease, leads to heart attacks -- a condition that accounted for one out of six American deaths in 2008, according to the American Heart Association.

On the other side of the coin are the out-of-pocket expenses and the increased radiation exposure that this test entails.  Previous studies show that radiation from CT scans has been linked to cancers.

Some doctors say the downsides of this test outweigh these benefits.

"I strongly disagree with the authors' conclusions," said Dr. Steven Nissen, chairman of cardiology at the Cleveland Clinic Foundation.  "CAC scoring is a poor bargain with high costs and real harms."

"The test is potentially worth the cost and small radiation risk only if it is going to change a clinical decision regarding the use of aspirin, blood pressure medications or cholesterol treatment," said Raymond Gibbons, professor of medicine at the Mayo Clinic.  

So for an intermediate risk patient who has additional risk factors, such as a strong family history of heart disease, he argues that this added test would be pointless, as these patients would be treated aggressively anyway.

Still, some doctors agreed with the idea that CAC could be used more widely to evaluate patients.

"With these new data, we have a much better understanding of the best utility for this tool and can understand much better how to apply this technology," Clyde W. Yancy, chief of cardiology at Northwestern University, wrote in an email.  "That coronary artery calcium scoring prevails against these and other candidate risk markers is the news of the day."

Copyright 2012 ABC News Radio

Sunday
May202012

Major Cancer Groups Recommend CT Scans for Lung Cancer

Hemera/Thinkstock(NEW YORK) -- For the first time, several top cancer organizations are recommending that smokers and former smokers ages 55 to 74 years who have smoked at least one pack of cigarettes a day for at least 30 years get an annual low-dose CT (LDCT)—a three dimensional X-ray—to look for lung cancer.

The recommendations, put forth as a collaborative effort by the American Cancer Society, American College of Chest Physicians, American Society of Clinical Oncology, and National Comprehensive Cancer Network, were released Sunday morning. They appear in the Journal of the American Medical Association.

Each year, more Americans die from lung cancer than from breast, colon, and prostate cancers combined. It has held its position for years as the second most common cancer for both sexes in the United States. Only prostate cancer is more common than lung cancer in men. Breast cancer is the most common cancer in women.

If detected early enough, lung cancer can be treated and survival chances improved. Despite this, until now there had been no formal recommendations on screening tests for this deadly cancer.

“We now have an important and critical tool to screen for the most common cancer in America, and can reduce the mortality through this screening,” said Dr. John Deeken, assistant professor in the division of hematology/oncology at Georgetown University in Washington, D.C.

Still, the question of whether every person at high risk for lung cancer should get an annual low-dose CT scan is not so simple. Since the type of CT scan used exposes the patient to radiation, albeit a low-level dose, there is a small health risk posed by this screening.

If doctors detect a questionable cancerous mass through a CT scan, they may have to evaluate it further through a minor surgery called a biopsy. In this procedure, a doctor will take a sample of the tissue for further testing to determine if the mass really is a cancer. While some of these may be cancerous, there are always a certain number which are not—meaning that the detection and subsequent surgery may not have been technically necessary.

The new recommendation also begs the question of who will be paying for the test itself.

“The cost of LDCT is currently not covered as a standard test,” said Dr. Chao Huang, lung cancer specialist at the University of Kansas Cancer Center. “Therefore, it is difficult to recommend this test when patients may be burdened by the cost of this test year after year.”

“The key question is when will more insurance companies, and most importantly Medicare, start paying for these screening tests,” Deeken said.

And then there is the issue of how many Americans will fall under the guidelines—and whether the resources exist to screen all of them.

“We currently do not have the infrastructure to manage the potential number of patients that would qualify for screening,” Huang said.

These issues aside, one thing is clear: screening CTs have been shown to save lives. Dr. Keith Mortman, associate professor of clinical surgery at Georgetown University School of Medicine, explains that a major study in 2010 called the National Lung Screening Trial found a 20 percent reduction in lung cancer deaths in patients who were screened with low-dose CT scans as compared to those who got chest X-rays.

Dr. Herbert Kressel, a radiologist at Harvard Medical School, says that in light of this, the recommendation is a step in the right direction.

“Lung cancer is an important health problem with a poor prognosis when it is discovered at an advanced stage,” Kressel said. “This study is important in further highlighting the importance of low dose CT screening for patients at high risk for lung cancer.”

Copyright 2012 ABC News Radio

Thursday
Apr052012

Doctors: Extra Tests Not Key to Best Patient Care

Comstock/Thinkstock(NEW YORK) -- In an effort to end medical over-testing, nine major medical professional organizations have banded together to try to change the way doctors use tests and procedures once considered fairly routine.

The campaign, Choosing Wisely, a joint effort led by the American Board of Internal Medicine Foundation and Consumer Reports, released a list of 45 common tests and procedures it hopes will be more carefully prescribed and performed.

The campaign is a frank attempt by a wide consortium of medical groups to address what many characterize as rampant, wasteful procedures and spending in the U.S. health care system.

"The distinction to be drawn is between 'care' and 'tests,'" said Dr. Thoralf Sundt, chief of cardiac surgery at Massachusetts General Hospital.  "Doing tests is not the same as providing care in all instances."

Several of the over-used tests called out by the specialty organizations are procedures that have long been considered routine or harmless by many.  Staples such as cardiac stress tests or chest x-rays before minor surgery got the thumbs down from several of the groups.

Some of the recommendations are not radically different from what other groups have been saying for years.  Several guidelines, such as those recommending against Pap tests for women under age 21 or bone density scans for women before age 65, have recently been publicized by the U.S. Preventive Services Task Force, the government body charged with reviewing and recommending health care processes.

But many doctors say that the endorsement of less testing by the heavyweight medical specialty groups may just resonate with more physicians and could alter what has been routine practice.

"It is important because it signals from physician leadership that there is waste in the system that should and could be reduced," said Dr. Harlan Krumholz, professor of investigative medicine and public health at Yale University School of Medicine.  "And it should be just the beginning of a movement."

Many doctors do such screenings and procedures for a variety of reasons other than patient care, doctors say.  Often the reason is simple: a given test or procedure is what the doctor has always done.

Others feel that ordering a barrage of tests will yield the source of a patient's problem, or will reveal an unknown danger.  Other doctors use tests defensively, out of fear that not ordering a test could look like negligence and prompt a lawsuit.

"After a while, getting a CT for a headache or fainting spell even without any neurologic deficits or a stress test for asymptomatic patients becomes the de facto 'standard of care' and physicians are afraid to miss something lest they be sued," said Dr. John Messmer, associate professor of family and community medicine at Penn State College of Medicine.

But experts say it's time to drop this just-in-case mindset.

Reframing conventional medical thinking about testing would likely be a money-saver for the U.S. healthcare system. Some research groups estimate that excessive, unnecessary testing and procedures account for as much as one-third of U.S. medical spending, which totaled more than $2 trillion in 2009 alone.

Copyright 2012 ABC News Radio

Wednesday
Apr042012

Five Medical Tests You May Not Need

Keith Brofsky/Thinkstock(NEW YORK) -- A routine visit to the doctor's office can bring up a laundry list of medical tests, all designed to screen for one serious disease or another.  But according to a new report from leading physician groups, a large number of medical tests and procedures billed as routine are largely unnecessary.

For many patients and doctors, it's easy to adopt the notion that if a little screening is good, more of it is better, "just to be sure" nothing is wrong.  But that approach is costly, both in terms of health care dollars spent and the potential risks of the screenings.

"There's no medical treatment or test that is 100 percent without risk," said Dr. Christine Cassel, president and chief executive officer of the American Board of Internal Medicine Foundation.  "Things that you might think are routine actually should not be done because they expose patients to risk."

To help patients parse through the barrage of medical procedures, the ABIM Foundation and Consumer Reports have created the Choosing Wisely project, a campaign that asked nine physician groups to identify five tests or procedures in their fields that are over used or unnecessary.

Cassel said the project is designed to give patients as much information as doctors have about screening, as well as to rein in health care costs.

The full list was published on Wednesday, but here's a look at five common tests you may not need:

Cardiac Stress Test


Cardiac stress tests were once considered a staple of routine check-ups.  Also called the treadmill test or an exercise EKG, doctors often use it to determine if a patient has blocked arteries.  The U.S. Preventive Services Task Force has long recommended that people at low risk for cardiovascular disease and with no symptoms of heart trouble don't need an annual stress test.  But a 2010 Consumer Reports survey of 8,000 people ages 40 to 60 found that 44 percent of low-risk people with no symptoms had been screened.

According to the American College of Cardiology, stress tests should only be performed on patients who have peripheral artery disease, diabetics over age 40 and people who have an increased risk of coronary artery disease.

Chest X-rays Before Minor Surgery

For many years, chest x-rays were another nuts-and-bolts part of hospital care.  But the test is going by the wayside.  The American College of Radiology said for most patients undergoing outpatient procedures, the tests are unnecessary. 

Some people should get a chest x-ray before going under the knife, such as those with a history of heart problems, lung disease or cancer.  For others with a normal physical exam, the ACR said the test leads to a change in patient care in only two percent of cases.

Imaging Tests for Lower Back Pain

According to the American Academy of Family Physicians, lower back pain is the fifth most common reason for all visits to the doctor's office.  But unless a patient has certain red flags of a deeper physical problem, such as spinal abnormalities or neurological problems, the AAFP and the American College of Physicians say doctors shouldn't use MRIs, CT scans or other imaging to investigate lower back pain.

Frequent Colon Cancer Screenings

Colonoscopies, perhaps the most unloved cancer screening, are a necessary aspect of health care after age 50.  A recent study found that having precancerous growths spotted on colonoscopies removed cut the death rate from colon cancer by 53 percent. 

Most major medical groups recommend that people over 50 get a colonoscopy every 10 years.  However, the key is moderation.  According to the American Gastroenterological Association, most adults who are at an average risk of colon cancer and who get a clean bill of health from a colonoscopy don't need another one for the next decade -- good news for health care pocketbooks, since the test costs an average of $1,050.

Bone Density Scans

Osteoporosis becomes a real risk for people, particularly women, with increasing age.  The National Institutes of Health estimates that one in five women over age 50 has osteoporosis.  But patients may want to ask their doctors how often they need a bone density scan to screen for signs of the disease.

The American Academy of Family Physicians echoes the U.S. Preventive Services Task Force in recommending that only women over age 65 get a bone mineral density test, called dual-energy x-ray absorptiometry, or a DEXA scan.  The AAFP also recommends the test for men age 70 and older, although the USPSTF said there is insufficient evidence to balance the risks and benefits of screening men for osteoporosis. 

The test costs more than $100, and unless a woman under age 65 has additional risk factors, such as smoking, an eating disorder or previous broken bones, doctors say the scan is unnecessary.

Copyright 2012 ABC News Radio

Tuesday
Dec132011

California Clinic Offers CT Scan as 'Gift of Health'

Hemera Technologies/Thinkstock(BEVERLY HILLS, Calif.) -- With the holidays just around the corner, a Beverly Hills clinic is selling "the gift of health": a computed tomography, or CT, scan they believe could help lead to early identification of heart or cancer problems.

Beyond valet parking and a spa-like atmosphere complete with bamboo floors and natural light, the gift's $1,200 price tag includes a report detailing any abnormal findings from the full-body scan -- from lumps and nodules to blood vessel irregularities.

"Screening is extremely important, and we think everyone should do it," said Dr. Ari Gabayan of the Beverly Hills Cancer Center, a "boutique" operation associated with Optima Diagnostic Imaging. "The whole idea is to catch things early before they become a problem."

But some experts say the risks of overscreening outweigh the benefits.

"This is a terrific gift to the financial health of the clinic," said Dr. William Schaffner, chairman of preventive medicine at Vanderbilt University Medical Center.  "If getting screening CT scans or MRIs was really thought to be useful and cost effective, then it would be recommended by medical communities."

A CT scan is a useful diagnostic tool when a patient has a certain set of symptoms and risk factors, said Schaffner.

"But going out and doing a lot of testing when someone is not symptomatic -- other than the screening tests recommended by professional societies such as the U.S. Preventive Services Task Force -- cannot be recommended as a gift of health," he said.

Some hospitals are using CT scans to screen for lung cancer in heavy smokers. But there is mounting evidence that overscreening in the general population can lead to anxiety-provoking false positives -- a diagnosis of cancer when there is none -- and even unnecessary surgery.

"The default is to assume that screening must be good; catching something early must be good," said James Raftery of the University of Southampton, U.K., author of a study on breast cancer screening published Thursday in BMJ. "But if a woman has an unnecessary mastectomy or chemotherapy or radiation, that's a tragedy."

Copyright 2011 ABC News Radio

Wednesday
Jun292011

Lung Cancer Screening Saves Smokers’ Lives

Stockbyte/Thinkstock(WASHINGTON) -- Last November, the National Institutes of Health announced results of a landmark study of lung cancer screening in smokers which for the first time showed that CT scans to screen for lung cancer saves lives. This information was widely reported, including by ABC News, but the details were not known until now.
 
The authors at the National Cancer Institute screened over 53,000 smokers using either CT scans or chest X-rays for lung cancer. During the five years after the screening program, the authors found that those who were screened using CT scans had a 20-percent lower rate of dying from lung cancer than those who were screened using X-rays. CT scans also reduced death from any cause by almost seven percent.  But both X-ray and CT scan-based screening resulted in a large number of patients getting a positive test that upon further examination turned out to not be cancer. This likely resulted in many unnecessary biopsies and other medical procedures as well as patient anxiety and undue stress.
 
Although screening can prevent lung cancer deaths, the question now becomes whether it is cost-effective to screen high-risk individuals.  

The findings of the National Cancer Institute report are published in the New England Journal of Medicine.
 
Copyright 2011 ABC News Radio

Monday
May092011

Study: Children Should Be Monitored Longer Before Getting CT Scans

Hemera Technologies/Thinkstock(BOSTON) -- Nearly half of all children who are brought into the emergency room for head injuries undergo CT scans, according to the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control.

But a new study suggests for many of these cases, a CT scan may be unnecessary.

Instead, children should be observed in the emergency room for a few hours longer before the physicians make a decision to send them for a CT scan, according to the study published Monday in the journal Pediatrics.

"The general conundrum is that blunt head trauma in children is common.  Serious traumatic brain injury is less common," said Dr. Lise Nigrovic, emergency medicine pediatrician at Children's Hospital in Boston and lead author of the study.  "But in some cases, it's hard to tell the difference."

CT scans are generally safe, Nigrovic said.  But studies suggest repeated radiation exposure from the scans over time raises the risk of some forms of cancer.  It's unclear how big a risk the scans pose.

Some children may show symptoms of head injury such as headache or dizziness, which warrant further attention.  But for many, it may just be a bump on the head and the signs could wane within a few hours.  While the study didn't assess how long doctors should wait, numerous studies suggest four to six hours can reveal telltale signs of injury.

"It's a question of degree and number of collective symptoms," said Nigrovic.

More serious signs of brain injury include vomiting, loss of consciousness, and impaired memory over a longer period of time.  These signs are less common among children who end up in the emergency room.

According to Nigrovic, physicians should spend more time monitoring for trauma symptoms than skipping straight to scans.

Copyright 2011 ABC News Radio

Wednesday
Apr062011

New Warning About Kids Getting CT Scans

Hemera Technologies/Thinkstock(CINCINNATI) -- Radiologists should take more care when youngsters come into emergency rooms for computed tomography, better known as CT scans, according to a new study.

That's because these kids are often exposed to radiation doses meant for adults, which can boost their chances of developing cancer later in life.

As it happens, children were five times more likely to get a CT scan in 2008 than 1995, during which time the numbers have soared from 330,000 to 1.65 million.

CT scans are usually administered for head injuries, abdominal pain and headache.  Due to improvements in technology, scans for abdominal pain shot up 21 percent over a four-year period.

According to the study by researchers at Cincinnati Children's Hospital Medical Center, CT scans in youngsters should be monitored carefully so that doses are adjusted properly to their smaller physique.

In some instances, ultrasounds, which are safer, may be substituted for CT scans, usually in cases of diagnosing appendicitis.

Copyright 2011 ABC News Radio

Wednesday
Dec012010

CT Scans May Not Be As Risky As Once Thought, Study Finds

Photo Courtesy - PRNewsFoto/AMERICAN CANCER SOCIETY(PALO ALTO, Calif.) -- Doctors have long known that CT scans can be a double-edged sword. Their diagnostic power is pivotal in modern-day medicine, but their inherent cancer risks leave both physicians and patients wary.

Now, a new study presented at a major scientific meeting may alleviate some CT cancer fears -- but it may also fuel the controversy surrounding the tests.

The study of more than 10 million Medicare patient records suggests the cancer risks from the scans are much smaller than past studies claim. Prior research estimated radiation-induced cancer rates associated with these scans around one-and-a-half-to-two percent, but results from the Stanford study found that CT scans were only associated with a 0.02 to .04 percent higher risk of cancer in its study population.

"The bottom line here is that not enough work has been done in this area yet," said Dr. Pat Basu, faculty radiologist at Stanford University and co-author of the study. "We need to be sure not to over-scan people, but not forget the tremendous benefits from CT scans; they can save lives and make medical care cheaper."

Dr. David J. Brenner, professor of radiation oncology at Columbia University, takes issue with the methodology of the study. Only patients who had received no less than the radiation of about four or five CT scans were included in the final risk results. Those patients who had only a few CT scans in the years studied were not included in the final results.

Today, more than 62 million CT scans are performed in the United States, compared with three million in 1980. A CT scan can have 50 to 250 times more radiation than a conventional X-ray.

For this reason, some doctors have raised alarm on unnecessary CT scans. Indeed, many studies have shown that patients are unnecessarily getting CT scans, exposing themselves to radiation.

Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society in Atlanta, agreed that the issue is in the amount of CT scans used on patients.

"We as a nation are in love with technology," said Lichtenfeld. "We're going in the complete opposite direction where I think we should go. We need to take a step back, respect technology, but understand the limitations of technology and not assume everything must be used all the time."

Copyright 2010 ABC News Radio







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