THE CAT IS OUT OF THE BAG

CAT (Computer Axial Tomography, now commonly called CT scans, are greatly over ordered in the United States. Given the highly profitable nature of diagnostic imaging, it’s no wonder this procedure is overused. Costing roughly $600 per study for overhead (which includes office space, employees, and a Radiologist), the upkeep on the scanner (which includes the cost, and repairs to the unit when heavily used), and a $1500 reimbursement from the insurance companies, indeed this procedure is a lucrative business. Some areas of the country do eight times more CT scans than other parts, yet do not have any detectable increases in health, only more expense. Despite the fact that the average American pays more for health care than any other nation, it is 16th in health and longevity. Japan is number one, followed by the Scandinavia. Moreover, when over ordered, the CT scans are dangerous!

CT scans are risky in three ways. One, the patient is overexposed to radiation. Second, it leads to more dangerous and unnecessary invasive procedures. Thirdly, the contrast used with most of the scans ruins the kidneys. It takes just one CT scan to equal up to 450 chest X-Rays. This translates to an extra 30,000 cancers each year. Furthermore, the radiation is accumulative and grows more each year. It may take 25 years for the cancer to appear. The mortality rate of these tumors, despite early pick-up and good treatment, is 50 percent.

The iodinated contrast material which is injected into the veins, is excreted by the kidneys. It is hypertonic and “dehydrates” the sensitive micro vessels and tubules of this organ. Also 3% of the population is sensitive to these organic iodinated molecules. Very rarely could one have such an acute allergic reaction and die suddenly! To avoid renal destruction, the Doctors should make sure the kidneys are working adequately by doing a serum BUN and Creatinine, both of which are Renal Function Tests. If the BUN is below 25 or the Creatinine is more than 1.8, the contrast is used for better definition. However even with normal function, unless the person is more than adequately hydrated and/or they take strong antioxidants such as N-acetyl cysteine they lose function every time they have contrast. It is additive over the number of studies a patient has over their lifetime. NAC, 600 mg three times a day on the day before, the day of, and the day after the study is advised. Lastly, CT scans are in many cases overly sensitive and pick up incidental findings of no real clinical relevance. Our medical profession should let “sleeping dogs lie”, but do not for reasons that may be not that altruistic. The medical mind-set taught to young doctors is supposed to be the more the better in our land of plenty, but what it really does is make more money for physicians by increasing the number of procedures and operations. Of course this also leads to heightened anxiety, further testing, biopsies and unnecessary surgeries creating earlier disability and death for the poor patient. With new healthcare legislation around the corner, the problem will only get worse. Because most patients are not told the full extent of the risks and consequences of these proedures, they are ultimately scared into invasive actions that are unnecessary. It is estimated by some that CT scans kill almost a million people a year! CT scanning is a great technology and do help to extend lives by better and earlier diagnoses, but should be used judiciously!