Whole body CT scans; their radiation may do more harm than good
the findings suggest that pan-scanning may be 26 times as likely to harm patients in the long run as to immediately help them in the acute care setting…. the results should serve as warning for the emergency department physician against ordering pan-scans for lower-risk patients
CT Pan-Scans Raise Radiation Dose Without Improving Results, Medscape Today, James Brice, February 21, 2012 — An Australian study of emergency department imaging practices has raised radiation safety concerns and new arguments about the clinical benefits of whole-body computed tomography (CT) imaging for the initial emergency department evaluation of critically injured patients.
Pan-scans, a wide field-of-view CT imaging protocol covering the body from the head to the pubic symphysis, stirred intensive debate when they were first introduced in the mid-2000s. A majority of academic authorities eventually accepted the high-speed application for diagnosing life-threatening, multifocal trauma in the emergency department, despite its propensity for exposing patients to levels of radiation of 20 mSv or more.
That single dose is double the amount of ionizing radiation the National Academy of Science’s Seventh Assembly of the Committee on Biologic Effects of Ionizing Radiation says will give a 40-year-old adult a 1-in-1000 chance of future cancer.
Stephen Asha, MD, and colleagues from St. George Hospital, Sydney, Australia, have drawn additional attention to CT pan-scans with their study, which compares 656 severely injured patients who were evaluated with conventional imaging before the introduction of a pan-scan protocol at a level 1 trauma center with 624 patients with similar injuries who were examined after adoption of the technique.
Their study was published online December 7, 2011, and in the February 2012 print issue of Emergency Medicine Australasia…… In an accompanying editorial published online February 8 and in the February 2012 print issue of Emergency Medicine Australasia, Dirk Stengel, MD, PhD, director of the Center for Clinical Research at the Unfallkrankenhaus Trauma Center, Berlin, Germany, writes that the results cast doubt about whether multidetector CT technology can minimize radiation exposure while increasing the diagnostic yield.
According to Dr. Stengel, the findings suggest that pan-scanning may be 26 times as likely to harm patients in the long run as to immediately help them in the acute care setting. His conclusions are based on the increased probability a trauma patient will be exposed to at least 20 mSv from a pan-scan, and the protocol’s limited ability to improve injury detection…..
Dr. Asha’s findings underscore the risk for overusing CT pan-scan, said Carlo L. Rosen, MD, vice chair for emergency medicine education at Beth Israel Deaconess Medical Center in Boston, Massachusetts….
For Dr. Asha, the results should serve as warning for the emergency department physician against ordering pan-scans for lower-risk patients, especially ones who only meet the criteria by mechanism….. Emerg Med Australas. Published online December 7, 2011, and February 8, 2012. Article full text, Editorial full text, Letter to the editor full text http://www.medscape.com/viewarticle/758967
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