Monday, March 23, 2009

CAT Scans - Friend or Foe?


I am astonished at the diagnostic accuracy of today’s radiologic technology. CAT scanners today, for example, can detect lesions that were invisible 5 or 10 years ago. As a gastroenterologist, I am routinely referred patients with subtle abnormalities seen in their livers, pancreases and digestive tract. Indeed, every medical specialty has been similarly affected. Pulmonary specialists see patients with tiny lung nodules that would not have been seen with older technology. Oncologists see patients with borderline abnormalities that can only be detected with the latest generation of scanners.

Shouldn’t we celebrate this futuristic diagnostic accuracy? I’m not so sure. I believe that these phenomenal technologies harm many more patients than they save. Follow my reasoning.

Most of the abnormalities that scans detect today are innocent lesions that will never make a patient sick. Our internal organs are not smooth and perfect. New scanners, like the satellites in space mentioned in the prior posting, reveal ‘abnormalities’ with their incredible resolution. Healthy people are told every day about internal irregularities, which doctors will then pursue. CAT scan abnormalities create an undertow that drags patients into medical deep waters. Consider a hypothetical example that happens every day in every city in America.

A concerned patient comes to the emergency room with chest pain. The ER physician properly considers a diagnosis of a pulmonary embolus, or a blood clot, and orders a CAT scan. No clot is found and the patient’s symptom resolves. However, the radiologist reports a tiny nodule in the right lung and states in writing that malignancy cannot be excluded.

This patient has just involuntarily entered the medical labyrinth. On the next posting, I will share what his sojourn there will be like. It’s a journey that patients are forced to take every day. It’s a long trip, but it’s no vacation.

3 comments:

Lynn Albro said...

I've got your RSS feed coming directly to my bookmarks. I like the interesting little picture, I'll be checking out more...

kakkaji said...

well said. Hopefully in the future the guidelines will be strong enough to say no further work up is needed.

Michael Kirsch, M.D. said...

Kakkaji, This will not occur in the foreseeable future. There are too many forces creating radiology momentum in the wrong direction. An interim strategy is for patients to discuss the rationale for CAT scans ordered by their physicians to determine if they are truly needed. Perhaps, the ordering physician can be referred to this blog!

MK

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