by Dr. William Shuman on May 16, 2012
Is low-cost an added benefit to widespread lung cancer screening? According to this article, from April’s Health Affairs—yes! The study on this much debated about topic asserts that routine CT lung cancer screening of high-risk individuals would save thousands of lives annually for less than one dollar a month per patient, if implemented throughout the US. According to these figures, the cost of low-dose lung cancer screening could be less than that for both breast cancer screening and colorectal cancer screening.
As we’ve pointed out, lung cancer screening is effective and life saving. For high- risk patients, those who are multiple pack year smokers for 25 years or more, screening provides significant benefits. For these individuals, low-dose CT screening reduces the number of lung cancer deaths by 20 percent!
Despite this, widespread lung cancer screening has yet to be implemented nationwide, largely due to cost. This study reports interesting and encouraging data about widespread implementation of the procedure, though. However, we must remember that there are also reputable articles which report much higher cost numbers when adjusted for quality-life-years saved. It is necessary to take these studies into account, too.
Looks like the jury may still be out on this one!
by Dr. William Shuman on May 11, 2012
The Choosing Wisely Campaign is a recent initiative of the ABIM Foundation to encourage physicians and patients to take a second look at tests and procedures that may be unnecessary… and potentially, harmful. The American College of Radiology was one of nine US specialty societies that developed lists of the Five Things Physicians and Patients Should Question.
See the ACR’s outlined recommendations of the procedures that should be utilized less in radiology practices:
• Imaging for uncomplicated headache, absent specific risk factors for structural disease or injury.
• Imaging for suspected pulmonary embolism (PE) without moderate or high pretest probability of PE.
• Preoperative chest x-rays without specific reasons due to patient history or physical exam.
• CT to evaluate suspected appendicitis in children until ultrasound is considered an option.
• Follow-up imaging for adnexal (reproductive tract) cysts 5 cm or less in diameter in reproductive-age women.
All five of these recommendations are ones that I would certainly agree with. In fact, I wouldstrongly emphasize that CT for possible pulmonary embolism in young women be avoided unless there are clinical criteria which raise suspicion to at least moderate level. Additionally, ultrasound is a great modality to check for appendicitis in children, especially those that are young and/ or thin.
For the full recommendations by the ACR, please see here. Remember, informed patients are an integral part of the Choosing Wisely campaign.
by Dr. William Shuman on May 8, 2012
A recent study on the high accumulation of radiation dosages in young patients with inflammatory bowel disease brings light to a topic of concern for any CT practitioner. This research, published in Clinical Gastroenterology and Hepatology, concludes that patients with digestive disorders may be exposed to significant radiation doses from abdominal CT over time.
It attests that the radiation levels among patients with gastrointestinal disorders have risen over the last few years. And, mostly due to repeat scanning, over 50 percent of the patients with cumulative exposure exceeding the 90th percentile, particularly those with IBD, were younger than 35 years old.
Here at UW, we recently acquired a new CT imaging reconstruction algorithm- VEO or model based iterative reconstruction. This lowers radiation dose 60 to 80 percent below that of ASIR reconstruction and 90 percent below that of FBP. The only disadvantage of VEO? It takes about 30 to 40 minutes per case to reconstruct because it is computationally much more intensive.
In planning how to begin using VEO, one of the first patient groups we’ve focused on is young patients with IBD. The use of this technology will help lower the accumulative radiation dose levels among those patients who require regular abdominal screening.
