CT Scans: How Much Is Too Much?

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Can you have too many CT scans?  On location at the 2015 American Society of Hematology (ASH) in Orlando, Florida, medical correspondent Carol Preston, interviews Dr. Lisa Hicks, oncological hematologist and Chair of the Choosing Wisely Task Force.  “CT and PET scans are enormously powerful….when done in the right setting and extremely helpful,” says Dr. Hicks, “But it is always appropriate for patients to ask.”

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Carol Preston:

Hello everyone and welcome.  I'm Carol Preston, and I'm reporting to you from ASH, the American Society of Hematology this year in Orlando, Florida.  With me is hematologist Dr. Lisa Hicks of St. Michael's Hospital in Toronto, but she also chairs a very, very important committee for ASH, the Choosing Wisely Task Force.

Dr. Hicks, can you tell us what that is? 

Dr. Hicks:

Sure.  I'd be happy to.  The Choosing Wisely campaign is a medical stewardship campaign that was initiated by the American Board of Internal Medicine Foundation, and it partners with specialty societies including the American Society of Hematology.  And really we try to identify areas of possible overutilization in medicine, areas where we want to start conversations about whether certain tests or treatments or procedures are really necessary and are helpful in all situations. 

Carol Preston:

And I understand this year one of your focus points is on CAT scans.  

Dr. Hicks:

Yeah, and CAT scans are interesting in that they've been a recurring focal point for our list.  So this year our list is quite different from past years.  In past years, we generated our own unique lists of five items for patients and physicians to question.  This year, we really wanted to leverage the work done by other societies, so what we did was review the work of more than 70 other societies, actually… 

Carol Preston:

Wow.  

Dr. Hicks:

…and prioritize their recommendations for what we thought were most relevant for hematologists and hematology patients.  And you're right.  Two of those—two of those items do have to do with CT scans, in one case CT PET scans.  So one of the items has to do with CT scans for patients who are being considered as having a possible pulmonary embolism, and those might be—some of those patients might have malignancy as the driving factor, others would not.  And that item comes from the American College of Radiology originally.  

Carol Preston:

Right.  So what exactly do patients need to know?  Should they be asking more questions about CT scans and PET scans?  The reason I ask is I related to you a little earlier that when I was first diagnosed with CLL within the space of a very short amount of time I had four CT scans, and some combined with PET, maybe all of them.  And I basically said to my hematologist, unless there's a compelling reason I don't want to have these anymore, and I haven't had one since 2006.  Now, I guess if I had needed one I would have, and this isn't about me, but I don't know how many patients feel comfortable pushing back. 

Dr. Hicks:

Yeah, so I think it's always appropriate to ask, and that's something that we really want to encourage.  You know, CT and CT PETs are enormously powerful technology. And when they're done in the right setting, they're extremely helpful.  So we certainly don't want to encourage patients to be turning down or not getting access to tests that are very helpful, but I think that over time there has been a tendency sometimes to use these high?technology tests when there are other ways of ruling out diseases or following diseases without requiring these tests. 

And, of course, there is a downside to all the tests that we do, and for CTs one of the downsides is a very small but not insignificant exposure to radiation, which is particularly important in very young patients.  Young patients are at higher risk of developing secondary malignancies, and they have a much longer life expectancy for that risk to accumulate.  So radiation?induced cancer is a concern in young people.  

Carol Preston:

Now, one of the areas where they may not be able to push back so easily is in the area of clinical trials because researchers need data and one of the ways they collect these data are through CT and CT PET scans. 

Dr. Hicks:

Yes.  

Carol Preston:

So that is a bit of a challenge, isn't it? 

Dr. Hicks:

Yeah.  You're absolutely right.  And I think it's important to clarify that none of the Choosing Wisely recommendations from ASH or from any other society for that matter are meant to impact on what's done in the setting of a research setting.  Research is about answering important clinical questions. And by definition we don't know the answer, so there are things that are done in a research setting which we would not yet want to continue in a wider, wider practice setting. 

So I think you're right that that's a very special circumstance.  But the amount of CT scans and PET scans might be something that someone might want to consider and talk about when they're considering a clinical trial.  

Carol Preston:

And that is a great way to end this conversation.  For patients who are watching this, feel comfortable in asking your physician or healthcare provider about the appropriateness and the frequency of the tests that are being recommended for you.  Dr. Lisa Hicks of Toronto, hematologist, thank you so much for joining us.  I'm Carol Preston.  Thanks for watching.  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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Page last updated on February 19, 2016