Do you really need a CT Scan or X-ray?:

Patients are often exposed to cancer-causing radiation for little medical reason, a Consumer Reports investigation finds

When James Duncan, M.D., a radiologist at Washington University in St. Louis, experienced intense pain in his abdomen in 2010, he rushed to a local emergency room. His doctors suspected kidney stones, but they wanted to be sure, so they ordered a CT scan. Duncan remained motionless as the machine captured a detailed, 3D image of his abdomen. He knew that the test was done when the machine stopped whirring. So he was surprised when the scanner kicked back on after a few seconds.

“I later learned that the technician running the CT mistakenly believed that the first scan didn’t include the top of my kidneys, and decided to acquire more images ‘just to be sure,’ ” Duncan says. “The irony: I was getting ready to give a lecture on reducing radiation exposure from medical imaging. And there I was, reluctantly agreeing to a CT scan and then getting overexposed.”

Duncan will never know whether that specific scan caused any long-term harm, because it’s almost impossible to link radiation exposure from any one medical test to a future illness. But like other researchers, he knows that doctors today order millions of radiation-based imaging tests each year, that many of them are unnecessary, and that the more radiation people are exposed to, the greater their lifetime risk of cancer.

X-rays have been used for almost 120 years, but the introduction of computed tomography, or CT scans, in the 1970s, was revolutionary. The new tests, which use multiple X-ray images, allowed doctors to see with unprecedented precision the inner workings of the human body, and earned the inventors of the device the 1979 Nobel Prize in medicine. Use of the tests grew quickly, rising from fewer than 3 million per year in 1980 to more than 80 million now.

But recent research shows that about one-third of those scans serve little if any medical purpose. And even when CT scans or other radiology tests are necessary, doctors and technicians don’t always take steps to limit radiation exposure.

All of that exposure poses serious health threats. Researchers estimate that at least 2 percent of all future cancers in the U.S.—approximately 29,000 cases and 15,000 deaths per year—will stem from CT scans alone. Even some standard X-rays, which expose you to much smaller amounts of radiation, can pose risks if you undergo multiple ones.

“No one says that you should avoid a CT scan or other imaging test if you really need it, and the risk posed by any single scan is very small,” says Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser. “But the effect of radiation is cumulative, and the more you’re exposed, the greater your cancer risk. So it’s essential that you always ask your doctors why they are ordering an imaging test and whether your problem could be managed without it.”

Given those risks, why are we—and our doctors—so scan-happy?

That’s the number of people estimated to die each year because of cancers caused by the radiation in CT scans alone.

For one thing, patients aren’t necessarily aware of the danger. A new Consumer Reports survey of 1,019 U.S. adults found that people are seldom told by their doctors about the risks of CT scans and other radiology tests. It’s no surprise, then, that only 7 percent of those who had a nondental X-ray and 2 percent of those who had a CT scan thought they might have received the tests unnecessarily. And only 4 percent ever told their doctor they did not want a CT scan. “That’s worrisome,” says Lipman’s colleague at Consumer Reports, Orly Avitzur, M.D. “Patients need to take the lead on this because their doctor may not.”

Other studies show that doctors themselves often underestimate the dangers CT scans pose. Moreover, some doctors may actually have a financial incentive to order the tests.

“Health care professionals shouldn’t have the right to image children or adults unless they first show that they can do it safely and appropriately, and most of the time in this country, that’s not happening,” says Stephen J. Swensen, M.D., medical director at the Mayo Clinic in Rochester, Minn. “If the scan isn’t necessary or emits the wrong dose of radiation, the risks far outweigh the benefits.”

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Study: Victims of mistakes in hospitals not reporting errors:

The Haverhill Gazette

By Lauren DiTullioStaff Writer | Posted: Thursday, December 11, 2014 1:10 am

Twenty years ago, one mistake at a renowned Boston hospital cost a Boston Globe reporter her life and permanently damaged the heart of a North Andover teacher. Today, nearly one in four Massachusetts residents still believe they or someone close to them has been affected by a medical error, a recent study by the Harvard School of Public Health found.

Of those people, more than a third chose not to report the mistake.

Justin Sayde,  administrative and research manager at Harvard School of Public Health, said the aim of the study was to gather preliminary data and get a sense of the scope of the medical error problem in the state. It was co-commissioned by the Health Policy Commission and the Betsy Lehman Center for Patient Safety and Medical Error Reduction.

The center is named for the Globe healthcare columnist who died after she was prescribed four times as much chemotherapy medication as necessary during a study at the Dana-Farber Cancer Institute in 1994. Maureen Bateman of North Andover died a little more than two years after she participated in the same trial.

“We’re just really trying to wrap our heads around the extent of this issue,” Sayde said. “It is very much still an issue. That’s the takeaway point. There have been some improvements, but something needs to be done.”

The study, released a week ago, asked 1,224 Massachusetts residents whether they or someone close to them believed they had experienced a medical error situation. Twenty-three percent responded that they had. Of those people, 54 percent chose to report the error, while 37 percent chose not to.

“The challenge here is that the reporting is spotty. The requirements depend on where you live. It’s different state by state,” Sayde said.

Of those who reported the incident, most told only their doctor, and just 8 percent reported it to a state agency. Those who chose not to report the error gave a variety of reasons, but 36 percent said it was because they didn’t know how.

“I think part of the issue is that most of the public isn’t aware of how to report these errors,” Sayde said. “I wish I could say there’s a hard and fast rule about what should be done if you think you’ve been involved in a medical error situation. The whole purpose of the Lehman Center is to look at what’s happening and try to … formulate a protocol.”

The Department of Public Health requires that hospitals report errors like the one that killed Lehman and injured Bateman, in addition to many other types of mistakes. The state defines a “serious reportable event” as an error that is “clearly identifiable and measurable … and of a nature such that the risk of occurrence is significantly influenced by the policies and procedures of the healthcare facility.” Examples include falls that result in injury, operations done on the wrong body part, procedures that leave foreign objects inside the patient, complications due to contaminated medications and more.

In 2012, Methuen’s Holy Family Hospital reported three major errors. In 2013, the number more than doubled, with eight incidents reported. The case was similar at Lawrence General Hospital and Merrimack Valley Hospital, which has since merged with Holy Family Hospital and is now called Holy Family Hospital at Merrimack Valley. Both reported four incidents in 2012. In 2013, the number at Lawrence General rose to seven. Merrimack Valley Hospital reported eight.

Lawrence General Hospital’s Chief Medical Officer, Dr. Neil Meehan, like Roach, attributed the increase to new reporting standards for hospitals. Still, he acknowledged that those in the field have been pushing to address a wide variety of patient safety issues in recent years. Lawrence General’s Chief Executive Officer Dianne Anderson sat on an expert panel during a presentation about the problem at the recent relaunch of the Lehman Center. Established in 2004, it closed in 2010 due to lack of funding, but was re-established this year as part of a larger piece of healthcare legislation passed in 2012.


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