| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Irogers{at}ajroffice.org
Whole-body CT screening is definitely in vogue. More and more radiologists are offering the service, and it is heavily advertised by those who do. Get on the bandwagon! It is just the thing for the worried (and moneyed) well. "Drop by. It will only take a few minutes and, after the CT examination, the radiologist will be able to tell you if you have anything to worry about: cancer, heart disease, or circulatory problems, among other things. But more likely you will walk away feeling good about yourself."
Of course, whole-body CT screening is not cheap. The charge for the examination may be as much as $1000.00. Surely no one is giving these examinations away. Nor are they covered by medical insurance. In fact, most facilities require payment up-front, by cash or credit card, before the examination is undertaken. Full pay, cold cash is hard to come by these days. Schedule a few such examinations every 15 minutes or so early in the morning before the regular schedule starts and a few more early in the evening after the regular schedule ends. Found money. Eight to ten thousand dollars a day is nothing to sneeze at.
Another major difference between whole-body CT screening and practically all other radiologic examinations is the source of the patient referral. Unlike patients undergoing almost all other diagnostic imaging that is performed at the request of a referring physician, patients who seek whole-body CT screening are self-referred.
Indeed, whole-body CT screening is consumer-driven. People today want to exercise control over their medical care; they have a sense of "medical empowerment." They are imbued with the concept of "wellness" and the prolongation of an active life span [1]. The idea of undergoing whole-body CT screening fits nicely into the concept of assuming personal responsibility for one's health. And some radiologists are now saying, "If they want it, give it to them—or rather, sell it to them."
From the perspective of science and medicine, there is only one hooker in all of this: there is no proof that whole-body CT screening is of any real value or benefit to the patient. I am quite struck by the fact that whole-body CT screening is being promoted and performed with little or no scientific evidence to justify or validate such screening. Certainly, to my knowledge, no comparative scientific studies of whole-body CT screening have appeared in the peer-reviewed literature to support its implementation. No such studies have even been submitted to the AJR. Simply put, there is no apparent scientific basis for whole-body CT screening.
That said, a lot of people seem to want whole-body CT screening, and many radiologists are willing and able to comply with their requests. Consequently, many (I hesitate to estimate how many) such examinations are performed daily. Where are the results of randomized, controlled clinical trials of whole-body CT screening? Again, none have been performed or published. Who should undergo or who would benefit from whole-body CT screening? What has been found and what is likely to be found by doing these studies? What are the false-positive and false-negative rates? What percentage of patients require additional studies? Do patients who undergo whole-body CT screening live longer, more productive lives than those who do not undergo such studies? Nobody knows, because no such studies have been published.
Most authorities agree that before any procedure is adopted to screen for disease, the risks, benefits, and costs of the procedure should be rigorously evaluated and the value of the procedure established. Before that evaluation is done, the value of the procedure must be considered unproven and unknown [2, 3].
On the other hand, if people want it or demand it, why not accommodate their requests? I mean, if they want a red sweater or a loaf of rye bread, they can go out and buy it. And if one store doesn't have the red sweater or the rye bread they are looking for, people can find another store that does. People are free to buy what they want. But that's commerce, not medicine. It may even be good commerce, but is it good medicine? When you supply and sell on that basis, you are more a seller of goods, more a merchant, and less a doctor of medicine.
Radiologists would benefit from an understanding of the scientific concept, the basic tenets of screening before embarking on various screening procedures in their practices. This issue of the AJR contains three excellent articles devoted to patient screening, all of which will assist with your consideration of the implementation of screening procedures. The first article, by Herman et al. [3], explores the scientific basis of and basic requirements for screening. The second, by Swensen [4], reviews the extensive experience at the Mayo Clinic with CT screening for lung cancer. And the third, by Lenny Berlin [5], explores certain legal ramifications arising from the performance of screening procedures. Your time will be well spent with these three articles.
Back to that question I think I heard on TV: "Is whole-body screening right for you?" Well, yes, it seems, as a radiologist, you might be able to do pretty well doing whole-body CT screening. But then, "Is whole-body CT screening right for your patients?" Unfortunately, it appears that the information required to make an informed judgment on the latter question is not available at this time.
References
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
 |
|
  C. T. Kolber, G. Zipp, D. Glendinning, and J. J. Mitchell Patient Expectations of Full-Body CT Screening Am. J. Roentgenol., March 1, 2007; 188(3): W297 - W304. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Muchantef and H. P. Forman Cost Accounting in Radiology: New Directions and Importance for Policy Am. J. Roentgenol., December 1, 2005; 185(6): 1404 - 1407. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. M. Hall and L. F. Rogers CT Screening Examinations Am. J. Roentgenol., April 1, 2003; 180 (4): 1178 - 1179. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
