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Radiation hazard in too many CT scans for chest pain

CT Scans For Chest Pain? Study Questions Benefit For Patients HUFFINGTON POST, By MARILYNN MARCHIONE 07/25/12 If you’re having chest pains, an advanced type of CT scan can quickly rule out a heart attack. New research suggests this might be good for hospitals, but not necessarily for you.

These heart scans cut time spent in the hospital but didn’t save
money, the study found. They also prompted more tests and questionable
treatments and gave relatively large doses of radiation to people at
such low risk of a heart attack that they probably didn’t need a major
test at all.

There is no evidence that adding these tests saved lives or found more
heart attacks, wrote Dr. Rita Redberg, a cardiologist at the
University of California, San Francisco in an editorial. Her
commentary accompanied the study in Thursday’s New England Journal of
Medicine. And since radiation from the scans can raise the long-term
risk of developing cancer, doctors “may legitimately ask whether the
tests did more harm than good,” she wrote……
more than 90 percent of the 6 million people who go to hospitals each
year in the U.S. with chest pain have indigestion, stress, muscle
strain or some other problem – not heart disease. Doctors are afraid
of missing the ones who do have it, and increasingly are using CT
scans – a type of X-ray – with an injected dye to get detailed views
of arteries.

More than 50,000 of these scans were done in Medicare patients in
2010, and their use is growing. Far more than that were done in
younger patients like the ones in this study, who were 54 years old,
on average.

The test requires a substantial dose of radiation, which can raise the
risk of cancer years down the road. In some cases, patients might just
be told that a doctor wants the test. They may be too frightened to
question it or unaware they can refuse or ask about other testing
options without jeopardizing their care…..
Researchers led by Dr. Udo Hoffmann at Massachusetts General Hospital
enrolled 1,000 patients who went to one of nine hospitals around the
country during regular daytime, weekday hours with chest pain or other
possible heart attack symptoms. All showed no clear sign of a heart
attack on initial tests – an electrocardiogram and blood work……
the average cost of care was $4,289 for patients given the CT scans
versus $4,060 for the others, despite spending seven hours less in the
hospital. That’s because CT scans led to more follow-up tests and
treatments, even though the burden of disease was about the same; 8
percent of both groups turned out to have heart disease and only 5 of
the 1,000 had had a heart attack……
A much larger study comparing CT scans and other tests for evaluating
heart risks in 10,000 patients is under way now, but it won’t provide
answers for several years.

In the meantime, a patient’s gender, age, and history of chest pain or
other illnesses such as diabetes go a long way toward predicting risk
as long as the initial EKG and blood work suggest no problem, Redberg
contends.

“With no evidence of benefit and definite risks, routine testing in
the emergency department of patients with a low-to-intermediate
risk…should be avoided,” she wrote. “The question is not which test
leads to faster discharge of patients from the emergency department,
but whether a test is needed at all.”
http://www.huffingtonpost.com/2012/07/25/ct-scan-chest-pain-heart-attack_n_1703974.html

July 26, 2012 - Posted by Christina Macpherson | health, USA