CT Center for Patient Safety Newsletter
December 2, 2009
In This Issue
CT Scans
Too much testing
More on mamograms

More than half of patients who undergo abdominal/pelvic CT scans receive unnecessary imaging tests that put them at risk for radiation-induced cancer, according to new research from the University of Wisconsin in Madison. 
Dr. Kristie Guite and colleagues studied 978 CT scans of the abdomen and pelvis that were performed on 500 patients and found that 52.2 percent of the patients' scans weren't necessary, Reuters reports. Moreover, the average excess radiation dose per patient was 11.3 millisieverts, about the equivalent of 113 chest X-rays.
"At the dose seen in our study, one in 1,000 patients could get a radiation-induced cancer," Guite said Monday during a presentation of her results at the Radiological Society of North America meeting in Chicago.  Radiation overdoses have been prominent in the news for quite some time.  In October, Cedars-Sinai Medical Center and GE Healthcare were named as co-defendants in a class-action suit representing patients who possibly received radiation overdoses during CT brain scans. In those cases, hundreds of patients had received more than eight times the normal dose of radiation required.

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Dear CTCPS members,
Yesterday I got notice that my health insurance - I have an individual policy - would be increased to $857/month.  This year I paid $770 each month.  This is outrageous and what indiviudals who buy their own policies face each year. This is more than a 10% increase. I can hardly wait for Medicare.  Yes.  I want a government run health care system and I want it to start right now.  As we watch the debate in DC, it is frightening to see our Senators stick to party lines instead of grasping the significance of reform.  Senator Lieberman needs to hear from all of us because been supportive of reform. Senator Dodd and the rest of our Congressional delegation have been there for all of us.  We must thank them.
Jean Rexford
203 247 5757 
How Can We Prevent Having to Undergo Too Many Tests?
The most useful answer to this question is knowledge. If your doctor orders tests for you, there are a few things you can do:
For all tests, Ask two questions. What is this test for? And, what do you expect to find?
For tests the doctor runs in her office (blood work, EKGs, even MRIs), ask the questions above, then ask what that test will answer that another test already ordered may not. Or, ask if there is a less expensive form of a test, or one that will supply enough information but not more than is needed. For example, a doctor might need to measure a diabetes patient's HbA1c by taking a sample of blood. That is one test. But the doctor could order a full panel of bloodwork instead, which is far more extensive, potentially unnecessary and billed at a higher rate (meaning she makes more money. It's up to the patient to figure that out.
For tests ordered in a lab not connected to the doctor's office, ask the questions listed above, but be less concerned about whether those tests are extra, unless you believe they might be included in the defensive medicine category. If the doctor can't profit from extra tests directly, there is less chance you'll have to undergo more than you need. Kickbacks or commissions, where a lab or facility pays a doctor for referrals, are illegal in most states in the United States. Yes, there are certainly examples of fraud. If you have enough energy, you might even pursue that possibility. But as the patient, your number one goal is to get well, not uncover fraud.
For all tests, ask when the results will be available, and ask that copies of the test results and records be supplied to you.

 Trish Torrey, Patient Advocate, came up with this list.
Study questions safety of mammograms for young women at high risk of cancer.
Yet another article in the New York Times questions the value of mammograms. Researchers saw an increased risk of actually getting breast cancer due to radiation exposure.  What are women supposed to do? While it is up to each woman and her doctor to decide the best course of action,  I think it underlines the risks of all medical interventions.  We want data driven evidence, best practices and we want industries that profit from the interventions banned from the evaluation of the drug and the procedures.
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