Medical Tip of the Week: Know when to decline a medical imaging study

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By Steven Greer, MD

One of my parents recently had an abdominal ailment and was almost given a CT scan by mistake, despite my elaborate efforts to have an MRI scan ordered instead to spare them from the radiation of the CT scan. If you have any relatives with an illness requiring surgery, there is a good chance that they underwent numerous medical imaging studies, such as CT scans.

All of us at some point will become ill and likely undergo some of these imaging studies. However, it is becoming more apparent to the medical community and public that many of these tests are harmful and unnecessary. This issue has been a concern of mine long before recent events that raised awareness. I will try to summarize the pertinent facts and let you know what your rights are as a patient.

Medical imaging studies that use large doses of radiation, such as CT scans, cardiology perfusion scans, etc. have been in the lay press over that last few years due to horrific stories of operators using ten times the radiation dosages and causing sever side effects and death. Less known to the public are the numerous academic publication in the New England Journal of Medicine, JAMA, and actions taken by the FDA and Medicare to curtail the overuse of CT scans and similar studies.

These medical publications and government actions have only begun within the last three years. Meanwhile, over the last two decades, medical imaging studies have more than doubled in usage and are a lucrative component to medical center and private practice office revenues. The latest trend is for cardiology practices to purchase their own CT scanner and perform routine scans of the heart to look for coronary artery disease (despite a lack of evidence that this does any good for the patient). The individual radiologists also profit from each CT scan that they read. The surgeon ordering the study gets some malpractice defense for ordering the tests.

All of these powerful factors have formed our current system whereby it is very possible for patients to receive multiple unnecessary CT scans, etc. during the course of diagnosis and ultimate therapy. Other than wasting money, what is the harm in unnecessary CT scans?

The medical literature is raising the concern that certain medical imaging studies increase the risk of cancer. One CT scan is equivalent to a hundred or more regular chest X-rays, depending on the type of CT scan.

How can you as a patient avoid being harmed by an unnecessary medical imaging study? The first step is to become informed of the basic facts by reading articles like this one, or the excellent series in The New York Times by Walt Bogdanich et al. Then, you need to ask your medical doctor if an alternative imaging study, such as portable ultrasounds or MRI scans, both of which deliver no radiation, would suffice. A new diagnostic skill set being taught to all medical student now is how to use handheld ultrasounds and obviate CT scans or other studies.

Every medical center should now be implementing plans to reduce radiation exposure to the patient, in the wake of the horrific accidents at Cedars Sinai, and elsewhere. If you sense that your doctor does not take your concerns seriously, or at the day of the scheduled imaging study, the radiologist tries to switch the order from an MRI to a CT scan, then simply walk out.

You have every right as a patient to tell your doctor, “No thanks”. Do not let the large number of people wearing scrubs and white coats intimidate you, although that is easier said than done. Hospital settings, combined with the fear of an unknown yet-to-be-diagnosed illness, create a formidable intimidating experience.

To read more about these matters, please refer to our prior works here:

Medical imaging is more dangerous than the Japan or Chernobyl accidents

Other reports on this serious problem

Reza Fazel, MD: Radiation exposure from medical imaging studies

Steven Greer MD: A discussion with Bill O’Reilly about radiation risks

Courtney Coursey, MD: The utility of pre-op CT scans in rule out appy

Update: U.S. Radiation levels from Japan

Mahadevappa Mahesh, PhD: The cancer risk from CT scan exposure

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