Articles Posted in Radiation Safety

Female_black_symbol-200x300Modern medicine isn’t addressing women’s distinctive health care needs as optimally as needed, with research further showing it may be time to dial down expectations about breast cancer screening, while heightening physicians’ awareness and best practices in eliminating gender biases.

Women also may want to keep close tabs on how changes with the Affordable Care Act affect them, and they may be well-served to remind themselves about Texas’ sudden surge in maternal deaths and one of health care’s major, gender-based debacles in hormone treatments for females.

Over-treatment tied to mammograms

bitewingThe cost won’t exactly break the bank. But it might equal what you will pay for the oral health care that prompted the visit. When the dentist starts saying it’s time for partial or “bitewing” X-rays, just say no, a health care economist recommends.

Austin Frakt, an expert writing in the paper’s Upshot column, hit a nerve with hundreds of New York Times reader-commenters when he noted that no less august a group than the American Dental Association recommends that bitewing X-rays should be taken sparingly and probably not annually, especially for an otherwise healthy (dentally speaking), recurring, adult patient in a practice.

But as Frankt pointed out, too many dentists have made these X-rays part of the yearly cleaning regimen. He says, in passing, that insurers often cover this procedure, which can cost as much as the cleaning−effectively doubling the per patient revenue for practitioners.

Now that the American Cancer Society has joined a growing chorus of experts and offered new screening guidelines for women with fewer mammograms and fewer breast physical exams, everything changes —  just like that, right? Not that easy.

As the New York Times points out, it will take time for patients to see these breast practice recommendations followed.

“Once physicians become conditioned to be more invasive, it’s hard for them to reverse course,” writes Aaron E. Carroll, a professor of pediatrics at Indiana University School of Medicine who blogs on health research and policy at The Incidental Economist. He looks to peer-reviewed, published research to see that, “after spending lots of money and many man-hours in interventions,” Canadian doctors reduced the too-high rate of Cesarean sections by meager amounts, from 22.5 percent to 21.8 percent.

Magnetic resonance imaging (MRI) is a body scan that provides detailed images particularly good for viewing soft tissue (versus a traditional X-ray that’s better for seeing bone). Sometimes, drugs are injected before you have an MRI to add contrast, making the images sharper. But some of the drugs in those agents might be toxic.

We recently wrote about another risk of certain diagnostic scans including MRIs, when people are not told about the risks of radiation. Now, according to ProPublica.org, it seems as though the brain can be damaged by a heavy metal the contrast drugs contain called gadolinium.

Marcie Jacobs, a woman profiled in the story, had a family history of breast cancer. In 2001, she decided to have an MRI for preventive care. She was injected with a contrast agent, and later began experiencing strange cognitive effects. At first they were fairly minor, like forgetting about work meetings.

A couple of months ago, the U.S. Preventive Services Task Force (USPSTF) stirred the cancer screening pot with its opinion that mammograms are of limited use as cancer screenings for younger women and that, mostly, only women 50 and older should get them regularly. This month, its recommendation (in draft form) received support from the World Health Organization.

As NPR explained, “The WHO’s International Agency for Research on Cancer has just finished its review of mammography to screen for breast cancer, and it, too, concludes that the value of these screening X-rays is ‘limited’ for women in their 40s.”

Both organizations fully support regular mammography for women in their 50s and 60s, and offer their advice for younger women only if they don’t have complicating factors, such as a family history of breast cancer. As usual, mammography is not a one-size-fits-all diagnostic tool, and the USPSTF and the WHO advise women in their 40s to discuss with their doctors their individual circumstances.

Earlier this month, the New York Times wrestled with the thorny issue of lung cancer screenings, and whether people who are entitled to certain screenings through their Medicare coverage should get them. As the paper pointed out, “… screening will not help everyone who is eligible, experts warn. Like any medical test or procedure, it will subject some patients to harm.”

According to HealthNewsReview.org (HNR), which rates media on how well they cover health and medicine news, The Times did a superior job of explaining why a yearly computed tomography (CT) scan is a good idea for some people, and maybe not for others.

Smoking, of course, is a huge risk for contracting lung cancer, and Medicare recently approved subsidizing a low-dose CT scan every year for people 55 to 77 years old who have a smoking history of at least 30 “pack years”; that is, they smoked a pack a day for 30 years, or two packs a day for 15, etc., and still smoke or have quit only within the last 15 years. (See our blog about the advisory panel’s analysis that informed Medicare’s decision.)

Another unsettling study indicates that people undergoing diagnostic scans involving radiation are not given information about the risks of the procedure. As reported by AboutLawsuits.com, less than half of those patients are aware of the scan’s potential health risks.

The study, published in the Journal of the American College of Radiology, found that 1 in 3 patients did not have a full understanding of testing procedures to which they were about to submit, and they were particularly unaware of the radiation risks.

The inappropriate or overuse of nuclear scans (those involving radioactive agents) and X-rays when diagnosing an injury or disease, over time, can cause cancer.

Cardiac stress testing can be a useful tool to assess heart function, but since it became trendy for companies to subject their executives to treadmill stress tests as part of their annual checkups, the technology has grown too big for its britches.

That’s paraphrasing the results of a study published recently in the Annals of Internal Medicine. The study, as summarized by MinnPost.com, showed that “Inappropriate use of cardiac stress testing – particularly testing done with imaging – is costing the U.S. health care system more than half a billion dollars,…”

But in addition to the cost, cardiac stress tests with imaging subject people to radiation, which the study says each year might lead to as many as 500 future cases of cancer. So the overuse of this technology isn’t just a waste of money, it’s a threat to patient safety.

Despite the increased use of CT scans to diagnose kidney stones for emergency department patients, the imaging technology is no better than an ultrasound exam, and ultrasound is safer.

Ultrasound, according to a recent study published in the New England Journal of Medicine, (NEJM) is the preferred first-line diagnostic tool when someone presents at the ER with the extreme pain characteristic of kidney stones. It was clear that although ER physicians routinely turn to CT scans for kidney stone diagnosis, “Ultrasound is the right place to start,” concluded the study’s senior author, Dr. Rebecca Smith-Bindman. She’s a professor at UC San Francisco.

The issue, as readers of this blog will recognize, is radiation. CT scans expose patients to significant amounts of radiation; ultrasound scans don’t.

Texas has about 28,000 licensed X-ray technicians, but if the state follows the recommendation of an advisory commission, the piece of paper that certifies that they’re qualified to dose you with radiation won’t be necessary.

The state, according to the Texas Tribune, might decide that radiologic technologists, as well as several other categories of health professionals, no longer need a license to do their jobs. What the members of the Department of State Health Services’ Sunset Advisory Commission don’t seem to understand is that licensing the people with the potential to cause serious harm is a measure of protection against lack of training and ability. (See our backgrounder on radiation overdose injuries.)

The commission, which is charged with identifying inefficiencies in state government, believes licensing is regulatory redundancy because people receive X-rays, MRIs and CT scans in health-care facilities that themselves are highly regulated. By that logic, no hospital that surpasses all oversight measures ever grants practice privileges to a surgeon who – oops! – leaves a sponge inside a patient.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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