Articles Posted in Radiation Safety

ctscan-300x214As Walmart tries to work with its 1 million-plus U.S. employees in controlling health care costs, the retailing giant has not only struck a blow for quality medical treatment, it also has raised key questions about a costly and booming specialization in health care: medical imaging.

Walmart decided to shake up this diagnostic field by telling its employees to pay more themselves or to first seek CT scans and MRIs at one of 800 imaging centers that a company-retained health care consulting firm has identified as providing high-quality care. Covera Health, a New York City-based health analytics company, “uses data to help spot facilities likely to provide accurate imaging for a wide variety of conditions, from cancer to torn knee ligaments,” Kaiser Health News Service reported.

KHN reporter Phil Galewitz said Walmart targeted improved imaging based on the giant retailers’ experiences already in funneling workers to select facilities its research has found to offer efficient, high-quality care in specific areas, such as organ transplantation, back and knee surgeries, and heart and cancer treatment.

breastimplantUncle Sam has paid what critics have called long overdue attention to women’s breasts and how surgeons and diagnosticians treat them.

In an angry and emotional public hearing, women ripped the federal Food and Drug Administration for lax oversight of implants that surgeons use to augment and reconstruct breasts, even as the agency proposed its first changes in 15 years to guidelines about mammograms for patients with dense breast tissue.

The FDA has been under fire for decades over breast implants, mostly banned in 1992 but allowed anew in 2005. Experts long have debated whether materials in the implants, notably silicone and not necessarily saline fillings, may be injurious to women’s health. New concerns have developed over surface texturing on the devices, which are supposed to help in the surgery but may affect tissues around and near the breast, leading to spikes in reported cases of rare cancers.

headmri-300x300When patients experience bad headaches, severe chest pain, back or neck aches, or even when kids come in with gut pain that likely is appendicitis, doctors too readily push them into and through what may be hospitals’ over-sized cash-generating machines. It’s past time to end wasteful use of high-powered imaging systems, experts from the Mayo Clinic and Stanford University say.

Drs. Ohad Oren, Electron Kebebew, and John Ioannidis have called out their medical colleagues in an opinion piece published in the medical journal JAMA over excess computed tomography (CT) and magnetic resonance imaging (MRI), saying conditions can’t justify why Americans undergo these costly scans at many times the rate, for example, that Finns do.

Research shows diagnoses don’t improve with many more MRIs and CTs. Instead, they may lead to yet more costly, invasive, and unnecessary tests and procedures, some of which can harm patients.

wheartatttack-238x300As cardiologists and oncologists swap cross-fire about the conditions they treat and how they do so, here’s hoping that, above all, their female patients end up helped and not harmed, getting vital information about risks and benefits of therapies for two of the leading killers of women: heart disease and breast cancer.

What’s behind the medical specialists’ cross currents? Cardiologists and the American Heart Association are pointing to a major therapeutic statement published in the medical journal Circulation.

On the one hand, it provides what many see as an important, needed call to doctors of all kinds to recognize that heart disease among women goes “dangerously under-diagnosed and under-treated,” due in no small part because practitioners still fail to see that women suffer heart attacks in different ways than do many men. They do not, for example, suffer stabbing chest pain, radiating into the arm. Instead, as they experience clogs in tiny veins and arteries, they may feel a constant exhaustion and a discomfort as if they were having their chest squeezed or crushed.

choosing-wisely@2x-300x197Up to a third of medical spending goes for over-treatment and over-testing, with an estimated $200 billion in the U.S. expended on medical services with little benefit to patients. But getting doctors and hospitals to stop this waste isn’t easy, nor is it a snap to get patients to understand what this problem’s all about so they’ll push their health care providers to do something about it.

Which is why kudos  go to Julie Rovner, of the nonprofit, independent Kaiser Health News Service, and National Public Radio for the recent story on how older women with breast cancer suffer needlessly and run up wasteful medical costs due to over-testing and over-treatment.

Rovner and Kaiser Health News worked with a medical benefit management company to analyze records of almost 4,500, age 50-plus women who received care for early-stage breast cancer in 2017. She found that just under half of them got a medically appropriate, condensed, three-week regimen of radiation therapy. Research has shown this care is just as effective as a version that’s twice as long, costs much more, and subjects patients to greater inconvenience, especially with more side-effects.

eclipsepm-300x270e2-150x150e1-150x150Did you find the full solar eclipse to be thrilling and energizing? Hope so. And even if not,  you can start planning to see the next one in 2019 in South America and parts of Asia, or in 2024 in eastern Canada, the central U.S., and part of Mexico.

If you got your hands on good, protective optical gear for the Great American Eclipse, such as the special glasses that complied with the ISO 12312-2 safety standards, store it well, and it should be good to go, even a few years from now.

Or you might want to donate them—the global nonprofit Astronomers Without Borders group is putting on a big online push to collect the give-away glasses for youngsters in the developing world for so they safely can watch the next total eclipse in their areas. Smithsonian Magazine says the group in 2013 rounded up, then donated thousands of such specs so youngsters in west and central Africa could watch a celestial event that year.

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.

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