Multiple CT scans increase “incidentaloma” risk

Children at emergency departments in the U.S. had five times as many CT scans in 2008 as they did in 1995, according to a recent study, increasing not only risks associated with radiation exposure but also risk of “incidentalomas,” the term physicians use for incidental findings that could be (but probably aren’t) cancer.

In addition, the study, published in the journal Radiology, found that 6% of pediatric visits to the ER involved a CT scan, while an earlier study by the same research group, led by Dr. David Larson at Cincinnati Children’s Hospital Medical Center, found an even greater rise in scanning during adult ER visits, with 25 percent of patients age 65 and older and 12 to 16 percent of younger adults getting a CT scan in 2007. CTs of the abdomen and pelvis were the most likely to turn up an incidental finding.

An earlier study published in the Archives of Internal Medicine found that nearly 40 percent of CT and MRI scans performed for research purposes at the Mayo Clinic from January through March 2004 turned up at least one incidental finding. In the 35 patients in whom doctors took further action (i.e. additional testing, specialist consultation, or surgery), only six were judged by researchers to have clearly benefited from an investigation, while in the rest there was no clear benefit or clear harm, such as complications from surgery for a benign tumor.

In response to growing concern about the rising numbers of incidentaloma, the American College of Radiology recently published detailed guidance for clinicians about how to approach such findings, and warns physicians that “subjecting a patient with an incidentaloma to unnecessary testing and treatment can result in a potentially injurious and expensive cascade of tests and procedures.” The college advises physicians to carefully consider an individual patient’s risk for cancer in deciding whether or not to recommend further evaluation.

It also advised patients who are told about an incidental finding to seek a second opinion to verify that the radiologist’s interpretation of their scan is correct, to adopt a “healthy skepticism” about testing, and only to consent to scans absolutely necessary to establish a diagnosis or plan of action, rather than to those ordered “just to be sure.”

Source: U.S. News & World Report

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