Computed Tomography (CT) scans produce incredibly detailed high-resolution pictures of the body, making them invaluable tools for the detection and treatment of disease. However as doctors rely on them more and more for diagnosis and monitoring and patients demand them for every ache and pain, the utilization of these high-tech scans has increased dramatically over the past 20 years. But how much imaging is too much? What if the burden of radiation exposure from these scans outweighs the benefits? Two new studies published in the Archives of Internal Medicine this week raise the concern that all of this scanning may be too much of a good thing. One study predicts that between 15,000 and 45,000 future cases of cancer may be caused by the radiation exposure, while another study tracks huge variation in the amount of radiation patients are exposed to, even for the same type of scan.
Overall, this story was well done. By accurately describing the predicted number of cases of cancer and resulting dealths in the study, the story avoids disease mongering. The story mentions several other testing options, such as simpler CT tests, conventional X-rays, ultrasound or MRI that involve less or no radiation. The story does a good job of describing the harm of exposure to radiation due to CT scanning, but could have also mentioned other harms from overuse of scanning, such as follow-up testing and procedures to evaluate suspicious findings that turn out to be benign.
The story could have been improved by describing the costs of CT scanning, which are substantial and climbing. We also think the story should have commented on the nature of the study projecting the number of deaths due to radiation from CT scans. The study used a model to predict cases of cancer and subsequent deaths. These cases were projected, but not directly observed. Modeling studies, while useful, have certain limitations and their results should be interpreted with caution. The story does not describe these limitations, other than to cite skepticism from a radiologist.
Consumers should be aware that they may be exposed to more radiation than they think and should discuss this risk with their doctor before undergoing CT scanning.
The story does not mention costs of CT scans, which are substantial.
It would not be necessary for the story to quantify the benefits of CT scanning. There is in fact no way to quantify the benefits of such a general test.
The story does a good job of describing the harm of exposure to radiation due to CT scanning. The story could have also mentioned other harms from overuse of scanning, such as follow-up testing and procedures to evaluate suspicious findings that turn out to be benign.
The story does not adequately describe the strength of the study projecting the number of deaths due to radiation from CT scans. The study used a risk model to predict cases of cancer and subsequent deaths. These cases were not directly observed. Modeling studies, while useful, have certain limitations and their results should be interpreted with caution. The story does not describe these limitations, other than cite skepticism from a radiologist.
The story accurately represents the number of cancers that are expected from the radiation doses observed in the study and how many of them could be fatal.
The story quotes multiple experts, including the authors of the study, the author of the accompanying editorial and a Radiologist who was not involved with the study.
The story mentions several other testing options, such as simpler CT tests, conventional X-rays, ultrasound or MRI that involve less or no radiation.
Clearly CT scans are available.
The story highlights the risks associated with the increasingly common use of CT scans. This issue is certainly not new. While the two cited articles in the story are important additions to our understanding of the risks, they are not seminal articles by any means. The issue of risk, necessity of testing and dose delivered per test have been discussed in the literature for at least a decade. Nonethless, we’ll give the story a satisfactory score on this criterion.
Because the story quotes multiple experts, the reader can assume the story did not rely on a press release as the sole source of information.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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