Anyone who has made a recent trip to the emergency room knows the visit is likely to set off a round of routine diagnostic tests: blood work, electrocardiogram, urine sample. And a routine CT scan? A new study shows that the emergency department use of these scans – also known as computerized tomography -- has increased nearly six-fold since 1995 and shows no sign of tapering off.
Is it too much?
CT, a pricey technology that once took nine days to complete, was used in 2007 to diagnose 16.2 million headaches, stomach aches, back pain, chest pain and the like – a huge increase from 1995’s figure of 2.7 million, according to the new study published online in the journal Radiology. Other studies have also sparked concerns about the technology’s possible overuse – including radiation exposure or the significant costs.
Dr. David Larson, author of the study, says it's getting more difficult for doctors to decide when to do a CT scan. "Because it's so widely available, because the images are so exquisite, there's the temptation to use it for anything." The findings suggest, he adds, that "we may be heading toward overutilization or inappropriate utilization."
But Dr. Jeff Goldsmith, co-author of the book "The Sorcerer's Apprentice: How Medical Imaging Is Changing Health Care," says it's different when you're the one lying on the table with a stabbing pain in your gut. He has twice had CT scans for abdominal pain and says he was "grateful" the scan could diagnose his problem and lead to quick treatment.
"It could be viewed as an emerging standard of care rather than something we should be 'concerned' about," he says. He even suggests that increased CT scanning might eventually lower health care costs by preventing unnecessary, even higher-cost, exploratory surgery. A typical CT scan of the heart can cost $500 to $1500.
Meanwhile, because the most recent available data lags a few years behind the times, it’s hard to know what the current utilization rates are. If the trends observed in the study have held true, then "by now probably about 20 percent of patient visits are affiliated with a CT scan," Dr. Larson says. He adds a note of caution about making such predictions, but preliminary data from 2008, which was not included in the study, seems to follow the trend.
Nonetheless physicians, including Dr. Larson and Dr. Goldsmith, see the need for more research into when CT scans might not be an appropriate tool so they can be sure they're not missing an important diagnosis.
"The value that a CT provides, even if it's negative, is reassurance. It's hard to provide a dollar value on reassurance," Dr. Larson says.