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Patient pressure. People urge doctors to "do something" to figure out what's wrong, and "often, doctors feel that the way to demonstrate that they're doing something is to order tests," said Dr. Christopher Cassady, a radiologist at Texas Childrens Hospital and the American Academy of Pediatrics' expert on this topic.
At his hospital, doctors first do an ultrasound on suspected appendicitis cases instead of rushing into a CT scan. Ultrasounds require no radiation.
Health care chaos. One doctor may not know that another has ordered the same test. If a patient is referred to a specialist, "it's often easier for him to order another study than to figure out how to get the one that was done somewhere else," Baron said.
Insurance issues. X-rays often are required by insurers to prove health, or for students to study abroad.
Availability. Rural hospitals may not have an ultrasound technologist on duty in the wee hours, but imaging machines are always there.
Treatment choice. A quick fix for chest pain -- artery-opening angioplasty -- requires far more imaging and radiation than bypass surgery does. The same is true of "virtual colonoscopy" instead of the standard version.
Which tests are overused? A scientific group, the International Commission on Radiological Protection, cites routine chest X-rays when people are admitted to a hospital or before surgery; imaging tests on car crash victims who don't show signs of head or abdominal injuries; and low-back X-rays in older people with degenerative, but stable, spine conditions.
Even when tests are justified, they often include more views than needed and too much radiation. Top offender: chest CT scans looking for clogged arteries and heart problems. Cardiologists are increasingly aware of this risk and are seeking solutions.
At Columbia University, a study on dummies by Dr. Andrew Jeffrey Einstein found two dose-modifying techniques could lower the needed radiation dose by 90 percent without harming image quality.
Another cardiologist and radiation safety expert, Dr. Gilbert Raff, showed the same in real life. A study he led of nearly 5,000 patients at 15 imaging centers in Michigan found that radiation dose could be cut by two-thirds with no loss of quality.
What should patients do?
"You should question everything -- what's the dose, why am I getting it? You should be an informed consumer," said Dr. Fred Mettler, radiology chief in the New Mexico Veterans Administration health care system. He led a study of health effects after the Chernobyl accident and is a U.S. representative to the United Nations on radiation safety.
He advised challenging "big ticket" tests like CT scans that deliver a lot of radiation to the chest and abdomen -- places where cancer is likely to develop. "You shouldn't get too excited about feet and knee X-rays," Mettler said.
Questions to ask about radiation scans:
Is it truly needed? How will it change my care?
Have you or another doctor done this test on me before?
Are there alternatives like ultrasound or MRI?
How many scans will be done? Could one or two be enough?
Will the dose be adjusted for my gender, age and size? Will lead shields be used to keep radiation away from places it can do harm?
Do you have a financial stake in the machines that will be used?
Can I have a copy of the image and information on the dose?
Mettler suggests bringing a blank CD or thumb drive with you.
"You should have all of your stuff digitally on something," he said. "I keep mine on my laptop."
Consumer information: http://www.radiologyinfo.org/
Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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