This isn't news. There's been so many stories on this very topic lately. My mother passed way from uterine cancer last year. In a 4 1/2 month span, from the time she was diag. until she passed , she had 3 cat scans and a pet scan. This doesn't include the ultrasound and biopsy she'd had prior to. (but those aren't radiation issues) If she had made it thru the last round of treatment, she would have had yet another pet scan. I visit a cancer discussion board frequently and I cannot believe how many scans some patients have. Is it worth it? I can't answer that. It certainly didn't help my mother.

Couple this with the story about health insurance rates going up next year.

What about the fact that these procedures will all get compensated for by insurance? If hospitals see these as sure ways to add to their revenue, they'll do them.

The problem is many patients demand to know right then and there what is going on. Ma'am I do not think that this is appendicitis, but I cannot tell you with 100% certainty. If your pain gets worse come back or if it is not better tomorrow follow up with your doctor. I want to know. What if it is appendicitis and it bursts can't you just do one of those scans? Save the radiation and risk the lawsuit or just do it?

Problem #2 The kidney stone patient. I know you say it feels like a stone, bit the last 5 Ct scans you have had show no stones, but I just need more drugs doctor. Some Perc 10's will do. Do you feed the habit or order the scan to prove drug seeking behavior and kick them out?

This is indicative of how health care cost are being driven by the cost of health care providers. The insurance co. pays and the hospital makes money.

HC reform has been centered around blaming the insurance companies, while they are no saints, this article points to a more profound problem, charges from the HC Providers.

Things like this may be a major portion of why our costs are so high as compared to the rest of the developed world. Every hospital has it, we have to make money off of it, just use it. Of course we don't want to get sued, so do it one more time just to make sure.

We must start HC reform by reforming the cost of this care.

I am probably in the top 1-2% of patients (under age 50) as far as the total amount of radiation I have received from medical scans. Having a very rare disease, I am often a candidate for exploring where/what could my disease process be attacking.

Whose responsibility is it to total up the amount of likely radiation I've received? Most of my scans are ordered by various specialists who don't look at the big picture. Is my primary care physician responsible, and if so, how can he influence specialists to reconsider their testing when they've been asked for their opinion?

Since most of my scans can be considered medically necessary, perhaps the focus should be on ways to decrease the radiation used during each procedure and track the cumulative dose for each body region.

Doctors may be able to manage my rare disease throughout my life, but then I'll die of cancer?

The doctor says "Your back pain is just some stress from sitting at your desk. Come back next month if it still bothers you." Second visit when excruciating pain necessitates the scan: "We've discovered you have Stage IV kidney cancer. Wish we could have caught it earlier." Now they scan regularly to monitor incurable cancer but it's too late.

I am now keeping track of the radiation my child is exposed to due to medical tests. This past year, she had a regrowth of a tumor in her jaw. Every year, she has to have a full scan of her head to watch for a regrowth and this past year, she had her first CAT scan of her head. It's a terrible position. If she has a regrowth than she needs surgery and predicting how big and complicated the surgery is becomes vital. Panic does not help. The key here is keeping track of it and informing doctors about how much radiation you have recieved over your life. The younger the exposure the more likely the development of cancer.

Excellent article! In addition...many unnecessary radiology studies are ordered by the emergency room physicians who are at the front lines of our health care fight. Another issue issue is that most physicians, unless they are radiologists, will not necessarily know the most appropriate study to order for the patient or the extent of harm they may be causing to the patient. Radiologists go through 5 years of residency and have to take physics boards in addition to written and oral radiology boards which is longer training than for most other residencies. Another issue is that the hospitals actually make MONEY the more radiology exams are ordered - and therein lies the problem.

What about dental X-rays? My doctor seems to think they are required one a year, just because..... Nothing to suggest there's a condition that needs to be monitored.

Not only is it expensive, but it adds to the radiation "bill" that you'll have to pay.

True, yet old, info here (a rare occurrence when the lay press reports on medical or scientific topics).

Plain x-rays (e.g. chest, dental, mammogram) have very low radiation.

CT scans involve moderate exposure.

Cardiac nuclear scans have the highest exposure.

Tort reform to reduce defensive medicine will reduce my ordering of such tests for the purpose of covering my medicolegal butt.

Ultrasound and MRI have zero radiation.

This must be a "I told you so" week. Yesterday, a MSNBC article said high blood pressure medication causes cancer. Before that, an article said statin drugs for cholesterol damages the liver. Now, radiation at the doctor's office is a problem. I have repeatedly rejected blood pressure and cholesterol medication given to me by doctors. I was thrown out of a dentist office recently because I refused to take the full-face X-ray where you are exposed to radiation for about 15 seconds as compared to the typical millisecond local X-rays. The doctor said no full-face X-ray, no treatment. Wake up people and think for yourself.

Roentgens of radiation exist forever, whether at your dentist or doctor, don't let them do this stuff unless you have to and otherwise keep track...radiation to your body accumulates and does not go away, forever...

If you as an "informed consumer" challenge what the doctor(s) have ordered, you will find no doctor will treat you and you are described as a difficult patient. Having been in the hospital recently, I can vouch for my above statement. I challenged the doctor had ordered and told if I refused the tests, then they no longer wanted to be in charge of my case.

When you are laying in a hospital bed and wanting to get better so you can get out of there, you are pressured into these tests as the only way the doctors have to cure you. Try talking to them about alternatives and they will tell you there are no alternatives. Then you as a patient are wondering what is the right thing to do. In most cases you will bend to the doctors will.

IMHO, most of these tests are not to help diagnose or cure the problem, but just a way the doctors can cover their rear end.

I note the radiation exposure to flying. Is this something to worry about? It could add up - especially for those who work for the airlines.

During the last period of "solar minimum," at an altitude of 30,000 feet, the dose rate was about 4 μSv per hour at the latitudes of North America and Western Europe. During solar maximum, which is occurring now, the dose rate fell to around 3 μSv per hour. For the higher altitude of 40,000 feet, the dose rates were about 8μSv per hour at solar minimum and now are about 6.5 μSv per hour. To put this into perspective, the legal value of "maximum permissible dose" for members of the public exposed to radiation originating from ground-based industrial or medical facilities is 1,000 μSv per year. So an airline passenger flying at an average altitude of 35,000 feet for a period of about 160 hours (75,000 miles) during solar minimum would receive an exposure at about the limit of the current acceptable level.

I told my dentist and physician that I won't revisit them every 6 months as "recommended". I said people going to their dentist to "clean" and doctor to "check up" so often for no reason. How dirty can my teeth get in 6 months? No wonder our insurance cost is so high and so many law sues. Once a year is more than enough, and I refused to get all kind of scans and unneccessary exams recommended by my physician. All they see are $ $ $ $ signs. Too sad!

How about the fact that the indivdual doing your test may not even be certified other than paying a filing fee and getting 7 hours of HIV training like here in Washington state, and being called a x-ray technician. These are people who have no formal training and are the majority of the reason the multiple images get taken over again. Each time the image is taken you get more radiation. There is a bill in the US Congress called the CARE bill that has been trying to get passed for a few years that would cause standardized and required training throughout the US. I am going to school to be a radiologic technologist, 40 grand into debt and all so I can minimize the radiation exposure that patients receive and take the image right the first time. You want to reduce your exposure? Then make sure the person taking your xray is a RT and nothing less.

How can it be that American's (I assume they mean US citizens) get more scans than anywhere else in the world. Without evil insurance system and Europe's glorified socialist system, why aren't they getting the most scans? Sounds like MSNBC just tripped over their own BS.

I'll sum up this story and with 2 words "Malpractice Lawsuits " . You get the Lawyers out of Medicine. And watch what happens to the amount of Scans & X-rays.

I had one CT scan in January, and based on that one alone my GI was not going to order a colonoscopy for me. Then he saw my CT scan from mid 2008 and promptly called to schedule one for me. I was diagnosed with diverticulitis, and had an adenomatous polyp removed. Had I not had BOTH CT scans the polyp likely would have gone unnoticed until it was too late as I'm no where near the age of needing a "routine" colonoscopy. I'm sure colon cancer would have taken me out long before the radiation. I have two little kids who need a mommy, so I'll take those 2 CT scans and STFU.

Pretty soon we`ll have a glow in the dark population.

"too many medical tests"

Certainly won't be a problem under ObamaCare.

This story fits right into the new Obamacare system's plans....don't detect problem until it's too late, it's cheaper. Just like they are now saying women can put off mammograms until later in life. Medical rationing propaganda! Good work MSNBC. Stay the course and steer us right into our new socialized lives.

What amazes me is that there is apparent technology out there to reduce exposure by 90%. Is that because some machines are more modern than others, or is it because some technicians know how to control radiation emissions better than others? Whatever the reason, it sounds like this problem is highly and quickly resolvable. Where are the FDA and the NIH in all of this?

I'd bet I could glow in the dark, from all the CT, Mri, and X-rays I have had in the past year. I was wondering about this.........But, the good news IS I WAS healthy until all the radioactive scans. LOL....

See latest from MSNBC below. My comments are in BLUE.

Mark Preston, M.D., J.D.
www.paragonradiology.com

Biggest radiation threat is due to medical scans

Americans get most medical radiation in world; dose has grown sixfold

Jim Cole / AP
Radiologist Dr. Steven Birnbaum assists a patient getting a CT scan at New Hampshire Medical Center in Nashua, N.H.
View related photos

By Marilynn Marchione

updated 8:18 a.m. ET, Mon., June 14, 2010

We fret about airport scanners, power lines, cell phones and even microwaves. It's true that we get too much radiation. But it's not from those sources — it's from too many medical tests.

Americans get the most medical radiation in the world, even more than folks in other rich countries. The U.S. accounts for half of the most advanced procedures that use radiation, and the average American's dose has grown sixfold over the last couple of decades.

Too much radiation raises the risk of cancer. That risk is growing because people in everyday situations are getting imaging tests far too often. Like the New Hampshire teen who was about to get a CT scan to check for kidney stones until a radiologist, Dr. Steven Birnbaum, discovered he'd already had 14 of these powerful X-rays for previous episodes. Adding up the total dose, "I was horrified" at the cancer risk it posed, Birnbaum said.

After his own daughter, Molly, was given too many scans following a car accident, Birnbaum took action: He asked the two hospitals where he works to watch for any patients who had had 10 or more CT scans, or patients under 40 who had had five — clearly dangerous amounts. They found 50 people over a three-year period, including a young woman with 31 abdominal scans.

When other radiologists tell him they've never found such a case, Birnbaum replies: "That tells me you haven't looked."

CT scans use has soared
Of the many ways Americans are overtested and overtreated, imaging is one of the most common and insidious. CT scans — "super X-rays" that give fast, extremely detailed images — have soared in use over the last decade, often replacing tests that don't require radiation, such as ultrasound and MRI, or magnetic resonance imaging.

My response: Doctors order the most appropriate exam given the patient's clinical findings. If an exam exposing a patient to ionizing radiation (X-rays, CT) is chosen, it is done so after weighing the benefits versus the costs (risk of contrast, risk of ionizing radiation)

Radiation is a hidden danger — you don't feel it when you get it, and any damage usually doesn't show up for years. Taken individually, tests that use radiation pose little risk. Over time, though, the dose accumulates.

Doctors don't keep track of radiation given their patients — they order a test, not a dose. Except for mammograms, there are no federal rules on radiation dose. Children and young women, who are most vulnerable to radiation harm, sometimes get too much at busy imaging centers that don't adjust doses for each patient's size.

My response: CT Scanners are evaluated and certified by the American College of Radiology. As part of the accreditation process, the dose of radiation utilized for different types of exams is evaluated to ensure that only the dose required to obtain an exam of diagnostic quality is utlized.

That may soon change. In interviews with The Associated Press, U.S. Food and Drug Administration officials described steps in the works, including possibly requiring device makers to print the radiation dose on each X-ray or other image so patients and doctors can see how much was given.

The FDA also is pushing industry and doctors to set standard doses for common tests such as CT scans.

"We are considering requirements and guidelines for record-keeping of dose and other technical parameters of the imaging exam," said Sean Boyd, chief of the FDA's diagnostic devices branch.

A near-term goal: developing a "radiation medical record" to track dose from cradle to grave.

"One of the ways we could improve care is if we had a running sort of Geiger counter" that a doctor checked before ordering a test, said Dr. Prashant Kaul of Duke University.

He led an eye-opening study that found that U.S. heart attack patients get the radiation equivalent of 850 chest X-rays over the first few days they are in the hospital — much of it for repeat tests that may not have been needed.

How much radiation is risky?

My response: No radiation may be too risky. When was the last time you heard of anyone undergoing EXPLORATORY SURGERY? The developments in imaging have allowed doctors to diagnose disease with much greater accuracy.

It's hard to say. The best guess is based on the 1986 Chernobyl nuclear power plant accident and studies of Japanese atomic bomb survivors who had excess cancer risk after exposures of 50 to 150 millisieverts (a measure of dose) of radiation.

A chest or abdominal CT scan involves 10 to 20 millisieverts, versus 0.01 to 0.1 for an ordinary chest X-ray, less than 1 for a mammogram, and as little as 0.005 for a dental X-ray. Natural radiation from the sun and soil accounts for about 2 millisieverts a year.

A big study last year estimated that 4 million Americans get more than 20 millisieverts a year from medical imaging. Two percent of people in the study had high exposure — 20 to 50 millisieverts.

Up to 2 percent of cancer could soon be due to scans

My response: We don't know. We don't have enough low exposure data over long periods of time to determine the actual risk of cancers due to exposure to radiation from diagnostic studies. We can extrapolate from higher dose events such as nuclear accidents or Hiroshima/Nagasaki, but the risk is thought to rise in a non-linear manner (e.g. many individuals fly on planes and have radiation exposure, but do we know of higher cancer risk from frequent fliers?)

Another study by Columbia University researchers, published in 2007, estimated that in a few decades, as many as 2 percent of all cancers in the U.S. might be due to radiation from CT scans given now. Since previous studies suggest that a third of all tests are unnecessary, 20 million adults and more than 1 million children are needlessly being put at risk, they concluded.

Just because a scan didn't find anything wrong doesn't mean a test wasn't needed. Scans are useful for many diagnoses. But many studies suggest people are getting too much imaging now. For example, Mayo Clinic researchers reviewed the medical records of 251 people given heart scans in 2007 and found that only a quarter of them were clearly appropriate.

Reasons for overuse:

• Accuracy and ease of use. Scans have become a crutch for doctors afraid of using exams and judgment to make a diagnosis. Some think a picture tells more than it does. Imaging that shows arthritis in a knee or back problems doesn't reveal how to make it better, said Dr. Richard Baron, a primary care doctor in Philadelphia.

My response: Accuracy is important. Diagnostic imaging is critical in the algorithm for clinical decision making in many instances. For example in the above example, is the arthritis mild that might be treated conservatively witih nonsteriodal medications, or is it sever to require referral to an orthopedist for further consult and treatment (e.g. arthrsoscopy or joint replacement).

"Physical therapy for an orthopedic injury is always the first choice," yet doctors rush to order tests, he said. "The question you should be asking when you do sophisticated imaging is, 'Is there something I can fix with an operation?'"

My response: Let's look at an orthopedic injury. Physical therapy although useful in the appropriate clinical setting, may not always be the best choice. Let me explain. An individual is injured. The choices are 6 weeks of physical therapy (perhaps missing all or part of work during that time period and the actual costs of physical therapy during that time period) versus an MRI which costs about $500. IF ORDERED WHEN APPROPRIATELY INDICATED, the MRI will provide a definitive diagnosis, guide treatment, and determine whether referral to an orthopedic specialist is appropriate. You can rest assured that a $500 MRI costs less than 6 weeks of physical therapy and 6 weeks of lost wages. Not to mention the pain suffered by the patient during the 6 week period.

• Malpractice fear. A missed heart attack or a burst appendix could be devastating for a patient — and mean a lawsuit.

My response : "A missed heart attack or a burst appendix could be devastating for a patient" - quote from article. Missing such a diagnosis is BELOW THE STANDARD of care and is unacceptable. Current diagnostc imaging with modern CT scanners allows doctors not to miss such a diagnosis.

"I have great sympathy for the ER physicians because of the responsibility placed in their hands with strangers that come in off the street," said Louis Wagner, chief physicist at the University of Texas in Houston. "They have to make a decision that could mean life or death for a patient, and the fastest way to find out is CT."

• 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.

My response : CT is a much better examination to diagnose appendicitis. In such circumstance, the question should be: "How do we arrive at the correct diagnosis and treat a possible appendicitis rather than utilize a much less effective exam to avoid the risk of radiation exposure.

• 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.

My response : All providers of diagnostic imaging who practice competently ALWAYS attempt to obtain images and reports of the same test if performed elsewhere. The test is only repeated if there are sound clinical indications for doing so.

• 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.

My response : Most hospitals have on call, if not on staff 24/7 technologists to perform exams as ordered by the medical staff.

• 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.

My response : This is simply wrong. Both angioplasties and bypass surgery of the coronary arteries require pre-procedure/preoperative diagnosis of the degree of stenosis (narrowing) of ther coronary arteries. This can be achieved with state of the art CT Scanners and/or coronary angiography both of which expose patients to radiation.

As to virtual colonoscopy, the risk of colonic perforation and peritonitis is significantly lower and furthermore, the cost of the exam is much lower than an endoscopic colonoscopy.

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.

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 ltrasound or MRI?

—How many scans will be done? Could one or two be enough?

—Will the dose be djusted 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?

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.

Mettler also 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."