April 24th, 2011 by GarySchwitzer in Health Policy, Opinion
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On the US News & World report website, Dr. Kenny Lin writes as a physician and a concerned observer about “Dangers of Incidentaloma: Why To Think Twice Before Getting a CT Scan.”
It’s an important issue. Give it a look.
Lin’s blog, “The Common Sense Family Doctor,” is also worth visiting. Recently he cited one of my alltime favorite essays, “The Last Well Person,” by Dr. Clifton Meador, who wrote in 1994:
“The demands of the public for definitive wellness are colliding with the public’s belief in a diagnostic system that can find only disease. A public in dogged pursuit of the unobtainable, combined with clinicians whose tools are powerful enough to find very small lesions, is a setup for diagnostic excess. And false positives are the arithmetically certain result of applying a disease-defining system to a population that is mostly well. … If the behavior of doctors and the public continues unabated, eventually every well person will be labeled sick. Like the invalids, we will all be assigned to one diagnosis-related group or another. How long will it take to find every single lesion in every person? Who will be the last well person?”
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
November 5th, 2010 by KevinMD in Better Health Network, Health Policy, Health Tips, News, Opinion, Research
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Lung cancer screening has been an area of considerable controversy. Before today, there had been no evidence that screening patients for lung cancer, either with a CT scan or chest x-ray, saved lives.
For years, doctors have been waiting for the results of the large, randomized National Lung Screening Trial (NLST), conducted by the National Cancer Institute.
[Yesterday] it was announced that the trial was stopped early, with a bold, positive finding:
All participants had a history of at least 30 pack-years, and were either current or former smokers without signs, symptoms, or a history of lung cancer.
As of Oct. 20, 2010, the researchers saw a total of 354 deaths from lung cancer in the CT group, compared with 442 in the chest x-ray group.
That amounts to a 20.3% reduction in lung cancer mortality — a finding that the study’s independent data and safety monitoring board decided was statistically significant enough to halt the trial and declare a benefit.
Previously, only breast, colon, and cervical cancer has had the evidence back up its screening recommendations. It’s still early in the game, but it appears that lung cancer may be following in that same path. That said, there are a variety of concerns before opening up the floodgates to screening chest CTs. Read more »
*This blog post was originally published at KevinMD.com*
July 23rd, 2010 by Happy Hospitalist in Better Health Network, Humor, Medical Art, Opinion
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Medical Pastiche blogger Peter Zavislak, whom I can always count on to point out the unusual and interesting sides of medicine, sent me to a website that has nothing but pictures and videos of food in an MRI scanner.
Here’s a series of images from their site of a cantaloupe as viewed from an MRI:
I just find myself thinking that these MRI machines aren’t cheap to run and maintain. Doctors and nurses used to be able to get “freebies” by buddying up with the X-ray, CT or MRI technologist and running a scan for free.
Some hospitals allow their employees to test the machines after being set up or maintained to get images for testing purposes. I’m sure more than a technologist or radiologist or two have found incidentalomas from this practice. Read more »
*This blog post was originally published at The Happy Hospitalist*
February 27th, 2010 by scanman in Better Health Network, Medical Art, True Stories
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A young adult (mid thirties), a known case of non-specific aortoarteritis (Takayasu’s arteritis) was referred for a CT scan of the Abdomen including a CT Aortogram to rule out mesenteric ischemia.
The inital plain (no IV or oral contrast) CT scan did not show any evidence of abdominal pathology. So a CT Aortogram was done.
The following is the best CT image of thoracic and abdominal wall arterial collaterals that I have seen in a decade of being a radiologist: Read more »
*This blog post was originally published at scan man's notes*
February 17th, 2010 by Shadowfax in Better Health Network, True Stories
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Seems like I’ve been on a real run of chest pain patients lately. Which is fine — it’s part of the gig. I did have a very interesting pair the other night. They were seen in sequence, right next to one another, in room 7 and room 8. They were both totally healthy women in their mid-fifties. And they were both over-the-edge, crazy, crawling-out-of-the-gurney anxious.
Anxiety is an awful red herring in the work-up of chest pain. People who are having an anxiety attack often if not always manifest some chest pain (pressure, tightness, whatever) as a prominent symptom of their anxiety. On the other hand, someone having a heart attack who is experiencing chest pain will also be anxious — and for good reason! Read more »
*This blog post was originally published at Movin' Meat*
