A hundred bucks doesn’t buy much these days. A crisp Ben Franklin can be exchanged for
- 50 Big Macs
- A Broadway show ticket
- A night in a New York City hotel (just joking)
- A college textbook (paperback)
- Your life
Your life? Yes, 5 crumpled Andy Jacksons can save your life, as was reported earlier this year in a front page article in The Plain Dealer, Cleveland’s only daily newspaper. University Hospital is now offering a $99 spiral computed tomography (CT scans) of the chest in individuals who are at increased risk of developing lung cancer. The rationale is that if cancers can be detected early, then the cure rate for surgical removal is very high.
Gary Schwitzer, medical blogger and press watchdog, tries to bring some balance to the distorted media coverage of CT lung cancer reportage.
The test is Read more »
*This blog post was originally published at MD Whistleblower*
Researchers from the University of Calgary have shown that doctors can make a stroke diagnosis using an iPhone application just as accurately (and faster) than they can on a traditional computer. In a study recently published by Journal of Medical Internet Research, two neuro-radiologists looked at 120 consecutive noncontrast computed tomography (NCCT) scans and 70 computed tomography angiogram (CTA) head scans. One used a diagnostic workstation and the other using Calgary Scientific‘s ResolutionMD Mobile app. The study results showed that using the ResolutionMD app is between 94%-100% accurate in diagnosing acute stroke, compared to a medical workstation.
In addition to accurately diagnosing a stroke, the app was also praised for its ability to handle a large number of images seamlessly and to detect subtle, but potentially critical findings in CT scans. Moreover, the mobile nature of the app gives doctors the ability to analyze and diagnose strokes from practically anywhere. Read more »
*This blog post was originally published at Medgadget*
There was an interesting study published this week in the journal Radiology:
Rising Use of CT in Child Visits to the Emergency Department in the United States, 1995–2008 (Abstract)
The results are not surprising to anyone who has been working in medicine in the US over the last fifteen years. Basically, in 1995, a kid visiting the ER had a 1.2% likelihood of getting a CT scan, and by 2008, that number was 5.9%.
I had written about this general phenomon not too long ago, in defense of the general increase of CT utilization in the ER, largely on the basis that CT is a better tool: it provides diagnoses in a rapid and timely manner, and excludes many potential life threats, saving lives and mitigating malpractice risk. That was largely relevant to the adult population, though, and kids are not, as they say, just little adults. The increase in scanning children is more dramatic, especially given the generally lower incidence of disease in kids compared to adults and the chonrically ill. Read more »
*This blog post was originally published at Movin' Meat*
Abdominal pain is the bane of many emergency physicians. Recently, I wrote how CT scans are on the rise in the ER. Much of those scans look for potential causes of abdominal pain.
In an essay from Time, Dr. Zachary Meisel discusses why abdominal pain, in his words, is the doctor’s “booby prize.” And when you consider that there are 7 million visits annually by people who report abdominal pain, that’s a lot of proverbial prizes.
One reason is the myriad of causes that lead bring a patient to the hospital clutching his abdomen. It can range from something as relatively benign as viral gastroenteritis where a patient be safely discharged home, to any number of “acute” abdominal problems necessitating surgery.
But more importantly, we need to consider how limited doctors actually are in the ER. Consider the ubiquitous CT scan, which is being ordered with increasing regularity:
The pros: CT scans are readily available, able to look at every organ in the abdomen and pelvis, and very good for ruling out many of the immediately life-threatening causes of belly pain. CT scans can also reduce the need for exploratory surgery. The cons: Often, CTs can’t diagnose the actual cause of ER patients’ abdominal pain. Worse, CTs deliver significant doses of radiation to a patient’s abdomen and pelvis (equivalent to between 100 and 250 chest X-rays). Over a lifetime, patients who receive two or three abdominal CT scans are exposed to more radiation than many Hiroshima survivors.
Add that to the fact that patients expect a definitive diagnosis when visiting the hospital — one that doctors can’t always give when it comes to abdominal pain. Read more »
*This blog post was originally published at KevinMD.com*
Emergency patients with acute abdominal pain feel more confident about medical diagnoses when a doctor has ordered a computed tomography (CT) scan, and nearly three-quarters of patients underestimate the radiation risk posed by this test, reports the Annals of Emergency Medicine.
“Patients with abdominal pain are four times more confident in an exam that includes imaging than in an exam that has no testing,” said the paper’s lead author. “Most of the patients in our study had little understanding of the amount of radiation delivered by one CT scan, never mind several over the course of a lifetime. Many of the patients did not recall earlier CT scans, even though they were listed in electronic medical records.”
Researchers surveyed 1,168 patients with non-traumatic abdominal pain. Confidence in medical evaluations with increasing levels of laboratory testing and imaging was rated on a 100-point scale. Then, to assess cancer risk knowledge, participants rated their agreement with these factual statements: “Approximately two to three abdominal CTs give the same radiation exposure as experienced by Hiroshima survivors,” and “Two to three abdominal CTs over a person’s lifetime can increase cancer risk.” Read more »
*This blog post was originally published at ACP Internist*