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ED Patients: We Want CT; Risks? What Risks?

December 15, 2010
Written by: , Filed in: Abdominal Imaging, Diagnostic Imaging, Emergency Radiology
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Emergency department patients feel more confident about being examined if that exam includes a CT scan. But they don’t know much about the risks. And many don’t even remember whether they’ve ever had a CT scan.

So indicates a study published online Tuesday in the Annals of Emergency Medicine. The study involved 1,168 patients 18 or older who showed up at the Cooper University Hospital ED in Camden, New Jersey, with nontraumatic abdominal pain lasting 72 hours or less. The study period encompassed March 2008 through May 2009. Sixty-seven percent of the patients were female, and median age was 40.7.

The researchers asked the patients to rate confidence in a medical evaluation on a 100-point scale. A medical history with a physical exam by a doctor got a median confidence score of 20. Median confidence rose to 84 with the addition of blood work, 85 with the addition of blood work and ultrasound, and 90 with the addition of blood work and CT.

When asked to compare the amount of radiation from an abdomen-pelvis CT scan to that from a pair of chest X-rays, more than 70 percent of the same patients underestimated the relative amounts.

The patients were also asked about whether two to three abdominal CT scans give the same radiation exposure that survivors of the Hiroshima atomic bomb received, and whether two to three abdominal scans over a person’s lifetime can increase the chances of cancer. Median agreement levels were 13 and 45, respectively, though both statements are in fact “true and well supported by the literature,” the study says. (A new study presented earlier this month at the Radiological Society of North America’s annual meeting calculated that the cancer risk from CT is considerably lower.)

Perhaps it’s not realistic to expect people outside the medical field to know technical details of radiation exposure from CT. But should they at least remember whether they’ve had a CT scan? The study found that of 365 patients who reported no previous CT imaging, 39 percent actually had undergone a CT scan within the previous five years, according to their medical records.

Regarding patient knowledge about imaging techniques, perhaps the best course of action is: assume nothing.

Related seminar: Emergency Radiology

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