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What do you do when the patient won’t fit in the scanner?

The Centers for Disease Control and Prevention say that more than one third of American adults are obese—and that, since 1990, the percentage has undergone a “dramatic increase.” HealthImaging on Thursday published a thoughtful exploration of the challenges that America’s increasing heft presents for radiologists (although it undercut the thoughtfulness by illustrating the article with a photograph of a rhinoceros).

Sometimes, current technology simply can’t handle extra-large patients, said Leigh Shuman, MD, staff radiologist at Lancaster General Hospital in Lancaster, Pennsylvania:

People die because they are morbidly obese and we can’t find a diagnosis. It’s not common, but it happens.

When patients are too big for a scanner, alternatives may be available, such as open MRI or ultrasound. But extra body tissue can reduce image quality. And manufacturers can’t simply keep making machines with ever-bigger bores. When the X-ray tube or magnetic coil is farther from the organ to be imaged, the image quality suffers. In the case of X-ray or CT scanners, boosting power to compensate carries the cost of increased radiation dosage.

“Of all the modalities we have, the best bet in an obese person is a CT scanner,” said Raul Uppot, MD, an assistant professor at Harvard Medical School in Boston. “If the person can fit, we can usually modify the settings to get diagnostic-quality images.”

Obese patients can cause wear and tear on not only scanners but also medical personnel who help position patients. Some institutions have added equipment to address the problem. At the University of Washington School of Medicine in Seattle, said Martin Gunn, MBChB, “We don’t put in new scanners anymore without putting in a crane at the same time.”

One perspective needs to be kept in mind: the patient’s. How will an overweight person feel about being told, “We’re going to hoist you onto the scanner table with this crane”? Treating patients with sensitivity needs to be part of the package—maybe the most important part of the package. Humiliating and angering patients is bad health care, not to mention bad business.

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Happy International Day of Radiology! This year, it’s “bigger and better than ever.” For details, see our Facebook page.

Related CME seminar (up to 26.75 AMA PRA Category 1 credits™): Thoracic Imaging

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