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May 2002 Issue
The Full-Body CT Scan Dilemma
by Michael Fick
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The Star Trek Tricorder is here, now. It's too big to clip on your belt, but it is at the nearest big urban mall or in a roving van, waiting to give you a full-body medical scan ... with fries, if you like ... for a grand or so, in minutes. It examines almost every molecule of your body - bones, muscles, tendons, ligaments, organs, blood vessels, fat, gray matter, etc. -- to determine what's right and wrong with it. It may detect a long list of minor and major problems so your HMO can fix you right up. Full-body computed tomography (CT) scans have saved many lives. Your life is worth a grand, isn't it?

After all, CT scans targeted at specific parts of the body for specific reasons are commonly and successfully used to detect and diagnose many cancers, tumors, cardiovascular problems, organs, joints, etc. Proponents say the scans will detect a long list of ailments early enough to cure them. People whose lives were saved by an early diagnosis of real problems are glad they bought their scans. Even miserly HMOs usually pay to further diagnose and treat problems revealed by full scans. My goodness; even some hucksters promote them.

So why do so many hospitals, radiologists, and medical agencies - most of whom could get rich selling full-body scans - advise against them for asymptomatic people? Here is the short answer, condensed from the looong answer available at a Google search on "full body scans".

Full body scan capability is increasing more quickly than are diagnostic, assessment, and treatment capabilities, so many imperfections surface which are meaningless, falsely alarming, or unnecessarily treated. Yet an HMO may feel compelled to further test, treat, or even operate to avert litigation, sometimes to the patient's detriment. The opponents say most irregularities are not worth fixing, and say the flood of false or inconsequential findings may swamp the medical system without improving or extending our lives. Many physicians say full-body scans subject asymptomatic patients to unnecessary exposure to radiation or to possibly risky follow-up diagnostic procedures for conditions that frequently turn out to be harmless. Many people who spent years worrying about, or even trying to cure, false scan alarms are sorry they got their scans.

There are two well-identified camps in the issue. Those opposing full-body CT scans for patients without symptoms or clearly defined family history of invasive disease include the AMA, the FDA, the AHA, the ACS, the NEJM, much of the rest of the alphabet, many major hospitals and universities, news sources nation-wide, the American College of Cardiology, the American College of Radiologists and Blue Cross/Blue Shield ... at which point I stopped counting or looking.

The director of the American Cancer Society's screening program said, "It's a waste of money and a bad idea", and the position of the American College of Radiology - this country's repository of scanning expertise -- on total body CT screening is:

    "The ACR ... does not believe there is sufficient scientific evidence to justify recommending total body CT screening for patients with no symptoms or family history suggesting disease. There is no evidence that [it] is cost-effective or effective in prolonging life. The ACR is concerned this procedure will lead to the discovery of numerous findings that will not ultimately affect patients' health, but will result in increased patient anxiety, unnecessary follow-up examinations and treatments and wasted expense."

FDA concerns center on the lack of scientific data or evidence that the scans are useful. "One question to us is, 'Just what is the benefit to the patient?' There are really no studies that show that they help that much", the FDA spokesman said. "Another problem", he added, "is that many of the scans are done without the use of an injected or ingested contrast material that better accentuates the difference between normal and abnormal tissue, thus raising the possibility that the quality of the scan is not the best."

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