Monday, November 30, 2009

Too Much Treatment Can be Harmful

Hopefully by now people are realizing that more is not necessarily better. A new study reported at the American Heart Association 2009 Scientific Sessions showed that patients with acute myocardial infarction (AMI) receive large doses of ionizing radiation per hospital admission.

They looked at patients treated at 55 academic hospitals and found, on average, each patient received seven studies per AMI admission. The studies included chest X-rays, chest CT, head CT, nuclear perfusion testing and cardiac catheterization, which added up to about 17.31 mSV of ionizing radiation. The average American receives 3mSV annual radiation from natural sources and 50 is the max exposure allowed in the workplace.

Ionizing radiation has the ability to affect the large chemical molecules of which all living things are made and cause changes which are biologically important.

The researchers did not say that the tests were not indicated. But they pointed out that physicians need to carefully evaluate the indications for tests involving radiation and consider decreasing the dose based on the admitting diagnosis.

With various specialists ordering tests looking at their specific body part, someone needs to be tracking the patient's total radiation dose. We have learned that there is great variation across the country in testing and procedures done, depending upon where the patient is and where the doctor trained. It may be time to take a look at cardiovascular imaging tests and determine if over testing is occurring.


Michael Kirsch, M.D. said...

Toni, agree completely. The fallacy that more medical care is better medicine is alive and well. We physicians bear much responsibility for this as we are the ones ordering CAT scans and other techno tests. Why do we do this? Here are my thoughts. Interested in your thoughts on how to break this cycle. Since every CAT scan is ordered by a physician, we are uniquely positioned to be part of the solution. If we don't reform this ourselves, then someone else will do it for us. Would this be better for patients?

Toni Brayer MD said...

Michael Kirsch, MD: I liked your post but I still cannot comment on your blog. It just won't post. Thanks for visiting.

sildenafil said...

Wow that's amazing, I thought that just the sun was dangerous, anyway thanks for share, I guess I will have to proctect from another think now.

Bryon said...

Quite helpful piece of writing, thanks so much for this post.
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Vincent said...

No doubt, the chap is totally fair.
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