Los Angeles Times Examines Growing Popularity, Concerns Regarding CT Scans

The Los Angeles Times on Sunday examined the "explosion" in the use of CT scans in the U.S. and how it has become "an economic engine for hospitals and doctors" who are "[g]enerating tens of billions of dollars in billing" annually.

According to the Times, CT scans "have become a standard procedure" for common ailments, such as kidney stones, persistent headaches or appendicitis. Physicians in 2007 ordered 68.7 million CT scans, more than three times the number ordered in 1995, according to IMV Medical Information Division. In addition, a 2007 study by McKinsey Global Institute found that the number of CT scan machines in the U.S. had increased to 24,000 since the first apparatus was purchased in the U.S. in 1973, which is nearly three times the number of machines available in most other industrialized countries.

Although 70% of the scanning machines are found in hospitals, the declining cost of the devices has encouraged more private practice physicians and independent imaging centers to install their own machines, the Times reports. According to the Times, manufacturers of the scanning machines, such as Siemens, "tout the ease of making money with the devices." A Siemens marketing brochure notes that two scans daily generate enough revenue to cover the cost of the machine and its operation over a five-year period, while 10 scans daily can generate more than $400,000 in annual profits.

Conflict of Interest, Concerns Over Radiation Exposure
According to the Times, a "fight is brewing over the potential conflict of interest" between cardiologists, orthopedic surgeons and other specialty doctors who provide their own CT scanning and radiologists who "rely solely on referrals for their business and resent the invasion of their turf." As a result, CMS' "most significant response" has been to reduce Medicare payments for various medical scans, including CTs, and it is considering "how far to go in restricting doctors from referring scanning business to themselves" to stem the rising costs of the procedure. CMS paid $2.17 billion for CT scans in 2006, more than twice the amount the agency paid in 2000, the Times reports.

The rising popularity of CT scans also has resulted in a growing concern that excessive exposure to radiation from the scans may have an effect on the health of patients, according to the Times. While the risk to an individual of a single scan is "minuscule, even a tiny increase in radiation exposure spread over a large population can eventually add up to tens of thousands of cancer deaths" annually, the Times reports.

According to the Times, some researchers estimate that up to one-third of CT scans could have been avoided or replaced by safer technologies, such as ultrasounds or MRIs. University of California-Los Angeles radiologist Jonathan Goldin said, "The problem is they are almost too good," adding, "People want to take a picture of everything just in case." He said, "In 20 or 30 years, the radiation debate will be like the smoking debate today. People will say, 'Why did I get this imaging in the first place?'"

However, Daniel Rosenthal, a professor of radiology at Harvard Medical School, said, "Talking about reducing the number of scans is like trying to stop the future," adding, "The equipment and images are so much better that it is pointless to try and stop it" (Zarembo, Los Angeles Times, 9/7).