Really guilty about CT-Scan

This was made more for providers, but the American College of Radiology (ACR) has a search engine to see what modality is most appropriate for a study.

Appropriateness Criteria Search

You can type in appendicitis, kidney stone, etc, but some others will need more specific terms.

It depends on what the doctor thinks the patient has and how to decide which appropriate study to use. For instance, the PDF (attached) pertains to suspected appendicitis includes it presenting as right lower quadrant (classic appendicitis picture). The PDF came from the link I provided above by searching "appendicitis" and was the first result.

It gives the effective radiation dose at the end of the document. In the comments section, it discusses the role of CT vs Ultrasound in pediatric patients if you're interested.

Deciding on whether or not to use CT can be subjective at times. When I had appendcitis, a very textbook presentation of it at that, they gave me a CT of the ab and pelvis with contrast. Some surgeons would argue to just go to the OR and remove it if it presents the usual way, but the ACR above has it as the most appropriate study to do if the doctor would want imaging first. There's not clear cut algorithm to do these things...merely guidelines that each provider uses to help assist in making a decision. Otherwise you could just program a computer to make yes no answers and decisions rather than having doctors.
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Good call. Ultrasound, gotta love those machines. Back pain can be anything that is potentially fatal (e.g. pulmonary embolism, aortic aneurysm). But if it is something that is pretty textbook, then totally avoid a CT. Ask for an X-ray and to use another machine if it's possible (MRI, ultrasound). However, CTs with contrast are absolute marvels and they can discover even stuff that you didn't know about.

 

+1,000,0000

Why is this thread continuing?

Right after this post i quoted, the chairman of a radiology dept kindly educated you all on the relative risk. Discussion over.

Blows my mind how people can read a post or two online and figure they know more than a the CHAIRMAN OF A RADIOLOGY DEPARTMENT people! He understand this issue infinitely better than some blogger, your RN cousin, even your buddy who is an OB/GYN.

I just don't understand this attitude in America. Having money doesn't mean you are more intelligent than someone else who does this for a living and spent 13 years becoming educated on the topic.

 

Not true. IMO, the OP was prudent in being cautious.

I was a medical researcher and I am curious about the comments by the "CHAIRMAN OF A RADIOLOGY DEPARTMENT" you refer to. Here are the salient facts about CT scans and effective radiation dosage from CT scans.

"effective radiation dose from CT ranges from 2 to 10 mSv" quoted from this link
"1.5 to 1.7 mSv: annual dose for flight attendants" quoted from this link​

So I really don't see how the "good doctor" could in all professional honesty say "...I can assure you the amount of radiation a child or adult gets from a scan is far less than the radiation one gets while getting on a plane and flying across the country...".

IMO, CT scans wouldn't necessarily harm a patient but they do deliver comparatively very high radiation doses, depending on the settings used on the CT machines. Sometimes the wrong doses can also be administered. IMO, CT scans should be avoided by everyone unless there are no satisfactory alternatives. My doctors in Canada always avoid prescribing me CT scans in preference for MRI or US. Here is what the NCI says about the risks of CT scans. For your reference in the NCI article, one milligray (1 mGy) absorbed dosage can be equated to 1 mSv effective dosage when discussing x-rays.

Don't implicitly trust any unsubstantiated comments that people post on the Internet. OTOH, when someone says "IMO" then it should be taken as a personal opinion, not necessarily as a fact. It's then up to you to check the references, if provided.

 

Hi, I would like to affirm the other posts refuting the highly inaccurate and dangerous claim that "the amount of radiation a child or adult gets from a scan is far less than the radiation one gets while getting on a plane and flying across the country".

Here are the statistics - feel free to check these statistics on scientific and other websites:

"The average passenger is exposed to about 0.01 millisieverts per year.
A 14-hour trip from New York to Tokyo produces about 0.1 millisieverts, less than a quarter of the radiation needed for a mammogram."

(from Flight risk: how much radiation do planes expose you to?)

On the other hand, abdominal and pelvic CTs expose the patient to anything between 8-14 millisieverts in a contracted amount of time (which researchers suspect may make a difference in lifetime cancer risk, as opposed to radiation exposure over longer periods of time).

So Testacojones - you were absolutely right to be concerned and the most positive way of viewing this experience is that you will now know to seek a second opinion and consider the options carefully when CT scans are suggested in the future, for you or for loved ones. You can also pass this valuable wisdom onto your son - we can all play a role in educating one another, and raising awareness, which is what makes forums like this so valuable.

Thanks for sharing your experience. I had abdominal pain in my early twenties and was submitted to not one, but *two* abdominal/pelvic CTs within a month - my family GP (who was semi-retired at the time I experienced pain and therefore unavailable for appointment) later expressed extreme surprise and concern that these CTs had been ordered for someone of my young age when other diagnostic options such as ultrasounds had not been exhausted & when my symptoms were not really consistent with cancer or other diseases that would have necessitated a CT scan for diagnosis. This experience suddenly made me aware of the issue - I, like you, had not given much thought to radiation risk from x-rays and scans - though I notice the issue has received more media coverage in the last few years.

I do not pretend to any medical training myself, but I definitely question the claim of the poster to be a radiologist and chairman of his/her department. If he is chairman, that only highlights the lack of awareness amongst some medical professionals of the risks involved in radiation from CT scans. My uncle was head of Yale Oncology for many years and is now leading oncology research at University of Pennsylvania - both his parents were also scientists (his mother an oncology researcher at Yale and Brown Universities) - all three are level-headed people not overly obsessed with health, but they are the three people most concerned about avoiding radiation I have ever encountered in my life. So I can assure you it is not only 'ignorant laymen' or hypochondriacs or overanxious parents who are concerned about x-rays and especially CT scans.

After my experience with the two unnecessary high-dose radiation scans, I swore never to submit to a CT scan unless it proved absolutely necessary, especially as I am still in my twenties now (allowing more time for the radiation to accumulate and cause cancer). However, recently, when mentioning my gag reflex and nausea to my dentist, he immediately ordered a head CT. He did not even tell me this, calling it a 'test', but I heard him murmur the word "CT" to his assistant. I immediately queried about radiation - and he said something very similar to pateljb - that the radiation was "a pindrop in the ocean" and that it was about the same amount of radiation I would get from flying "Sydney to Melbourne". I mistrusted this comment but he was so impatient and contemptuously dismissive of my concerns and so insistent on doing the scan, that I allowed him to proceed. In retrospect, my weakness in allowing this to happen boggles my mind! (Naturally, the scan did not show the abnormalities he suspected but which I did not.) I understand anyone who has been in a medical situation and feels pressurised into agreeing to tests by condescending doctors - many of us feel uncomfortable challenging medical professionals, especially if we see them on a regular basis, even when we ourselves are highly educated and fairly confident individuals in the rest of our lives. But doctors are just human beings and we shouldn't be afraid to ask questions.

If you are still experiencing the intermittent concern that strikes me from time to time, here's how I've chosen to look at the experience of having had the unnecessary CT scans:
* exercise caution regarding future CTs and education ourselves about the risks and benefits of *all* medical procedures before jumping in.
* use the experience to raise awareness for others

* Finally, accept that life is risky, though I know this is so hard for parents! Be philosophical about it - life and matters of health are so incredibly complex, we are probably exposing ourselves to cancer and other health risks in other ways right now, without being aware of it, and this is just the nature of life - we cannot know everything before making our decisions. What you *can* do now is to minimise your son's health and cancer risks by doing all those things you probably do already - giving him healthy diet, encouraging exercise, keeping his sun exposure without sunscreen to safe levels etc. I wonder if our anxiety might have some positive overall effect on health - as I've decided that I've had these scans, so all I can do now is to minimise my risk to cancer by living as healthily as I can and getting antioxidants in my diet, as another poster recommended. Perhaps I would have been sloppier in my habits if I hadn't had this jolt of concern - and that would have increased my cancer risk gradually and invisibly - unlike the CT scans, where the risk is now widely known.
* Remind ourselves that even actually getting cancer is no longer the definite death sentence it once was - early detection is making survival rates higher and higher all the time, and let's hope that this trend will continue throughout your son's life!

Take care!

 

Dont beat yourself up. You did the best you could w the options you had. You had best intentions for your son. Imagine if he did have appendicitis and you didn't take him to the CT scan & it exploded.

Back when my Mom was in her last days all the choices the Drs gave me were bad or worse. I did the best I could w the options I had. Cant beat myself up for the poor choices I had.

 

I'd also suggest you ask some Drs how much radiation the CT scan puts out and if this has any long term side effects

 

You made the right choice, plain and simple.

A friend of mine is quite reckless and was told by his doctor that he had too many CT-scans in the period of time and could not perform one. He is still very healthy with no adverse effects.

 

Geeeez. Obviously you are very health conscious and your kids will be raised the same way, and so they will not be subject to the constant ongoing bombardment of all these types of things, which is what it would take to be considered remotely at greater risk of anything. It blows my mind what people subject their kids to. Starting in infancy with the cocktail of immunizations. But this is hardly a concern when in reality he could have had appendicitis.