 
|
|||||||||||||
              
|
Beyond skin deep Pricey full body scans purport to reveal any ill in your insides, but are they worth it? Tuesday, March 13, 2001 By Anita Srikameswaran, Post-Gazette Staff Writer
The concept seems flawless. Spend a few minutes getting CT scans of your head down to your toes, have them reviewed by a radiologist and find out what medical evil is lurking in your heart, lungs, and the rest of your body.
Such information could seem worth a very high price tag. People can expect to pay $700 to $1,500 for the body scan because insurance companies don't cover it.
The CT scans, or computed tomography, take about 20 minutes, or just seconds if the latest technology is used. A series of X-ray beams are sent through the body at a variety of angles to produce detailed images of the tissues. Patients then review their scans on a monitor with a radiologist.
Although total body CT scanning is taking off in places like California and Arizona, so much so that one company is opening the imaging facilities in suburban shopping malls in the west, doctors say it's a waste of money and there is no proof that it will improve the health of the population.
For each of the few instances where the scans led to life-saving diagnoses, many other people spent a lot to get little of practical use, critics say.
"The likelihood of finding a significant disease is very, very small," said Dr. Harvey Neiman, head of radiology at Western Pennsylvania Hospital. "Most of what is found are changes of aging."
Neiman is also the chairman of the board of chancellors of the American College of Radiology. The organization issued a statement last autumn in response to the public and media interest in total body scans.
The college "does not believe there is sufficient evidence to justify recommending total body computed tomographic [CT] screening for patients with no symptoms or a family history suggesting disease," they said. "To date, there is no evidence that total body CT screening is cost efficient or effective in prolonging life."
The CT scans are not yet available in the area, but people have been asking about them, said Dr. Anthony Lupetin, director of body imaging at Allegheny General Hospital.
He tells the curious that the procedure is "not as quick and dirty as you may think it is. There's all these other side issues. It would be great if we could afford to screen everybody for everything all the time. But the cost is enormous."
In general, screening is a low-yield endeavor, Lupetin said. Only one or two cases of cancer might be found when looking for every cancer in several hundred symptom-free people.
Another big problem is that red herrings, so to speak, may show up on a scan that are not indicative of any disease process.
"We call them incidentalomas" because they are incidental findings, Lupetin said. "If you take the whole population on the United States and run them through a scan, about a quarter of them are going to have these incidentalomas."
He remembered a surgery trainee at the hospital a few years ago who had a bad headache and on a whim had a magnetic resonance imaging or MRI scan of his head. It showed an overgrowth of blood vessels on a part of his brain.
"It's something a lot of people have," Lupetin said. "But now [the trainee] knows he has this thing in there. It probably had nothing to do with his headaches and he may have never known his whole life that he had it."
And essentially he didn't need to know because nothing had to be done about it.
Insurers may cover the follow-up of suspicious lesions found on the body scans, even though the patient has no symptoms of a problem, Lupetin said.
Then "some people will have workups for the incidental findings that will cause them harm," he noted. "They'll have a surgical procedure or some other procedure where there's a complication. There's the added emotional cost, the added physical cost to having the workup done. There may be added financial cost if your insurance doesn't cover everything."
Neiman added that CT images are cross-sections of the body, like slices in a loaf of bread where you see the top and bottom surfaces but not the substance in between. That means you could miss the needle because all you can examine are the surfaces of the haystack. The thickness of the slice can be varied, but cost can increase when large numbers of thin slices are taken.
So "it's possible with thick slices to miss a tiny abnormality between the slices," Neiman said. There is no proof whether that concern is justified or can be put to rest, he added.
The exposure to radiation is small and not an issue in most cases, but it needs to be examined if a large number of people get repeat body scans over a period of time.
The big question is whether the body scans are truly effective tools for improving health.
"Screening is only half of the equation," said Dr. Joel Weisffeld, of the University of Pittsburgh Graduate School of Public Health. "Once you find something, you have to treat it. Is early treatment better than just waiting until the condition becomes clinically apparent or symptomatic and treating then?"
At this point, such scans are better done in research settings to assess their utility, he said.
For the American College of Radiology, Neiman set up a task force to evaluate some potential radiology-based screening tests, such as CT scans to check for early lung cancer and for colon screening, a procedure called virtual colonoscopy. The task force will also examine CT scanning of the carotid arteries to look for calcifications in the blood vessels that may indicate artery disease.
Neiman said these focused procedures have stronger scientific foundations to support them than total body scans and, if proven effective, they may eventually be added to the arsenal of screening tests.
|
||||||||||||
