And if he is sending you to a radiology clinic, ask whether he is financially affiliated with it. If your doctor owns a scanner, ask why you need the CT or whether another test might be an option. And studies have found that physicians who own scanners or are part owners of radiology clinics use imaging substantially more than others. Your doctor owns a CT scanner or has a financial interest in an imaging centerĪn in-office CT might seem convenient, but it carries an inherent financial conflict of interest. And ask for copies of your scans to be put on a CD so that you can show them to new doctors. To track your scans, jot down the date, facility, and ordering physician in a journal.
So let your doctor know if you recently had an imaging test. That often happens because doctors may prefer to get a new test rather than look at a previous one. The Institute of Medicine reports that $8 billion is spent annually on repeat testing, much of it unnecessary. Avoiding the highest of those doses could almost cut in half the number of future radiation-related cancers, according to a 2013 study in the journal JAMA Pediatrics. The strength of the radiation dose used during a CT scan can vary tremendously, even when done in the same institution and for the same medical purpose. So before you get scanned, ask the person taking the test whether they’ve factored all of that into your scan. The circumference of your chest, hips, thigh, or waist can also change the dose. The smaller or thinner you are, the lower the radiation dose you need. Also check online to see whether the radiology professional, imaging facility, or referring physician has joined efforts to reduce the overuse of medical imaging, such as Image Gently, which focuses on children, and Image Wisely for adults. Ask whether the facility is accredited by the American College of Radiology, whether the CT technologists are credentialed by the American Registry of Radiologic Technologists, and whether the person interpreting the scans is a board-certified radiologist or pediatric radiologist. There’s no guarantee that the equipment will work or that the providers are skilled. For more, read our report " When to Question CT scans and X-rays." So ask why the test is being done, how the results will be used, what will happen if you don’t get the test, how much radiation you will be exposed to, and whether there is a radiation-free alternative like MRI or ultrasound that could be substituted. Of course, don’t turn down a test if it’s really needed. Here’s our advice on what to do before you get any radiation-based imaging test: In fact, unlike mammography, there are no federal radiation limits for any kind of CT imaging. About one-third of the people in our survey assumed that laws strictly limit how much radiation a person can be exposed to during a CT scan. Many back-pain sufferers, for example, ask their doctor for an X-ray or CT scan (and many doctors acquiesce) even though expert guidelines say that such tests are usually warranted only if the pain lasts a month or longer. When you or your child is in pain, it’s normal to want an imaging test to find out the cause. For example, almost as many people in our survey (17 percent) were very concerned about magnetic resonance imaging (MRI), which doesn’t emit radiation, as were concerned about CT scans (19 percent). It’s not surprising, then, that many patients have mistaken assumptions about the dangers of medical radiation. Fewer than one in six patients in our survey said their doctors had warned them about the radiation risks of medical imaging.
In another study, only 9 percent of 45 emergency-room physicians said they knew that CT scans increased cancer risk. In a 2012 study of 67 doctors and medical providers caring for patients undergoing abdominal CT, fewer than half knew that the scans could cause cancer. Almost 35 percent of imaging tests are ordered mainly as a defense against lawsuits, not because of true medical need, according to a study presented at the 2011 meeting of the American Academy of Orthopaedic Surgeons. Such physicians order far more CT scans and other imaging tests, research shows. And many doctors have invested in radiology equipment or clinics. Most doctors are paid by volume, he notes, so they have an incentive to order lots of tests.
Overuse is caused “not just by greed and money, but that’s part of it,” says Swensen of the Mayo Clinic. The main reasons for excessive scanning are:
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