sensitive. Up to 50% of smokers (and plenty of non-smokers) over the age of 50 have at least one small pulmonary nodule detectable on a CT scan. The vast majority of them will be of no significance, but the occasional one will be the first sign of a developing lung cancer. Which one? We have no way of telling, other than to follow up the individual with a further scan, and probably a further scan after that, to make sure that the nodule is not growing. And what is 'normal' anyway? In the early days of 'well-person CT' in the USA, a radiologist in California was famously quoted as saying proudly that: “We haven’t found a normal yet”. Every one of us who has reached adulthood will be harbouring something detectable on a scan which could conceivably hold some importance for our future health. A renal cyst, a lung nodule, a fleck of calcification in a coronary artery… the possibilities are many. What do they all mean? For the most part we have no idea except that they almost certainly mean subjecting the individual to further tests, with all the worries and sometimes real physical harm that they will generate. A subtle change on a follow- up scan may lead to a biopsy or even an operation, and all for something which might have had no impact whatsoever on a person’s health if left undetected. Knowing this, why would anyone want to subject themselves to a CT scan? Of course, most of this is not well-known and is certainly not well-understood, even by healthcare professionals. Even for someone not looking to post images of their body on Facebook or Instagram, the idea of having a scan is quite seductive. It seems to make sense that having a scan must surely be good for you and asking for more medical imaging must surely be a health-seeking behaviour, akin to eating more vegetables or taking exercise. Conceptually it is very difficult to convince people unfamiliar with the intricacies of radiology, that seeking medical imaging could actually be an unhealthy behaviour. There is perhaps a slight similarity with antibiotic usage. Until quite recently, most people would have believed that demanding antibiotic treatment for a sore throat was healthy behaviour, but we are starting to realise that any benefits come at a cost, both to the individual and to society. It is very important to recognise the difference between on-demand scanning and a screening
program. The term 'screening' should be reserved for an organised program of care, integrated with the individual’s other healthcare needs, in which the benefits and risks of imaging have been carefully evaluated, and in which structured and detailed information is provided to each participant,
-65-
There are powerful influences pushing us in the direction of performing more scans
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68