and systematic analysis of the outcomes performed, thus allowing improvements to be made to the program for the benefit of all participants. This is very different from scanning an individual at their request.
Do people not have the right to purchase scans if they want to? Of course they do. We allow people in our society to do unhealthy things – drink alcohol, smoke tobacco – but rightly we insist that they should be properly informed about the risks beforehand. There will undoubtedly be people who gain from having a CT scan while asymptomatic, but there will be others who lose through harm connected with incidental findings. Isn’t it simply a decision for an individual to take? Why should the rest of us be concerned if one
person decides to pay for a scan? The reason why it is an issue for all of us is that when the scan reveals an abnormality, it is highly likely – as we have seen – that further tests will be advised and those are more often than not going to be paid for by the tax-funded National Health Service. So although the individual has paid for the first examination, the three or four further scans which might be needed to confirm the benign nature of a small lung nodule, for example, will often be picked up by the NHS. So in the end we all pay. Moreover, a service which is overburdened with follow-up examinations for incidental findings could result in delays for other patients who might benefit more. It might seem odd to hear a radiologist suggesting that medical imaging can be harmful. The
advantages that imaging has brought to human health are enormous, but those apply for the most part to people with symptoms. I know that I won’t convince everybody but my hope is that I’ll make a few people think twice – is this really the right thing for me? Do I understand the downside as well as the advantages of having a scan? And perhaps I can encourage those engaged in this practice – radiologists and radiographers – to do their utmost to ensure that people without symptoms, who put themselves forward for CT scans, are as well informed as they possibly can be about the pros and cons of the procedure. The Department of Health in England commissioned a working party to review the evidence and make recommendations as to when self-referred CT examinations can be justified. Their report covers the principal areas of lung, colon and cardiac scanning and makes recommendations in each instance as to the groups of people for whom the potential benefits are such that a CT scan can be justified in the absence of symptoms6
.
In summary, CT has been one of the outstanding successes of the so-called 'Golden Age' of medical imaging and has brought enormous benefits to patients. We must however, beware of assuming that
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the same or equivalent benefits will also accrue when it is applied to people without symptoms. Every healthcare intervention carries risks as well as benefits and the balance is fundamentally different in people who are 'well'. It is part of our duty as imaging professionals to understand that difference as best we can and to be prepared to explain it to patients and the public.
CT for everyone who will benefit? I certainly hope so. CT for all? Not at the moment, thank you.
References 1.
NHS England. Annual Imaging and Radiodiagnostics data. 2014. Available online at
http://www.england.nhs.uk/ statistics/statistical-work-areas/diagnostics-waiting-times-and-activity/imaging-and-radiodiagnostics-annual- data/ (last accessed 01.03.2015).
2. Organisation for Economic Cooperation and Development Health at a Glance 2013. Available online at http://
www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf (last accessed 01.03.2015).
3.
National Cancer Research Institute. Early Detection of Cancer. Available online at
http://www.ncri.org.uk/ initiatives/early-detection (last accessed 01.03.2015).
4. US Food and Drug Administration. What are the Radiation Risks from CT? Available online at http://www.fda. gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/
ucm115329.htm (last accessed 01.03.2015).
5. Ahmad A, Ormiston-Smith N, Sasieni P 6. . Trends in the lifetime risk of developing cancer in Great Britain:
comparison of risk for those born from 1930 to 1960. British Journal of Cancer, advance online publication 3 February 2015; 112, 943-7.
Department of Health. Justification of computed tomography (CT) for individual health assessment. 2014. Available online at
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/326572/ IHA_-_June_Report.pdf (last accessed 01.03.2015).
ABOUT THE AUTHOR Dr Giles Maskell is a Consultant Gastrointestinal and Oncological Radiologist based at the Royal Cornwall Hospital in Truro. He is currently President of the Royal College of Radiologists.
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