Radiation danger, repeated CTs by frequent flyers

We are currently tracking opiate usage by frequent flyers, to protect them from harm. A CT scan has 150-1100x the radiation dosage of a standard x-ray. Yet, we are handing them out like candy to frequent flyers. I'm thinking of your chronic, abdominal pain pt, often a young or middle aged woman. They get repeated CT scans, often as defensive medicine, not sound holistic practice.

A kid bumps his head and he gets a CT. A guy falls and twists his back, and off to CT. I think they are over used, and the population that runs to the ER for every little bump, bruise, or stomach ache is getting over-exposed to radiation.

I think this is irresponsible medicine, but unfortunately, providers are forced to cover their behinds, and the public expects CTs and doesn't realize the dangers. And, they are a nice, fat billable charge for the hospital too.

[zmansc, ASN, RN]

I agree. I read an article a few months ago about the radiation exposure of CTs to pediatrics and their risk of developing cancers as an adult, it was quite alarming. Unfortunately, there are no pressures built into the system to keep the providers from ordering CTs and there are numerous pressures on them to order the CTs, so I don't think it's going to get any better very soon.

[mama.RN]

I'll be interested in the answers to this, as I don't work in ER and have no background in ER nursing, but have unfortunately found myself there 3 times in the past year for a few different reasons (long story, bad year health-wise), and each time was sent for a CT scan. I won't list all dx here, as people who may know me may figure out who I am. I could be mistaken, but I really think in only one of the cases was a CT truly warranted. They seemed very cavalier about the risks and really brushed off my concerns and seemed irritated that I would even bring it up.

[xoemmylouox, ASN, RN]

I think it's more where you live. Here they (for the most part) use them sparingly, sometimes not doing them when they really should.

[psu_213, BSN, RN]

I'm never going to question an individual doctor's order for a CT--it is going to be (mostly) their butt on the line if something is missed that a CT scan could have picked up. However, I think that we too many CT scans. Our best docs never seem to order a CT that ends up negative--i.e., there is an obvious need for the CT and it often will show some sort of pathology if one of these docs orders one.

On the other hand, we have docs who order a CT scan on almost everything. Vague upper abd pain? CT with contrast. Low back pain? CT with contrast just in case it's pyelo. 28 yr old with a migraine? She hasn't had a migraine in 9 years. CT head for that one. Thankfully we only have a few docs who are in the "CT everything" camp, but I think it is overdone. I will not, however, give the patient any inkling that I think the CT is unnecessary.

One of the "better" moments--a doc refused to do a CT of the head on the healthy, young male who had classic migraine symptoms. Pt really didn't seem to care, but his girlfriend was furious...yelling and screaming about how we know nothing and that a HA like that "needs" a CT scan. The GF made the pt leave AMA with no tx. for his migraine.

[KelRN215, BSN, RN]

When I worked in the hospital, there was a big push to move away from them. We used to CT all of our shunt patients all the time. The movement was towards doing MR/Vent Checks instead to minimize radiation. I took care of an infant with hydrocephalus once who probably had a couple dozen CTs throughout her first stay with us- which was a good 2 1/2 months. Any long term effects remain to be seen. Now, I had a brain tumor as a teenager and I've only ever had 2 CT scans in the 12+ years since diagnosis.

CT Scans Associated With Increased Cancer Risk - Medical News Today

My primary patient population is oncology and I don't think I've ever met a child who had a history of radiation exposure by CT before they presented with symptoms. If anything, the vast majority of my patients were "perfectly healthy" before they acutely presented with symptoms of their cancers.

[nurse2033, MSN, RN]

There are new guidelines for pediatrics, although I don't have the source off the top of my head. There is a movement to only do CTs on kids if there is a strong clinical indication. Of course, there were no CT scans when many of us were kids so we have a lower lifetime total risk. I had a patient who proudly told me she has had over 150 CT scans of her abdomen! I agree that many docs practice defensive medicine, but until there are significant changes to the system that's going to continue. I know for my family, we are only getting a CT if absolutely necessary.

[meanmaryjean, DNP, RN]

My facility leans towards MRI (for inpatients)

[Ruby Vee, BSN]

Frivolous CTs helps drive up health care costs, and that's one thing we don't need driven up!

[msjellybean]

We have an alcoholic frequent flyer, who typically presents drunk after a fall of some kind. She has had 8 brain CTs so far this year. I hate to think about how much radiation her brain has received over the last few years.

Unfortunately my ED got a crop of young, new docs & they seem to be firmly in the camp of CT-ing almost everyone.

[Lunah, MSN, RN]

We have an alcoholic frequent flyer, who typically presents drunk after a fall of some kind. She has had 8 brain CTs so far this year. I hate to think about how much radiation her brain has received over the last few years.

But you know it won't ever be anything radiation-related that kills her, it'll be a bleed the one time she falls and no one does a CT scan. Hello, Murphy: your law-fu is strong.

[utadahikaru]

I read this quote from the Scientific American Journal,

"a single CT scan subjects the human body to between 150 and 1,100 times the radiation of a conventional x-ray, or around a year's worth of exposure to radiation from both natural and artificial sources in the environment."

I'm just spit-wadding here, but my interpretation of that information means that cancer risk will rise sharply for anyone having more than 10 CT scans in a lifetime.