LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

CT scan

Have You Had Your CT Scan Today? 5 Tips You Need to Know

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Statistically, the answer is probably yes because we are handing these out like candy.  Fill up at Quik Trip and you can have your windshield repaired and a CT scan ordered.

I recently had a patient with a headache that was not responding as expected.  Her PCP ordered a CT scan.  Not an MRI.  When I told her she needed to get him to order a MRI instead, his office noted that they do not order MRIs.  What????  For her situation, there was absolutely no reason for a CT scan over the MRI.  As a matter of fact, the only reason to order a CT over the MRI is when we need rapid information, such as an intracranial hemorrhage after head trauma.  Or maybe if some type of bone growth is suspected.  Also, you can’t do an MRI when any type of metal is in the body such as a pacemaker or spinal fusion.

Other than these limited situations, MRI preferable to CT scans.  Despite this, CT scans are now coming in cereal boxes and kid’s meals in the drive thru.  In an ER setting the argument is usually that CT scanning is much quicker (read = you can make more money off of it), which is why ERs only use CT scanners.  And some will say that the initial cost of purchasing the scanners is much cheaper for the CT scan over the MRI.  This may be a good argument for a hospital, but NOT for a physician ordering from an imaging center with access to both.

So why all the frustration on my part?

Because the radiation associated with CT scans has been estimated to contribute to some TWENTY NINE THOUSAND cancers per year in the US alone.

That makes this discussion incredibly relevant to your long-term health, since it’s highly likely you’ve had a CT scan done before.  The article noted above was published over 5 years ago, so this has been plenty of time for physicians to change their addiction to ordering CT scans.  Heck, you could practically hear the screeching of the brakes immediately after this study was published.

Turns out that the screeching sound was actually the tires squealing as the number of orders for CT scans took off at full speed.  Yup, according to this review article, there were just over one million CT scans order in England in 1996-97.  By 2012-13 this number had jumped to a whopping five million.  Even worse, for 2013-14, there was a 13% increase with no sign of “plateauing.”

How are these numbers even possible???

I know that I often complain that it seems like most physicians don’t keep up with medical literature, but geez-o-Pete.  We’re talking 5 years since the concerns started to rise that one of the CT scan side effects included a large increase in cancer risk.   Despite this, we still have physicians ordering these scans.  Even worse, they are ordering them for situations where an MRI would be an even better choice or (even worse, in my opinion) they are ordering them for situations where they should not be ordered.  This happens an awful lot for conditions like headaches, shoulder pain and back pain.

So what should you do?

  1. Avoid the ER if at all possible.  Try urgent care or find a good chiropractor.  If you do go, make sure they feel the CT scan is absolutely, positively needed and the benefits of obtaining the scan outweigh the increase in cancer risk from ionizing radiation.
  2. If your doctor is ordering a CT, have a discussion with him or her about ordering a MRI instead.  There is no radiation with a MRI.
  3. Just like in the ER, if your doctor is ordering a CT scan, make darn sure the imaging itself is actually needed.  All too often a CT scan is done as a shot in the dark.  Imaging should be done to help confirm a diagnosis, NOT to fish around for ideas.
  4. If you have an ultrasound done, it many cases it is NOT necessary to order a CT scan on top of this just to confirm what the ultrasound found.  It’s ridiculous.
  5. If a CT scan is absolutely determined to be the best option (if you have a pacemaker, for instance). then check with your doctor and the radiologist about ways to lower the radiation exposure for the test (such as imaging ONLY the area of concern).

For a full review of the Committee of Medical Aspects of Radiation’s 16th report you can click here to read more about it.

CVD RISK? – GO FOR CT SCAN FIRST – (09-17-07)

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Multislice Computed Tomography in an Asymptomatic High-Risk Population

As this technology has advanced, it has consistently proven itself to be an effect method of screening patients already at some degree of risk for CVD. Screening for everyone would be very expensive without strong benefits.

The problem is that this technology is not being used effectively. Many patients still undergo “screening” coronary catheterization and this procedure is NOT without significant risks. Anyone who is at risk for CVD and is told by their cardiologist that they need the surgical procedure should strongly consider the CT scan first.

Read entire article here

IS THE ARTHRITIS IN MY SPINE THE CAUSE OF MY PAIN?

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IS THE ARTHRITIS IN MY SPINE ON MY MRI THE CAUSE OF MY PAIN?  This article finds little correlation between arthritis on CT scan and pain.  The concept of arthritis causing pain is something I deal with every day.  Having a patient tell me “my doctor said I have arthritis” is common.

The problem is it that just because you have arthritis (spinal or otherwise), it does NOT mean you have to have pain or that the arthritis is even causing the pain.  Can’t tell you how many times an “arthritic knee” was completely pain free in 3-4 visits.  Did the arthritis get fixed?  Of course not–it just wasn’t what was causing the pain in the first place.  Before anyone has anything done because they “have arthritis” I would strongly recommend they find someone adept at soft tissue manipulation work on the problem spot.  You might be surprised at the results.

USING CT TO LOOK AT YOUR HEART VESSELS

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Something that is not well understood by the general population (except devout readers of my rantings…) is that there is plaquing of the arteries and there is plaquing of the arteries.  None of it is good and it is a sign of poor vascular health.  But without a doubt, the soft, vulnerable plaque is far more dangerous than the hard, stable plaque.

Picture a nice, wide open blood vessel that has some plaquing in it.  The plaque takes up maybe 10% of the opening of the canal.  If it’s a stable plaque this is just fine.  Plenty of blood flow and oxygen are getting the heart.  Your treadmill stress test comes through with shining colors. 

But what if the plaque is unstable?  That mass taking up 10% of the lumen of a large blood vessel, but now it breaks free and works its way into a smaller vessel, taking up most of the canal, starving the heart muscles for oxygen and causing a heart attack.  The stress test on this plaqued artery prior to the mass breaking off?  Again passed with shining colors.

What??  Am I saying that you can drop dead of a massive heart attack leaving a perfectly healthy stress test?  Yup.  And it all boils down to the stability of a plaque.  So how do we know? 

First, this study looks at the ability of CT scan to identify the soft vs hard, stable plaques and finds that it does a pretty good job.  Not too shabby.  Next, we can easily check lipoprotein-associated phospholipase A2 (Lp-PLA2, or PLAC test for short) in the blood.  This test has some pretty strong correlation with being able to predict if any plaques are unstable and ready to rupture.

Even more importantly, what can we do to make sure any plaques were are sporting are the stable type?  Exercise, higher intake of healthy fats (raw nuts, seeds, wild caught fish, avacodos, flax, olive oil, etc..) and lowering our levels of inflammation (see earlier blog postings) all increase the stability of a plaque.

Of course, making sure they’re not there in the first place sounds more preferable to me.

http://www.sciencedirect.com/science/article/pii/S0002914911003912