Full-Body CT Screening Divides Radiology Community

December 04, 2002

Peggy Peck

Dec. 04, 2002 (Chicago) - In the radiology community, the words "full-body CT" elicit very little consensus, an observation that was apparent from a pair of presentations here at the 88th Scientific Assembly and Annual Meeting of the Radiological Society of North America.

Opponents criticize the highly promoted full-body CT screening for giving patients either false assurances or needless worry. Moreover, they state that at best the scans provide useful information only half the time and even then the utility of the results depends on additional costly tests and good follow-up care. Nationally, centers charge $800 to $1,000 for the service — costs that are not covered by insurance but follow-up tests usually are covered by private insurance or Medicare.

Proponents counter those arguments by saying that the scans do help promote good health, claiming, for example, that smokers and obese patients seek scans as the first step toward lifestyle modification. Moreover, they say that "worried well" patients are reassured by the results of CT scans.

Max Rosen, MD, MPH, assistant professor of radiology at Harvard Medical School and chief operating officer/medical director at BeWell Body Scan in Boston, Massachusetts, favors the use of full-body CT. He presented results of a survey of Boston area residents' attitudes about full-body CT.

He said that 450 residents who answered questions in a random telephone survey conducted in September 2001 initially had no opinion about full-body CT. "But after an explanation of what full-body CT is, 82% said they were interested in it," Dr. Rosen said. And 72% said they liked the "idea that they could go over results with a radiologist." Seventy-nine percent said they had concerns about their risks for developing cancer and 60% were worried about heart disease but 48% said their own physicians or medical plans didn't do enough screening for these conditions.

Asked if his study differed from surveys used by business to test new markets, Dr. Rosen said "Well, it actually was a marketing survey." He noted that BeWell Body Scan opened in May 2002.

Nonetheless, Dr. Rosen said the survey results indicated a genuine interest. Moreover, he presented additional data on 310 people who have had full-body CT at his center since it opened. The average age of those patients was 54 years, and 181 were men. On average the men said they had visited their physicians within the previous nine months and the women said they had had a physician visit in the previous four months. "About 50% of these people are former or current smokers," Dr. Rosen told Medscape.

Half of the scanned patients required no additional follow-up, while half needed more tests, usually additional imaging studies such a chest CT or full cardiac evaluation, he said.

Those follow-up numbers reflect the findings of a retrospective study presented by Giovanna Casola, MD, professor of radiology and chief of body imaging at the University of California, San Diego. Casola analyzed results of 1,192 full-body CT examinations conducted by a for-profit scanning center in Southern California. She said that 46% of the scans exhibited abnormal findings - usually in the lungs, kidneys, or liver - and required additional tests.

Dr. Casola said full-body scans are a hot-button issue for California physicians because "this all really started three years ago in Southern California. Most of us found out about the scans while we were driving to work, from ads on the radio." Those radio plugs typically advised listeners to be scanned because they "owed it their loved ones." At that time, she said, the emphasis was on electron beam CT to detect coronary calcium. "So men with wives and children would have the scans as a way of 'protecting' the family," said Dr. Casola.

Twenty-five percent of the abnormal findings indicated indeterminate or suspected malignancy and 1% were highly suspicious for malignancy or aortic aneurysm.

Of the 1,192 total patients, 442 were told they needed more tests. Most of the patients who required additional testing were older than 45 years, said Dr. Casola. "So, one recommendation that we can make is that full-body CT should be limited to those who are older than 45. In this series there were 22-year-olds getting scanned - that is too young because CT scans do expose people to radiation, which itself is a risk for cancer." Ideally people should have as few scans as possible over the course of a lifetime, she said.

But the most troubling aspect of the scans, said Dr. Casola, is that the kind of scans offered are not the most effective type of tests for detecting abdominal abnormalities. "To detect abdominal abnormalities one needs to do a contrast scan. These scans are all done without contrast," said Dr. Casola.

She also criticized the lack of follow-up at most commercial scanning operations. "There is a total lack of communication with a primary care physician," Dr. Casola said.

Dr. Rosen said that is not the case at his center because not only does the radiologist personally review the scans with the patient, but the results are also sent to the patient's physician. If the patient has no physician, Dr. Rosen's center arranges for primary care follow-up. Both Drs. Rosen and Casola agreed that there is a need for guidelines for full-body CT, but Hedvig Hricak, MD, PhD, chairman of the department of radiology at Memorial Sloan-Kettering Cancer Center in New York, said that little is being done to formulate the needed guidelines. She noted that no professional society endorses full-body CT.

Moreover, Dr. Hricak said that several states have enacted laws to regulate the screening centers. For example in New York, "patients must have a referral from a physician. No walk-in screening is permitted. And radiologists cannot refer for full-body CT because self-referral is barred," she added. Moreover, the New York law requires that "a radiologist be on site at the CT center." Pennsylvania and Texas have also passed laws that ban patient self-referral, she said.

RSNA 88th Scientific Assembly: Abstracts 317, 319. Presented Dec. 2, 2002.

Reviewed by Gary D. Vogin, MD

Peggy Peck is a freelance writer for Medscape.

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