tag:blogger.com,1999:blog-4968787219619380438.post1163225259506483706..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: Irrational fear of CT scans in appendicitisSkeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger11125tag:blogger.com,1999:blog-4968787219619380438.post-26288043388139332332016-07-17T08:27:20.267-04:002016-07-17T08:27:20.267-04:00Mark, you could be right. I was actually referring...Mark, you could be right. I was actually referring more to physicians' reluctance to order CT scans because of the fear of radiation-induced cancers in the future. I suppose there are some potential patients who share the same concerns.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-1209663108270956942016-07-15T06:23:58.075-04:002016-07-15T06:23:58.075-04:00You know plenty of people fear all of the medical ...You know plenty of people fear all of the medical procedures and the entire building too, so it may be a much more complex issue.Mark Sandelhttps://www.blogger.com/profile/10304927394861200451noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-71674366088675027642016-07-06T13:05:19.567-04:002016-07-06T13:05:19.567-04:00I agree. I had the same issue with an OR staff tha...I agree. I had the same issue with an OR staff that was not in-house after 11 PM. It makes a huge difference to have positive CT scan so they can be on their way in and ready after you have seen the patient. <br /><br />I know there are those who feel appendectomies can be delayed without harming the patients. I always felt like it was better to get it done at night instead of hoping for an opening in the next day's OR schedule and disrupting your entire day.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-75449995734473701912016-07-05T20:28:24.191-04:002016-07-05T20:28:24.191-04:00If, like me, you work in a hospital that does not ...If, like me, you work in a hospital that does not have a surgery crew and anesthesia in house 24/7, one of the last things you feel like doing is wasting time up at the hospital while waiting for them to drive in and set up. So I don't mind if ER docs want to scan someone before calling me. Our ER docs are usually primary care guys who have quit private practice, and as such they don't have a good feel for appendicitis anyway. Patients in this day and age usually want to be scanned before they get cut, and I'd rather spend 30 minutes or so up there as opposed to a few hours. <br /><br />I trained in the 1990's, and we had to examine a lot of bellyaches without the benefit of a quick CT. In all modesty, I think I got pretty good at making the diagnosis without a CT (more so on exam than history, and regardless of the WBC). I wasn't 95% accurate though. Still, it comes from seeing and examining a LOT of patients, and today there just isn't enough time for the volume of that kind of learning curve, neither in residency nor afterward. artigerhttps://www.blogger.com/profile/13361655152970244221noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-66132857380530420692016-07-03T12:28:41.869-04:002016-07-03T12:28:41.869-04:00The boat has sailed. In my area, most patients wit...The boat has sailed. In my area, most patients with abdominal pain get CTs before surgery is called. <br /><br />I blogged about this 6 years ago [http://skepticalscalpel.blogspot.com/2010/08/appendicitis-diagnosis-ct-scans-and.html] saying "In a non-teaching hospital where there are no residents, it is very difficult to have every patient with a suspicion of appendicitis seen by a surgeon. When the emergency physician calls and says she has a patient with a positive CT scan for appendicitis, the diagnosis is correct more than 95% of the time."Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-76718904067104534332016-07-01T17:34:01.319-04:002016-07-01T17:34:01.319-04:00I'm a surgical dinosaur, brought up in the tim...I'm a surgical dinosaur, brought up in the time when the diagnosis of appendicitis was entirely clinical. We relied on Zachary Cope, and his alter ego, Zeta.<br /><br />And then came ultrasound, and it only seemed to delay diagnosis – if we actually got an answer from it. And now CT; well, in the NHS in my part of the Celtic wastelands, getting one was always a matter of being nice to a friendly radiologist.<br /><br />Have we completely lost clinical skill? I don't mean the skill to guess that it might be appendicitis, I mean the skill to be (reasonably) certain. Is this really progress – or am I just superannuated?Korhommehttps://www.blogger.com/profile/05497111884933914657noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-80251650979013641702016-06-27T11:15:13.299-04:002016-06-27T11:15:13.299-04:00It seems we all agree that LNT is far too simplist...It seems we all agree that LNT is far too simplistic. Believe me, that’s a major agreement. <br /><br />Epidemiological studies are a very poor measuring instrument to tease apart how much excess cancers are from radiation at doses typically seen in CT. Particularly as intensive imaging unmasks a reservoir of clinically silent cancers – a well-described phenomenon known as overdiagnosis. <br /><br />It is important not to confuse “we do not know the risk therefore it is better to take precaution” with “radiation is giving us cancer.” It is also important not to confuse “be prudent with CT” with “don’t use CT scans at all.”<br /><br />Prudence, not fear-mongering, is the way forward. <br /><br />SaurabhAnonymoushttps://www.blogger.com/profile/03296668579350446909noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-32284118855961884022016-06-27T10:32:25.727-04:002016-06-27T10:32:25.727-04:00Living at high altitude increases background radia...Living at high altitude increases background radiation, which is continually delivered in minute increments. I see no reason to assume that a burst of radiation delivered in a fraction of a second is as safe as the same dosage spread out over a full year. There are also epidemiological studies showing that CT scans increase cancer risks, particularly in children. Of course in some circumstances the benefits exceed the risks. However, pretending that there are no risks will have two negative consequences: doctors who believe it will dish out needless CT scans that later cause cancer, and patients who don't believe it will refuse useful CT scans because there's no way to discuss risk-benefit ratios with someone who doesn't acknowledge one half of the equation.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-60223928611250687782016-06-25T08:34:00.554-04:002016-06-25T08:34:00.554-04:00Vamsi,
You are correct that the rate of dose of r...Vamsi,<br /><br />You are correct that the rate of dose of radiation is important. It is for this reason that cumulative dose (or how many CTs one has had), which is now tracked, is not terribly helpful.<br /><br />Can 10 msv be the threshold for radiation-induced malignancy? It is not impossible but unlikely. The radiation-cancer curve is more likely to be sigmoid than linear. This means once the threshold is crossed there should be a rapid rise. Were 10 msv the threshold, 20-50 msv should be the part of the rapid rise. The extra cancers at doses > 100 msv are detectable. Below that, epidemiological studies are, at best, contradictory.<br /><br />Saurabh Jha<br />Anonymoushttps://www.blogger.com/profile/03296668579350446909noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-66200116707923425702016-06-25T06:54:25.230-04:002016-06-25T06:54:25.230-04:00Another perspective
http://www.scientificamerican...Another perspective<br /><br />http://www.scientificamerican.com/article/how-much-ct-scans-increase-risk-cancer/Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-46642968852648697022016-06-24T19:33:49.452-04:002016-06-24T19:33:49.452-04:00Dr. Jha and Dr. Scalpel,
I'm convinced by you...Dr. Jha and Dr. Scalpel,<br /><br />I'm convinced by your argument that radiation risk is non-linear. But there is an implicit assumption in your argument that CT Scans are on the right side of that non-linearity.<br /><br />After all, what if it's not just non-linear based on absolute dose, but non-linear based on the rate of the dose as well? The annual background dose may be 3 msv, but that is spread out over a year. In contrast, the radiation from an abdominal CT is 10 msv over approximately 1 minute- the rates are different by 5-6 orders of magnitude. Logically, a few DNA breaks here and there over the course of a year have plenty of time to be repaired, while a million breaks over the course of a minute overwhelm the repair mechanism.<br /><br /><br /><br />Respectfully,<br />Vamsi AribindiVamsi Aribindihttps://www.blogger.com/profile/05182545135805006712noreply@blogger.com