On January 30th, an op-ed in the NYTimes by Drs. Redberg and Smith-Bindman made the assertion noted in this title. We addressed it skeptically, the nicest term for our skewering of the numerous fallacies contained therein. (Several letters to the editor of the Times agreed in the main with our point of view, including one from the President of the American College of Emergency Physicians). Most annoyingly, the co-authors both clinicians ignored the specter of defensive medicine that stalks ERs, thanks to predatory plaintiff s lawyers second-guessing every decision, using the 20/20 retrospectroscope.
So it was gratifying to see a dialogue under the auspices of Medscape, in which the expert interviewer was Dr. Robert Glatter, Director of Sports Medicine and Traumatic Brain Injury , Department of Emergency Medicine, Lenox Hill Hospital in New York. He discussed the assertions and ramifications of the Redberg-Smith-Bindman op-ed with Dr. David Schwartz, Professor of Emergency Medicine at New York University School of Medicine, and also a specialist in diagnostic imaging and emergency radiology.
Some of the highlights of this enlightening interchange included: the increase in CT scans is an expected phenomenon, considering the technology is only 30 years old or so, new areas of usefulness are being discovered, and the approaches are being fine-tuned as more experience is gathered. Moreover, the actual risk of cancer from one or a few CT scans is remote, when compared to its benefits when used appropriately. The actual risk decreases with age children are more vulnerable, theoretically, as radiation exposure is cumulative thus the cancer risk in the over-40 age group is hypothetical only. And, while other non-ionizing radiologic investigations (ultrasound, MRI) are sometimes indicated, as a rule CT scans are the most valuable in the ER setting. Both Drs. Glatter and Schwartz expressed concern that the simplistic message of the op-ed might cause needless confusion among anxious patients and parents of children with emergency situations, compromising care.
(There is also another informative discussion on that same Medscape site, the commentator this time being Jonathon A. Leipsic, MD, Vice President of the Society of Cardiovascular Computed Tomography)