CT scan dangerous? Enough reason to get one?

[Eddie Dane]

My wife has been feeling under the weather for months now, combined with light belly ache.

She went to an internal specialist. A coloscopy and some simple blood tests (Hb, Leucocytes, etc.) didn't show any abnormalities.

The doctor basically went 'I don't expect to find anything, but I'll let you have a CT scan just to make sure'.

It would be a scan of her whole abdomen and thorax.

But looking at some background info about CT scans, there is a high dose of radiation involved. We are starting to doubt if there is enough reason to choose this technology, and especially to do a combined CT scan of abdomen and thorax (the only reason to do a thorax scan is that she was a little breathless sometimes and that she had pneumonia recently). Apparently, CT scan of thorax means an especially high dose of radiation for the patient.

We've requested to cancel the CT scan of the thorax and just have a CT scan of the abdomen, or to choose MRI instead, but the doctor refuses to review his choice.
Furthermore, we feel the phenomenon of breathlessness and pneumonia could be first examined by a long doctor...

In conclusion, we feel a CT scan of both abdomen and thorax is out of proportion. And he himself told us not to expect to find anything.

What would you do?

[randman]

Not a doctor so don't hold me to anything, but sounds like the doctor felt he was doing you and maybe himself a favor by authorizing your insurance to pay for the CT scan.....but that doesn't really mean it's a good idea. Maybe the radiation levels are a problem as some are saying recently.

Ultimately, you and your wife need to get some personal clarity on how serious the symptoms are and whether they could be related to something else like diet, an allergy, chronic GI issues, stress or whatever. Maybe get another exam by another doctor and ask this doctor if he can order the CT in a couple of weeks if it doesn't clear up but you want to see if it will.

[Xulld]

I work in radiology, but am NOT a doctor and there for cannot render medical advice as such this should not be seen as medical advice.

With that said, I would only get a CT scan say over an X ray, or no scan at all if the potential for a serious medical condition were eminent.

X rays when done right, and when processed with a high quality digital scanner can render good contrast and rule out a bunch of medical issues that could be of concern at a small fraction of the dosage (~100-700 times less dependent on technique and type of scan)

CT scans offer more information and can be rendered tomographically. I would ask the doctor what kinds of conditions would the exam rule out, is he a radiologist? If not then he may not have the expertise to know what kind of scan will best present the information he is looking for. Is it a question of money and insurance? If so that makes it much harder to justify exams that are not covered. I think it helps a ton as a informed patient if the doctor can give you some conditions he is trying to rule out with the exam. It also allows you to place a price against the gain. What is the price of 2% increased risk of cancer over your entire life vs $2000-10K dollars out of pocket, against the risk of whatever conditions he wants to rule out and the effect on mortality of not catching it soon enough.

Often times when a doctor wants to get a given scan performed it may just be a way to rule out the worst possible outcomes and avoid any liability, not that the symptoms posed are in themselves a reason to get the exam done.

I know that what I have said may not ultimately be very helpful in making your decision. Maybe this will help more, here is a chart with the relative dosage of each type of exam.

http://www.radiologyinfo.org/en/safety/index.cfm?pg=sfty_xray
Now it is pretty tricky to take this information and then apply it directly to say . . . chance of getting a particular cancer.

I do believe studies have been done and good information is out there, atm I am having trouble finding the reference material. The figures I mentioned above were pulled out of my ass just as examples of the way my mind thinks about this topic. MRI, and CT scans can be as cheap as $600 for a 30 minute MRI scan or many thousands of dollars for a hi resolution CT scan then reported against by a highly qualified radiologist.

[bigred]

http://www.cancer.gov/cancertopics/factsheet/detection/CT

I'm also no doctor but my general understanding/impression is that the risk of not getting one usually well out-weighs the risk of getting one, a risk which tends to be rather small. That said, I would explore other options.......and always ALWAYS I would get a second opinion about any serious or potentially serious medical situation. g/l

[Skeptic Ginger]

Well I am a nurse practitioner and as much as people criticize me for giving medical advice on the forum, I ignore them.

Here's the algorithm that doctor is likely going through:

What are the most likely things? checked
What are possible things that are easy to test for? checked
What are the most likely things left that are more invasive to test for? Sounds like he/she is about at this stage.

The questions I would ask are:

1) What things might show up with a CT that have not shown up with these other tests?

2) Are any of those things potentially dangerous if we wait and see vs getting the CT scan?

3) Are there any avenues of investigation we have not yet tried?


The false belief these tests are ordered to pad the bill are naive. That is rare, not a common occurrence. What is much more likely is the doctor believes your wife is in distress and is simply offering to do one more thing before saying he/she cannot help her.

What patients don't always do is communicate their wishes to the doctor. Are you and your wife willing to have no answer? Are you willing to wait and see if she doesn't get better (depending on the answers to questions 1&2)?

Sometimes a 2nd opinion is helpful. Sometimes they just repeat the same tests so be sure to take a copy of everything if you do get a second opinion.


Now for my guess, get the scan. There are a few things that don't show up on the exams she's had that might show up on a CT scan. But I say guess because this is one of those things I don't have enough information about your wife's problem and work up to give a more specific informed opinion.


I had a chest CT to rule out a complication of an illness I have. It does creep one out thinking about an X-ray of every one millimeter slice of one's chest and I'm still due for my 2 year mammogram and the last one was repeated because they saw a shadow that turned out to be a shadow. But I'm still going to get the needed tests. People are not dropping like files from getting CT scans and other X-rays or even nuclear med studies where they inject radioactive material right into your bloodstream. It's more scary sounding than it is dangerous.

[Beerina]

I can't imagine it's any statistically even remotely dangerous level or else this would have easily shown up by now.

[Xulld]

I would say Ginger has summed up the key questions to ask better than I did.

I would also say that trying to determine the effect of law suits and liability on doctors decisions to order testing is a cognitive science/ psychology question of which studies have been done and it is not an insignificant factor.

It is also a factor that many doctors do not really know the statistical risks associated with many exams. Ask them, often times they are very unaware. Always get a second opinion and do research yourself.

Strict guidelines are posed for people who work with radiation x ray equipment because of the very real risks associated. (single exposure offers a lower risk, but still there is risk and its better to be aware of it)

A good set of guidelines to understand the risks.
http://www.physics.isu.edu/radinf/risk.htm

[epepke]

If you were in the US, I'd say that you shouldn't get it. Since you're in the Netherlands, if I were you, I'd get it. The reason is that in the US they'll give you a CAT scan if you fart. They're much less likely to give you one in Europe. So if it's even on the table, it's more likely to be a reasonable thing to do.

[Skeptic Ginger]

If you were in the US, I'd say that you shouldn't get it. Since you're in the Netherlands, if I were you, I'd get it. The reason is that in the US they'll give you a CAT scan if you fart. They're much less likely to give you one in Europe. So if it's even on the table, it's more likely to be a reasonable thing to do.You got any evidence of this claim? I'd be interested in seeing it.

[ben m]

Can the doctor explain *why* an MRI wouldn't work? It's good 3D scan information with zero radiation dose. As far as I remember, it's comparable in cost.

The radiation-safety regime in the US is NOT "measure risk and do cost-benefit analysis". (The risks from CT scans are, statistically speaking, basically too small to measure, and known only by extrapolation from high-dose cases.) The safety regime is "As Low As Reasonably Achievable" (ALARA). If an MRI is reasonably achievable, ALARA says start with that. I'd say that the doctor owes you a good explanation of this option.

[theprestige]

All I can say is, per xkcd, you are probably blowing the radiation concern out of proportion by one or more orders of magnitude:

http://xkcd.com/radiation/

[Skeptic Ginger]

I would say Ginger has summed up the key questions to ask better than I did.

I would also say that trying to determine the effect of law suits and liability on doctors decisions to order testing is a cognitive science/ psychology question of which studies have been done and it is not an insignificant factor.

It is also a factor that many doctors do not really know the statistical risks associated with many exams. Ask them, often times they are very unaware. Always get a second opinion and do research yourself.

Strict guidelines are posed for people who work with radiation x ray equipment because of the very real risks associated. (single exposure offers a lower risk, but still there is risk and its better to be aware of it)

A good set of guidelines to understand the risks.
http://www.physics.isu.edu/radinf/risk.htmIf your physician cannot explain the potential benefit of the exam, that would be a concern.But I do know the questions to ask and I do do my own research and I know what to look for and how to look and I still find in the end my own physician can indeed explain what benefit a test will provide, often it is something I did not find in my search. Occasionally I am able to share some new research with the physician.

There is a false stereotype being presented here that medicine in the US is all about padding the bill and ordering unneeded tests to prevent lawsuits. Think about it, we have third party payers who very often decline to reimburse for unneeded tests and why do you think those tests protect from lawsuits? Could it maybe be that you can miss some critical things if you don't do certain tests? No one sues unless they were caused damage. An extra test does not typically hurt a person, but missing a diagnosis certainly does.

[Skeptic Ginger]

All I can say is, per xkcd, you are probably blowing the radiation concern out of proportion by one or more orders of magnitude:

http://xkcd.com/radiation/I agree. The reason I posted my own experience is even knowing this^, all those thoughts still cross your mind. They did mine. But in the end I got the scan. I was actually relieved to quit worrying I might have serious organ involvement with my disease. I figure that decrease in stress counters a lot of radiation risk.

[Skeptic Ginger]

Can the doctor explain *why* an MRI wouldn't work? It's good 3D scan information with zero radiation dose. As far as I remember, it's comparable in cost. ...Assuming this information is correct, there are differences in what the tests best detect. Don't assume they are equally useful regardless of the thing one is looking for.

CT Scan vs MRI (http://www.diffen.com/difference/CT_Scan_vs_MRI)

[epepke]

You got any evidence of this claim? I'd be interested in seeing it.

Only my personal experience and that of my father and mother in Europe and the US.

(And if you want evidence of giving people a CAT scan for farting, that's tongue-in-cheek.)

However, from http://www.oecd-ilibrary.org/docserver/download/fulltext/8110161ec033.pdf?expires=1328579078&id=id&accname=guest&checksum=75F345AF3B7AEAB57D18358FF5DA8267 you can see that the Netherlands has 10.3 CAT scan machines for every million people, and from http://www.emedicinehealth.com/ct_scan/article_em.htm you can see that the US has about 6000 CAT scan machines, which is about 20 per million people.

[Lolly]

Well, here in nationalized-medicine land, we get CT scans whenever they are deemed necessary.

I've never given the radiation or other risks a second's thought (other than in relation to whatever form they have you sign where you acknowledge the risks, but those are "worst-case" scenarios). I just go by how sick I feel and how much I trust the doctor. For instance if I think the doctor is just being cautious about getting sued and I don't feel that bad then I'll defer it, or not have it. If I know there's something wrong with me and/or it's really hard to deal with, then I want all the tests they've got to find out what's going on and fix it. If it's a doctor that I think really knows what they are doing, then I'll do it, even if I personally don't feel that bad.

How about an ultrasound instead? Would that tell your doctor anything about what he's looking for or hoping to exclude?

[Xulld]

I agree. The reason I posted my own experience is even knowing this^, all those thoughts still cross your mind. They did mine. But in the end I got the scan. I was actually relieved to quit worrying I might have serious organ involvement with my disease. I figure that decrease in stress counters a lot of radiation risk.

I agree, I really only wanted to present data, as a physicist tech working in the radiology software development field I have plenty of anecdotes, but nothing I feel should be considered from a raw risk/benefit analysis.

Doctors are human, that in itself is plenty of facts to pause when seeking answers.

The questions to ask you made clear, and I agreed
The questions I would ask are:

1) What things might show up with a CT that have not shown up with these other tests?

2) Are any of those things potentially dangerous if we wait and see vs getting the CT scan?

3) Are there any avenues of investigation we have not yet tried?


MRI scans actually tend to yield more information on soft tissues, so what exactly we are trying to rule out makes a big difference.

CT scans are amazing as far as quality goes, but can really be way overboard as well. They also tend to offer better contrast with bone then soft tissues

"As Low As Reasonably Achievable" (ALARA).
Indeed.

The information bandwidth of each modality is different due to the physics involved. Detecting the decay of RF after exciting water atoms offers one way to image the body and hitting a person with high energy light and gauging the relative attenuation of that light offers another. The fact that MRI offers a good potential alternative with no risk is something to consider . . again dependent on what could be ruled out by the CT vs the MRI that the doctor feels might be representative of the symptoms.

I will say this, one reason I tend to be very skeptical of any given doctors decision is I work with them every single day and often find reasons to doubt their foundational understandings of not only physics. But hey I said I wouldn't offer anecdotes so its probably unfair to illustrate doctors in some generalized way. They are after all human, no amount of initials changes that fact.

I just wanted to say . . . take it with a grain of salt and make sure to put anything into perspective of the above questions Ginger so aptly listed. I wouldn't get a CT scan for just any old ache pain, or sense of a lack of well being.

[casebro]

I've had both, maybe 3-4 times each.

I'm thinking the division i uses gets blurred when contrast dyes are used? Different dyes, with different side effects, would be a ruling factor. Like xray opaque dyes work on the CT, but I don't know what dyes are used for MRI, sine it's detection is proton based.

I also know that being 98th percentile in size, I fit the MRI like a cork in a bottle. But the latest CT scanners are much more open, no claustrophobia effects to worry about. That is an important consideration, if you don't like the thought of spending 30-40 minutes trapped in a sewer pipe, awaiting the rescue miners to drill an escape hole, or at least pipe in fresh air when you are hyperventilating and going into a panic mode and wetting yourself... But I exaggerate- My arm joints sure got sore from being bound that tight that long. I weighed close to the limit, 300 pounds, at that time. Smaller folks will breeze right through an MRI.

[casebro]

But back to the OP's point: These scans are getting very common place. If they were so deadly or carcinogenic, wouldn't the mortality/morbidity stats be showing increases? Yet our average life span keeps growing. Like a cancer? ;)

There is more to be gained by finding an existing cancer early, while still treatable, than is lost by the astromnomically rare happening of causing a cancer to start by irradiating you.

My own scan found an 'adrenal incidentaloma', something small and innocuous. Good: it showed. Bad: it was meaningless, cancer worries for nothing. Initial scan took minutes, follow up two years later took seconds. Lots of other tests in the meantime, looking for adrenal anomalies. No problems. ever.

[Bionic Hips]

I'd ask. I don't want to add to your worries, but in my wife's case it detected some things you want detected as early as possible.

[bigred]

But back to the OP's point: These scans are getting very common place. If they were so deadly or carcinogenic, wouldn't the mortality/morbidity stats be showing increases? Yet our average life span keeps growing. Like a cancer? ;) To be fair (and I don't think CT scans are esp "dangerous"), that's a huge oversimplification. How would we know if CT scans were causing an increase, since there are so many factors which can go into getting or not getting cancer, we have become so much better at prevention in so many ways, etc etc? Really we are still only guessing at many of the possible causes of cancer.

There is more to be gained by finding an existing cancer early, while still treatable, than is lost by the astromnomically rare happening of causing a cancer to start by irradiating you.Generally agree, but to a point. I think that is why all the flak is going on about mammograms.


No one sues unless they were caused damage.
Apologies up front for any offense and your posts here overall are outstanding, and also pardon the sidetrack, but that is frankly naive. Lots of people can, have and will sue at the drop of a hat, even with false accusations, if they think they can get away with it and get "free money."

[casebro]

To be fair (and I don't think CT scans are esp "dangerous"), that's a huge oversimplification. How would we know if CT scans were causing an increase, since there are so many factors which can go into getting or not getting cancer, we have become so much better at prevention in so many ways, etc etc? Really we are still only guessing at many of the possible causes of cancer.



Yes, but obviously the give away/take away of modern treatments are a net gain.

"Medicine is a game of numbers". I read that somewhere on the net. The final score shows as the big numbers in epidemiological studies. The score keeps getting higher, we are winning. In general.

Whether a particular treatment helps a particular subject is a different matter. Dr.s "treat the numbers" way too much, not the particular patient. Hey, you don't know how hard I've had to fight to NOT get sedated, or, with a pre-existing myopathy, NOT get statins.

But the incidents of cancer proven to be caused by medical xrays are so rare I don't consider it to be having any effect on this one patient's life.

That all said, lately I did read some Woo about thymus damage caused by not being given a throat guard when being xrayed. I haven't followed up on it, but if it is that probable, the techs would pull the guard out of the drawer lots more often.

[Eddie Dane]

Perhaps "dangerous" was too strong a word to use in my initial question.

But it is a lot of radiation, especially as it is both chest and abdomen.
And it adds to one's chances of cancer.

Cancer is a fear in my family as my wife's mother died at an early age (42) from it.

Our concern is that the doc seems to be using a shotgun approach for quick and easy results.
It didn't help that he said it is even used on pregnant women, when the brochure we received says explicitly that this is only done in extreme cases.
He doesn't seem to be clued in on the downsides.

OTOH, my wife would like to finally work to a conclusion of eight months of feeling like crap.
Some progress would be really welcome at this point.

[Xulld]

Our concern is that the doc seems to be using a shotgun approach for quick and easy results.
It didn't help that he said it is even used on pregnant women, when the brochure we received says explicitly that this is only done in extreme cases.
He doesn't seem to be clued in on the downsides.It is these kinds of impressions that we cant really get at here just reading a forum post, so Id say if you think he is being overly dismissive and clearly does not understand the, real yet statistically small danger, then Id find someone else.

I really do not want to dis on doctors, but I work with them every day and I think the ones who are truly scientific in their approaches mirror the general population, ie a small percentage. Most just memorize facts and work with old knowledge never reading new studies until it comes time to recert.

The reason children/babies ect are NOT scanned unless it is mission critical to fix a life/death complication is becuase the models which provide us data on cancer risk center on how many years of life expectancy you have.

I am 32 years old, I expect to live at most another ~50 years. The probability of a high energy event occurring now that in 20-40 years will cause a cancer is a set value based on dosage.

A child in the womb has a total life expectancy of ~80+ years giving almost twice the time to develop a cancer from a high energy event.

Another thing to consider, statistics are all well and fine, but the ontology of high energy radiation causing cancer requires only a single event. (we live in a world of danger, I do not see this fact as reason to get all noid, but nevertheless it is a true fact.)

IMHO less exposure is better unless you have a real reason to get an exam done. I have broke my back twice, and both times got an MRI instead of a CT even thought the doctor wanted me to get one. The MRI revealed the damage just fine for a qualified radiologist to complete an accurate report.

IMHO (again not medical advice) not feeling well just isn't enough of a reason to get a CT scan until you have seen a few other doctors who do not give you the feeling they are dismissive, or uninformed.

~1500-3000mrem may not seem like a lot, and perhaps nether is ~.008% increased cancer risk over 20 years, but it is something which doesn't need to occur unless you feel validated by the doctors expertise, which from your explanation you are not feeling all that great in regards to his knowledge.

I'd ask. I don't want to add to your worries, but in my wife's case it detected some things you want detected as early as possible.
This cannot be overstated enough. Id find a second opinion that I can respect and if that doctor thought the test was needed to rule out life threatening disease then I would not hesitate.

[Miss_Kitt]

As others have expressed, I'd get a second opinion. Are you seeing a general physician, or a gastroenterologist? What are the specific concerns the doctor has that he (she?) wants to eliminate with the CT scan?

Sometimes getting a scan is really a good idea. One of my friends went from general digestive discomfort to throwing up; was diagnosed with GERD, but then ended up in hospital with pancreatitis. She'd have taken a CT scan over a miserable week in the shop and a long rehab, easily...

Best wishes and keep us posted, MK

[Eddie Dane]

I'll let my wife speak for herself:

"Thank you all very much for your input, especially Xulld and Skeptic Ginger for their valuable advice!

I indeed do not trust the willingness and ability of my internal specialist to try lots of "avenues of investigation" (quote Skeptic Ginger). I suspect, together with my husband, that he wants to use CT Scan to have my inside made visible in one time in high definition, which is understandable and not in itself incorrect. BUT he obviously is unaware about the dose of radiation and possible health risks involved. He therefore cannot weigh the risks against the benefits.

Let me be clear: if there was any serious and well-founded suspicion that I might have a life threatening disease like cancer, I wouldn't hesitate to have a CT scan done. But in my case, we've only just begun testing, and the few tests made didn't point in any direction. I think I will indeed approach the internal specialist with Skeptic Ginger's 3 questions:


1) What things might show up with a CT that have not shown up with these other tests?

2) Are any of those things potentially dangerous if we wait and see vs getting the CT scan?

3) Are there any avenues of investigation we have not yet tried?


And while having further testing, I'd hope he'd follow the ALARA principle (applicable in The Netherlands, too), or in Xulld's words:

Xulld:

IMHO less exposure is better unless you have a real reason to get an exam done. I have broke my back twice, and both times got an MRI instead of a CT even thought the doctor wanted me to get one. The MRI revealed the damage just fine for a qualified radiologist to complete an accurate report.


It's not easy over here in The Netherlands to get a second opinion or to switch doctor. I hope I can find a reasonable and serious doctor when I'm finally recovered from pneumonia who takes the time to do further testing and help me getting better again.
Thank you very much for your advice! It really helped me clearing my mind on this matter!"

[casebro]

From above- "~1500-3000mrem may not seem like a lot, and perhaps nether is ~.008% increased cancer risk over 20 years,"

Lessee if I understand this: .008% increase of the ummm 30% who die of cancer these days?

Umm, thats a change of from 70% chance of NOT dying of cancer, to a 69 3/4 % chance of NOT dying of cancer. Vs a much larger chance they they may find something to fix, and extending a life by several decades.

Scan me many times please.

[Lolly]

But it is a lot of radiation, especially as it is both chest and abdomen.
And it adds to one's chances of cancer.

Cancer is a fear in my family as my wife's mother died at an early age (42) from it. Personally, I'd be more likely to get a scan if I had a family history that might indicate there's a real issue. If you've got an increased risk because of defective genes, then there might be something to be looking for, rather than just your average patient with no known history and the scan just being a fishing expedition possibly without sound reason.

(I'd be interested to know whether the radiation is adding to the risk of somebody "programmed" by genes to get cancer or not. Interesting question)

[Roboramma]

Anecdotal: my mother had stomach pain for a long time before finally seeing a doctor. Eventually she was diagnosed with pancreatic cancer and died of it about 8 months later.

While there are concerns with radiation dosage, and certainly other means of diagnosis should be looked at, it's probably best not to simply ignore such discomfort.

[Skeptic Ginger]

Anecdotal: my mother had stomach pain for a long time before finally seeing a doctor. Eventually she was diagnosed with pancreatic cancer and died of it about 8 months later.

While there are concerns with radiation dosage, and certainly other means of diagnosis should be looked at, it's probably best not to simply ignore such discomfort.

Two words: Steve Jobs.

Sometimes there are important things that need to be ruled out, even if they are not likely to be occurring.


But I have a question for you, Eddie Dane, does the pneumonia not explain your wife's symptoms?

[Eddie Dane]

Two words: Steve Jobs.

Sometimes there are important things that need to be ruled out, even if they are not likely to be occurring.


But I have a question for you, Eddie Dane, does the pneumonia not explain your wife's symptoms?

The history up till now is:

Eight months ago diagnosed with gallbladder infection. Surgically removed
Fifteen days later diagnosed with acute infection of appendix. Surgically removed.
Since then, not feeling well, fatigue, pain in upper abdomen.
Two weeks ago: diagnosed with pneumonia. Treated with antibiotics.

She already had the appointment with the internal specialist before the pneumonia hit.

[casebro]

Eddie, two of my neices have also had gal bladder and appendix probs. And both have had chronic pancreatitis since infancy. And one of them's fathers, my brother, died of pancreas cancer at 54. Nine months after diagnosis.

Chronic panrceatitis is treated with a dietary supplement of digestive enzymes to prevent mal absorption and cramping.

Pancreas cancer is not usually diagnosed until it is too late, 6 month average survival after diagnosis. (Jobs had a rare, very non-fatal kind, and was a fool to go the alt med route.)

Get her to the scan, .008% increase be damned.

[bigred]

Two words: Steve Jobs.

Sometimes there are important things that need to be ruled out, even if they are not likely to be occurring.

Exactly. The things a CT can either rule or out God forbid find out-weighs the risk by a truckload.

[jhunter1163]

In my own case, a CT showed that my aortic aneurysm was larger than the MRI had indicated and surgical intervention was, in fact, warranted. Did it save my life? Hard to say, but I wholeheartedly agree with bigred; get the scan. You'll feel better knowing for sure.

[Skeptic Ginger]

The history up till now is:

Eight months ago diagnosed with gallbladder infection. Surgically removed
Fifteen days later diagnosed with acute infection of appendix. Surgically removed.
Since then, not feeling well, fatigue, pain in upper abdomen.
Two weeks ago: diagnosed with pneumonia. Treated with antibiotics.

She already had the appointment with the internal specialist before the pneumonia hit.
I assume she's been cultured for C-dif (http://www.mayoclinic.com/health/c-difficile/DS00736)?


I should add, multiple problems one after the other suggest an underlying cause should be investigated. That differs from trying to find the cause of a vague persistent complaint. It sounds like you are at the stage of the referral to the specialist. I'd go ahead with the scan and anything else he/she suggests. If your wife doesn't improve point out the problems she's having are evidence clinically (as opposed to that vague persistant complaint) and ask for another opinion. It's not typically time to ask for a second opinion because you have concerns about a CT scan and she doesn't get the test. That doesn't make sense.

Also, you should consider that after two major surgeries, it takes a while for people to bounce back. She could have gotten the pneumonia from not getting up and moving post op. This could all just be a rough recovery and nothing else, even after 8 months. Abdominal adhesions for example can cause prolonged post op problems.

[Eddie Dane]

Again, I let my wife speak for herself:

[I][I]"Thank you for your input. In the meantime, I had the occasion to talk to one of the radiologists in the hospital, who took my concerns seriously. He could, however, relieve my worries to a great extent since the hospital uses the newest generation CT scans which are able to make a CT scan of a thorax with only roughly 1 Millisievert. That's much less than it used to be (6-8 Millisievert).
It might be interesting to know that he explained that an MRI can deliver good images depending on what kind of tissue you are looking for (e.g. tumors, bones etc.). The radiologist has to adjust the MRI according to what is being looked for. For example, if he is asked to look for tumors, he adjusts the MRI to tumor tissue. But he might not be able to see other troublemakers made of a different tissue.
In contrast to a CT scan, which makes it possible to "see" all kinds of tissue.

My internal specialist doesn't have a clue what to look for, which explains why he refuses MRI.

As I said, I wouldn't hesitate to have CT scan done if there was a severe suspicion that I might have a life threatening disease and if it could only be discovered by CT scan. By coincidence, this is exactly what happened last night, when doctors were afraid I might have a lung embolism. CT scan of my thorax was done after a couple of blood tests - and luckily everything was o.k.!!!

Anyhow, trust in your doctor remains an important factor. I am happy I got to talk to the radiologist himself. He and the other doctor at First Aid did what a good doctor should do, I think: explain what he is doing and why he is doing it and make you feel taken seriously. [I][I]"

[ben m]

Glad to hear you got your scan and that the results were good. That's very interesting about the MRI; I had not been aware of this adjustment, I'll go off now and try to learn more.

[Skeptic Ginger]

Again, I let my wife speak for herself:

[I][I]"Thank you for your input. In the meantime, I had the occasion to talk to one of the radiologists in the hospital, who took my concerns seriously. He could, however, relieve my worries to a great extent since the hospital uses the newest generation CT scans which are able to make a CT scan of a thorax with only roughly 1 Millisievert. That's much less than it used to be (6-8 Millisievert).
It might be interesting to know that he explained that an MRI can deliver good images depending on what kind of tissue you are looking for (e.g. tumors, bones etc.). The radiologist has to adjust the MRI according to what is being looked for. For example, if he is asked to look for tumors, he adjusts the MRI to tumor tissue. But he might not be able to see other troublemakers made of a different tissue.
In contrast to a CT scan, which makes it possible to "see" all kinds of tissue.

My internal specialist doesn't have a clue what to look for, which explains why he refuses MRI.

As I said, I wouldn't hesitate to have CT scan done if there was a severe suspicion that I might have a life threatening disease and if it could only be discovered by CT scan. By coincidence, this is exactly what happened last night, when doctors were afraid I might have a lung embolism. CT scan of my thorax was done after a couple of blood tests - and luckily everything was o.k.!!!

Anyhow, trust in your doctor remains an important factor. I am happy I got to talk to the radiologist himself. He and the other doctor at First Aid did what a good doctor should do, I think: explain what he is doing and why he is doing it and make you feel taken seriously. [I][I]"So I'm confused. Did you get the CT scan of the abdomen? While extremely unlikely it is possible you had a sponge left behind when you had the appy. I'm not trying to suggest this is something you should worry about, and I believe an abdominal X-ray would have already ruled that out, but I don't know exactly what your discomfort is nor what tests have already been done.

That C-dif culture is still on my list.

[Eddie Dane]

My wife answers:
"Sorry for the late reply and thank you for your concerns. I guess it's a little bit difficult to explain the history of my symptoms, which tests have been done - and with which results -, and discuss all options via internet.

In conclusion, the good news is that newest technology allows CT cans to create HD images with much less radioactivity than before. Still, a CT scan of the newest generation means roughly 1 Millisievert in a couple of seconds on a small surface. An X-ray means 0,04 Millisievert.
A CT scan of the newest generation therefore still involves much more radioactivity than an X-ray, even though much less than it used to. Whereas ultrasound and MRI are methods which don't imply use of potentially harming radiation (as far as known). IMHO, a CT scan should still only be used when really necessary and when other diagnostic instruments (depending on the symptoms: blood tests, ultrasound etc.) fail to deliver an answer or when fast diagnose is crucial to save a patient's life."

[bigred]

A CT scan of the newest generation therefore still involves much more radioactivity than an X-ray ? And-? "More" doesn't necessarily mean "way too much" or "so much it's a real danger." 10 cents is way more than 1 but neither will make you rich. Unless you're a REALLY good gambler. :)

IMHO, a CT scan should still only be used when really necessary and when other diagnostic instruments (depending on the symptoms: blood tests, ultrasound etc.) fail to deliver an answer ...or are likely to, I'd add. Fair enough, but sounds like if not there you're getting close to it-?

Best to you both