tag:blogger.com,1999:blog-19490962.post117571172525396287..comments2023-12-10T10:06:41.979+00:00Comments on mutations of mortality: CT scansTerry Hamblinhttp://www.blogger.com/profile/06346629921055055879noreply@blogger.comBlogger17125tag:blogger.com,1999:blog-19490962.post-33416821527162659272007-04-17T14:34:00.000+01:002007-04-17T14:34:00.000+01:00You should be aware that children are especially v...You should be aware that children are especially vulnerable.Terry Hamblinhttps://www.blogger.com/profile/06346629921055055879noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-51240078050316406062007-04-16T19:49:00.000+01:002007-04-16T19:49:00.000+01:00Hospitals are concerned about CT radiation. Why s...Hospitals are concerned about CT radiation. Why shouldn't I be?<BR/><BR/>Here's a relevant press release from the University of California, Davis Health Care System:<BR/><BR/>FOR IMMEDIATE RELEASE<BR/>April 12, 2007<BR/><BR/><BR/>STUDY SEEKS TO DEVELOP RULES FOR SAFER USE OF CT SCANNING ON CHILDREN WITH INTRA-ABDOMINAL INJURIES<BR/><BR/>(SACRAMENTO, Calif.) -- James F. Holmes, associate professor of emergency medicine at UC Davis Health System, has received a three-year, $1.3 million grant to develop criteria for determining when computed tomography (CT) should be used on children with intra-abdominal injuries.<BR/><BR/>The study aims to generate clinical guidelines for identifying children at high risk and near-zero risk of intra-abdominal injuries in need of acute intervention.<BR/><BR/>These guidelines are intended to achieve safer and more efficient and effective use of abdominal CT in children at risk for intra-abdominal injuries.<BR/><BR/>Although CT is the standard for diagnosing intra-abdominal injuries, the procedure has serious risks, primarily that of developing radiation-induced cancer.<BR/><BR/>For every 1,500 children who undergo abdominal CT scanning, approximately one child will die from a cancer caused by the radiation, and up to three additional children will develop non-fatal cancers from the exposure. Less than 10 percent of the abdominal CT scans currently performed on children with trauma show intra-abdominal injuries...<BR/><BR/>Public Affairs<BR/>UC Davis Health System<BR/>4900 Broadway, Suite 1200<BR/>Sacramento, CA 95820<BR/>www.ucdmc.ucdavis.eduAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-19490962.post-1176191976815740782007-04-10T08:59:00.000+01:002007-04-10T08:59:00.000+01:00I absolutely agree that most stage 0 patients don'...I absolutely agree that most stage 0 patients don't need a CT scan at diagnosis; I have been saying so for years. What the Montserrat paper was doing was pointing out that some patients with apparent stage 0 CLL have large retroperitoneal lymph nodes, and may go untreated when they really need treatment. The question then is which patients do need a CT scan for this purpose.Terry Hamblinhttps://www.blogger.com/profile/06346629921055055879noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-1176137667711317762007-04-09T17:54:00.000+01:002007-04-09T17:54:00.000+01:00You miss the point.We should not expose ourselves ...You miss the point.<BR/><BR/>We should not expose ourselves to UNNECESSARY risks. <BR/><BR/>This thread concerns CT scans at diagnosis. No one argues that a CT scan is sometimes necessary and imperative.<BR/><BR/>Let's agree on that.<BR/><BR/>As far as the swimming pool argument, this is disingenuous. There are millions of children who swim without incident. However, there are few who play with guns.<BR/><BR/>Therefore, if you compare exposures to deaths, I'd argue that a child is much more likely to be harmed playing with guns, PER INCIDENT, than while swimming.<BR/><BR/>Of course, proper decision-making regarding pools, guns, and CT scans will reduce risks even further.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-19490962.post-1176121409101993452007-04-09T13:23:00.000+01:002007-04-09T13:23:00.000+01:00I don't think there is any evidence that of every ...I don't think there is any evidence that of every 100 people getting a CT scan 1 or 2 will die of a cancer he or she would not otherwise have got. Then you have to say that the CT was unnecessary. I can certainly think of patients who would not have died if they had had a timely CT scan. <BR/><BR/>Here is another statistic to make you sit up and think. Would you rather let your child play with a friend whose house contained a) a revolver, b) a swimming pool?<BR/><BR/>Answer, the swimming pool is far more dangerous.<BR/><BR/>As a famous paediatrician in England recently discovered, we should not go around quoting statistics unless we really understand them; but it is always worth applying the common-sense test to any that we come across.Terry Hamblinhttps://www.blogger.com/profile/06346629921055055879noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-1175998985641393042007-04-08T03:23:00.000+01:002007-04-08T03:23:00.000+01:00Well I suppose the medical profession can cover it...Well I suppose the medical profession can cover itself by noting that most cancer patients will die early, so effects won't be known!<BR/><BR/>To trivialize the danger is unfortunate, since a small amount of research on the internet gives quite a bit of information. And it has been shown that most doctors (including radiologists!) have no idea the amount of radition a CT scan delivers.<BR/><BR/>As to the lunacy of comparing a CT scan exposure to an airplane flight, go to www.hss.energy.gov and calculate how many round-trip trips from LA to NYC equal an abdominal CT scan. It's over 400 trips!!! Not the one or two a doctor will tell you.<BR/><BR/>And the exposure time is a factor. This sizable dose of ionizing radiation is done in a few seconds, if that. That means that damage will be done.<BR/><BR/>Even the government, which loves to downplay risks, says that CT scans will increase the number of people who will get cancer. And if you factor in the higher rate of secondary malignancies in CLL patients, this risk is doubled. So, out of a 100 people, perhaps one or two MORE people will get cancer, according to the US government's own data! And that may be understated, we don't know.<BR/><BR/>One thing to remember, radiation is not innocuous. It is a proven cancer-causing agent. <BR/><BR/>It's interesting to note that the Japanese who were bombed with atomic weapons had increased rates of cancer, in particular, leukemia (before Dr. Hambling heads to the blogger machine, yes, we know that wasn't CLL but acute leukemias). <BR/><BR/>Most people have heard of radon, which is a radioactive gas that can collect in buildings and represent a health hazard. It's a health hazard because of (ta da!) radiation.<BR/><BR/>As has been pointed out, sometimes X rays and CT scans are necessary. However, at diagnosis with CLL, it almost always isn't.<BR/><BR/>And wouldn't YOU hate to the the one or two out of a hundred who died pointlessly???Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-19490962.post-1176005027345905292007-04-08T05:03:00.000+01:002007-04-08T05:03:00.000+01:00Terry-Happy EasterJenny LouTerry-<BR/>Happy Easter<BR/>Jenny LouAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-19490962.post-1175882933222423532007-04-06T19:08:00.000+01:002007-04-06T19:08:00.000+01:00The proof of the pudding is in the eating. There i...The proof of the pudding is in the eating. There is little to suggest that in practice necessary CT scans to any harm to patientsTerry Hamblinhttps://www.blogger.com/profile/06346629921055055879noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-1175881410332728632007-04-06T18:43:00.000+01:002007-04-06T18:43:00.000+01:00If the chest is mostly air, why do an X-ray or CT ...If the chest is mostly air, why do an X-ray or CT scan at all? The answer, of course, is that there are solid tissues in front of, inside, and behind the lung. These are the tissues that absorb the high energy X-rays. That is where the damage to the DNA can occur. <BR/><BR/>If you talk about rems or millisieverts, no one is going to know what that means. Most everyone has at least heard of a chest X-ray. Conceptually, this is easier to understand. <BR/><BR/>Another factor is the amount of time this dose is administered. It's like running into a brick wall. It's different if you hit one time at 75 mile per hour one time, that hit it 75 times at one mile per hour.<BR/><BR/>That factor is missing in some of the discussions.<BR/><BR/>I don't think Dr. Hamblin would say that any X-ray is perfectly safe and represents no risk to the patient. <BR/><BR/>Again, it is a matter of balancing the need versus the risk. And the risk at diagnosis is very, very small that there are real problems that are asymptomatic.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-19490962.post-1175877014897462062007-04-06T17:30:00.000+01:002007-04-06T17:30:00.000+01:00Wrong guess Terry - Try again:O)It's a hard hidden...Wrong guess Terry - Try again:O)<BR/><BR/>It's a hard hidden image to locate...<BR/><BR/>Did you like any of the videos on my blog???<BR/><BR/>Best - -Professor Howdyhttps://www.blogger.com/profile/12189934292678757335noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-1175859121761295292007-04-06T12:32:00.000+01:002007-04-06T12:32:00.000+01:00The figure of one CT scan equals 400 chest X-rays ...The figure of one CT scan equals 400 chest X-rays is a bit misleading because a chest X-ray deliveres such a minute dose. The chest is mostly air which does not stop the radiation at all. A better comparison is that a CT scan equals 6 abdominal X-rays. It certainly gives a lot more information than a hundred abdominal X-rays.<BR/><BR/>I certainly don't think that every stage 0 patient requires a CT scan, but it is advisable in selected cases. I think it is much more important to get teh molecular markers done. For example, I recently saw a patient with a lymphocyte count of 4.1 who was free of all signs and symptoms. Unfortunately she has unmutated VH genes, so although she does not actually have CLL according to the IWCLL definition, it is pretty sertain that she will eventually progress, and she will require close monitoring.Terry Hamblinhttps://www.blogger.com/profile/06346629921055055879noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-1175853660072835532007-04-06T11:01:00.000+01:002007-04-06T11:01:00.000+01:00Pam Sykes at The Flinders medical centre is doing ...Pam Sykes at The Flinders medical centre is doing some interseting research that seems to show that low dose radiation actually lowers the chance of DNA damage, so the conventional wisdom that radiation = bad is not neccesarily so.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-19490962.post-1175831748372121302007-04-06T04:55:00.000+01:002007-04-06T04:55:00.000+01:00My first hem/onc ordered a CT scan as part of the ...My first hem/onc ordered a CT scan as part of the workup of diagnosis. At the time, only CD 38 was available to me as a prognostic test, so this did provide some additional information of value. I tend to think that, regardless, a CT at diagnosis may be helpful in uncovering problems, as this new study indicates. This may impact treatment decisions in an intelligent way. The more we know, the better we can fight. After the diagnosis stage, I agree that "routine" CT scans are unwarranted, but that they are useful in some situations: for example, before deciding to use Campath as a chemo chaser in an effort to eliminate MRD. What's the point of doing Campath if there are enlarged nodes that won't respond to it? Let's also remember that we have cancer, that sometimes we must take risks, even involving a little radiation, in the larger cause of fighting it.David Arensonhttps://www.blogger.com/profile/13876562687586184006noreply@blogger.comtag:blogger.com,1999:blog-19490962.post-1175820309641139832007-04-06T01:45:00.000+01:002007-04-06T01:45:00.000+01:00I am not so worried about the radiation as the pri...I am not so worried about the radiation as the price tag for a low priority test for CLLers. Prognostic blood tests should tell much more, much earlier about what is going on.<BR/>Our research clinicians in the states recognize this reality, but community oncs. must count on CT scans to keep their profit margins up.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-19490962.post-1175795752748715032007-04-05T18:55:00.000+01:002007-04-05T18:55:00.000+01:00I continue to believe that it is unlikely that the...I continue to believe that it is unlikely that the risk to the patient from a CT scan - the equivalent of 400 chest X-rays - will balance the benefit in an early-stage, asymptomatic patient.<BR/><BR/>Of what value is it to know if a patient is a stage 1 verses stage 0? Very little if any. <BR/><BR/>A FISH and flow cytometry (which should be standard tests for suspected CLL) can give the clinician the gross chromosomal abnormality data (revealing, say 17p) as well as any adverse cell markers (say CD38). Couple this with an accurate ZAP-70 test (available at research labs such as UCSD or perhaps in the UK at your facility), I would submit that all of the necessary prognostic data will be available to accurately predict a patient's progress. Other prognostic factors may be soon proven that will provide even more data to fine-tune the definition of the risk of progression.<BR/><BR/>Symptoms that crop up may be cause for a CT scan at some point, but the chances that that would be necessary at diagnosis in a stage 0 or 1 patient is slim indeed, IMO.<BR/><BR/>As the patient progresses, there will be plenty of time for the physician to subject the patient to lots and lots of ionizing radiation.<BR/><BR/>Radiation that is a proven, well-known carcinogen.<BR/><BR/>Physicians like to pass out CT slips like candy. It is easier for them, but potentially deadly for the patient.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-19490962.post-1175777756839168772007-04-05T13:55:00.000+01:002007-04-05T13:55:00.000+01:00CT Scans definately have their place in CLL. Very...CT Scans definately have their place in CLL. Very good post on this, Terry.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-19490962.post-1175739792981834142007-04-05T03:23:00.000+01:002007-04-05T03:23:00.000+01:00Very interesting. My U.S. doc immediately sent me...Very interesting. My U.S. doc immediately sent me for a CT scan and told me he was looking for enlarged nodes. It came back negative and I was pronounced stage 0. My WBC at the time was 25K. I always assumed it was standard protocol to scan. In addition he did a bone marrow biopsy. I guess he was pretty thorough. Three years later I remain at stage 0 and was comforted that I had no nodes. As far as the bone marrow biopsy I was relieved that it was not diffuse infiltration.Anonymousnoreply@blogger.com