Medicare Patients Exposed to Excess Radiation from Unnecessary CT Scans

Hospitals around the country have exposed thousands of Medicare chest patients to what are most likely <"">unnecessary double CT scans. According to a report in The New York Times, hospitals performed 76,000 such scans on Medicare patients in 2008, costing the federal health insurance program $25 million.

In addition to the enormous costs, the widespread use of double CT scans may be needlessly exposing patients to worrisome amounts of radiation. Just a single CT scan exposes patients to 350 times the radiation of a traditional x-ray.

“The primary concern relates to radiation exposure,” Dr. James A. Brink, chief of diagnostic radiology at Yale-New Haven Hospital, told the Times. “It is incumbent upon all of us to limit it to the amount needed to make a diagnosis.”

A double CT scan consists of two scans done consecutively – one with imaging dye, the other without. According to the Times, many radiologists say such procedures are rarely necessary. What’s more, guidelines developed by the American College of Radiology provide very few reasons to perform a double CT scan.

Yet at some hospitals, Medicare chest patients are routinely subjected to double scans. According to the Times, 2008 outpatient claims show that Medicare patients at some facilities were undergoing double CT scans almost 80 percent of the time. However, the true number of patients who receive double CT scans is probably much higher than the Medicare numbers indicate, as patients with private insurance or Medicaid, as well as and those without health insurance, aren’t being tracked by any agency.

The Times investigation found that double CT scans are most likely to be performed at small, community hospitals. For example, Memorial Medical Center of West Michigan in Ludington performed double scans on its Medicare chest patients 89 percent of the time. In response to questions, an official with the hospital told the Times that the facility has made “dramatic” changes to protocols since 2008. Due to these changes, the rate of double CT scans performed at Memorial Medical Center dropped to 42.4 percent in 2010 and to 3 percent in the first part of 2011.

While smaller hospitals perform these scans often, large hospitals are not immune. For instance, St. John Health System in Tulsa, Oklahoma double-scanned 80 percent of the time. A spokesperson for that facility told the Times that the system recognized that “those numbers were higher than we needed to be,” and has since changed its protocols. According to the Times, the official claimed that the rate of such scans now hovers around 5 percent at St. John.

But even 5 percent is high number, when you consider that the Times found most major university hospitals perform double CT scans on less than 1 percent of their Medicare chest patients. For example, double scans accounted for only a fraction of 1 percent of cases at Yale-New Haven Hospital. And none of the 2,000 chest scans performed at UNC Healthcare in Chapel Hill, N.C. 2008 involved a double procedure. Dr. Paul L. Molina, executive vice chairman of radiology UNC Healthcare questioned why a facility would perform any double CT scans.

“I would be very surprised as to why that would occur,” Molina, told the Times. “Someone’s got to educate me as to why they see the need to do both.”

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