Are CT scans for the heart useless?
Posted on July 2nd, 2008 – 7:31 PMBy Thomas Lee
Do yourself a favor and read the excellent story in the past Sunday New York Times that questioned the medical value of doctors ordering powerful CT scans for the heart. The story argues there is little evidence that proves the benefits of advanced CT scans. Medicare, the story noted, doubted whether such procedures were necessary before ultimately deciding to cover the cost.
In a way, the story goes to the heart of medical innovation in America. We are good at building newer, faster, more power technology. But often times we innovate for innovation’s sake, building the stuff first and then searching for the right application and/or the right patient, a rush to market thinking that’s behind soaring health care costs in the U.S.
“A faith in innovation, often driven by financial incentives encourages American doctors and hospitals to adopt new technologies even without proof that they work better than older techniques,” the Times story says.
Later the reporters write: “The problem is not that newer treatments never work. It is that once they become available, they are often used indiscriminately, in the absence of studies to determine which patients they will benefit.”
I instantly thought of implantable cardioverter defibrillators or ICDs, the stopwatch devices that shock a errantly beating heart back into rhythm. While ICDs are highly effective in thwarting sudden cardiac death — which kills about 300,000 to 400,000 people a year in the United States — knowing which patients should receive the expensive devices has long vexed doctors. According to industry estimates, 30 percent of patients who qualify for an ICD never get the implant. Conversely, a high number of patients who have ICDs don’t need them and sometimes receive painful electric shocks.
Powerful CT scans are the latest rage in the medical world. Demand for advanced scanning technology that can provide detailed multi-dimensional images of hearts and other organs has exploded in recent years, as doctors increasingly rely on CT and MRI machines to diagnose diseases and develop treatments.
The number of imaging procedures is expected to grow at an annual rate of 15 percent. By 2020, the country will be short 15,000 radiologists, according to the American Journal of Roentgenology.
At the Radiological Society of North America’s annual conference in Chicago last November, major manufacturers like General Electric, Siemens, and Philips tried to outdo each other by building the bigger and more powerful CT scanner (Toshiba claimed bragging rights by debuting a 360 slice scanner compared to the 64 slice typically used today.)
Come to think of it, no one really made an effort to explain to me who really needs a 360 slice scanner. Sure, the technology was cool, such powerful scans can produce very detailed 3D or 4D images of organs like the heart. But benefits and costs seemed more of an afterthought- “Who cares? Imagine what you could do with this technology!!!!”
This is not a mere science project. You can bet your booty that Toshiba fully plans to sell the stuff today and not thirty years from now.
The growing use of advanced scanning technology is obviously important to the Twin Cities. Virtual Radiologic Corp. of Minnetonka contracts with radiologists across the United States to interpret and analyze imaging data from CT scans. Vital Images Inc., also of Minnetonka, makes software that analyzes CT scans.
Asked for a reaction to the NYT story, a spokesperson for Vital Images referred me to a letter sent by the Medical Imaging Technology Alliance to the paper’s editor:
While numerous peer-reviewed studies demonstrate that such scans detect heart disease and help patients avoid heart catheterization, your readers were presented only with critical anecdotes. Readers would have gained a fuller understanding of the issue, forexample, had the article cited a 2007 study showing how multi-slice heart scans reduceddiagnostic time and produced cost savings.
Proper utilization of any medical technology is important. To address this matter,
policymakers and medical societies are embracing appropriateness and accreditation criteria so health decisions remain the domain of physicians and patients and not insurance companies. Unfortunately, your story made no mention of this.
Reactions?
One response to "Are CT scans for the heart useless?"
Mr. Lee, since when is the New York Times a proper source for a medical conclusion? “A faith in innovation ….” It seem to me that quote merely “begs the question” and provides only anoth reporter’s opinion. Please, in your search for evidence, facts and medical reality do not rely on another publication. Refering to the Times article is fine, but to use their conclusion as evidence of something is not good reorting. Good Luck!
