By Randy Hendrickson
Although multislice cardiac computed tomography (CT) angiograms are the newest technology for imaging the heart and arteries, this technology has never been proven to be superior than the older traditional (and less expensive) diagnostic methods. Patients, physicians, and advocacy groups are questioning the value of these scans and are now demanding proof of their efficacy. According to the New York Times, “[t]he problem is not that these newer treatments never work. It is that once they become available, they are often used indescriminately, in the absence of studies to determine which patients they will benefit.” Even the Centers for Medicare and Medicaid Services questioned the benefits of cardiac CT angiograms and requested more large-scale studies; however, heavy lobbying by the Society of Cardiovascular Computed Tomography caused them back down from this position.
Many cardiologists have been very receptive to this new tool. It “lets them see inside the heart with unprecedented clarity while also providing them with a new source of income. 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.” Cardiac CT angiogram scanners are expensive, over $1 million. Once a scanner is purchased, it is in the hospital’s or practice’s best interest to use it as much as possible, even if that means using it on patients who may not really need it. Patients can expect to pay between $500 and $1500 per scan. These scans are being promoted heavily by the media and have been advertised on radio, television, and internet. Both Time magazine (“How New Heart Scanning Technology Can Save Your Life” Sept 2005) and Oprah have both endorsed the cardiac CT angiograms, even though there is little evidence that the scans are worth the cost and the risk. Unlike clinical trials to prove the safety and effectiveness of drugs, medical device manufacturers do not have to conduct studies to show patient benefits. They only have to demonstrate that the scanners are safe and provide accurate images.
Additionally, because this technology uses a series of x-rays to produce a composite image of the beating heart, it also exposes patients to large amounts (approximately 21 millisieverts) of radiation, equivalent to that produced by over 1,000 standard chest x-rays. With radiation exposure, the doses are cumulative and additive over time. Dr. David J. Brenner, from the Center for Radiological Research at Columbia University, explains that “each scan creates an additional lifetime risk of cancer that is somewhere between 1 in 200 and 1 in 5,000, and younger patients and women are at higher risk.”
At best, this is a new technology that hasn’t yet quite found its best application. “Even cardiologists who think the CT scans are overused say they may one day prove valuable. If manufacturers can produce scanners that can determine which plaques are stable and which are likely to rupture, the machines could revolutionize the treatment of heart disease.” In the meantime, CT angiograms continue to be used in greater and greater numbers, despite the unclear benefit and potential risks.
Although multislice cardiac computed tomography (CT) angiograms are the newest technology for imaging the heart and arteries, this technology has never been proven to be superior than the older traditional (and less expensive) diagnostic methods. Patients, physicians, and advocacy groups are questioning the value of these scans and are now demanding proof of their efficacy. According to the New York Times, “[t]he problem is not that these newer treatments never work. It is that once they become available, they are often used indescriminately, in the absence of studies to determine which patients they will benefit.” Even the Centers for Medicare and Medicaid Services questioned the benefits of cardiac CT angiograms and requested more large-scale studies; however, heavy lobbying by the Society of Cardiovascular Computed Tomography caused them back down from this position.Many cardiologists have been very receptive to this new tool. It “lets them see inside the heart with unprecedented clarity while also providing them with a new source of income. 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.” Cardiac CT angiogram scanners are expensive, over $1 million. Once a scanner is purchased, it is in the hospital’s or practice’s best interest to use it as much as possible, even if that means using it on patients who may not really need it. Patients can expect to pay between $500 and $1500 per scan. These scans are being promoted heavily by the media and have been advertised on radio, television, and internet. Both Time magazine (“How New Heart Scanning Technology Can Save Your Life” Sept 2005) and Oprah have both endorsed the cardiac CT angiograms, even though there is little evidence that the scans are worth the cost and the risk. Unlike clinical trials to prove the safety and effectiveness of drugs, medical device manufacturers do not have to conduct studies to show patient benefits. They only have to demonstrate that the scanners are safe and provide accurate images.
Additionally, because this technology uses a series of x-rays to produce a composite image of the beating heart, it also exposes patients to large amounts (approximately 21 millisieverts) of radiation, equivalent to that produced by over 1,000 standard chest x-rays. With radiation exposure, the doses are cumulative and additive over time. Dr. David J. Brenner, from the Center for Radiological Research at Columbia University, explains that “each scan creates an additional lifetime risk of cancer that is somewhere between 1 in 200 and 1 in 5,000, and younger patients and women are at higher risk.”
At best, this is a new technology that hasn’t yet quite found its best application. “Even cardiologists who think the CT scans are overused say they may one day prove valuable. If manufacturers can produce scanners that can determine which plaques are stable and which are likely to rupture, the machines could revolutionize the treatment of heart disease.” In the meantime, CT angiograms continue to be used in greater and greater numbers, despite the unclear benefit and potential risks.
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