High-tech diagnostics no longer just for ill

Imagine doctors consistently finding cancerous tumors before the disease spreads, or detecting aneurysms before any symptoms appear.

Sound like science fiction? Some people are turning to computed tomography (CT) scans to screen for medical time bombs ticking away inside them.

“People want to take control of their health,´ said Shira Itzhak, a spokeswoman for MRI & CT Diagnostics in Virginia Beach, Va. “People don’t want to die of cancer at age 38.”

Although CT scans, also known as computerized axial tomography (CAT) scans, have been around for more than 20 years, the newest generation of CT scanners seems light years ahead. They are able to zip over the body and gather detailed information in 10 seconds, and then display it in a three-dimensional format. Medical-care providers can review the virtual body in detail with their patients.

The cost of the equipment ranges from $500,000 to more than $1 million per unit, said Cathy Wolfe, a spokeswoman for multinational Toshiba Corp., a CT scanner manufacturer.

One reason that today’s CT scanners are superior to previous designs is because the rings that image the body move continuously. As a result, the images the rings gather form a much clearer picture, because they are taken in closer succession. It’s like videotaping a birthday party instead of taking dozens of photographs.

CT scanners are commonly used with cancer patients or to diagnose the cause of mystery symptoms. Hundreds of healthy Americans, however, now are getting CT scans to see if an undetected disease exists. In this application, the equipment is used for screening, not diagnosing.

“This is a relatively new market,” Wolfe said. “But most of our market is in (traditional scanning).”

When Itzhak’s mother had a heart screen performed, a problem was found elsewhere. “We found kidney cancer at a very early state,” Itzhak said. “We were able to save her life. The number of lives we are saving may not be dramatic, unless you’re the patient.”

Dr. Robert Stanley is the president of the American Roentgen Ray Society in Leesburg, Va., and chairman of the Department of Radiology at the University of Alabama at Birmingham.

“It’s fluffy stuff and testimonials,” he said of the data supporting CT screening. “The promoters are generally entrepreneurial. There is no data coming from any of these so-called health centers that says they have been preventing health problems.”

Itzhak said she has heard claims that only one in every 10,000 patients who receives a screening has a previously undetected problem. Her facility has been screening for only a few months, however, and she said that so far two lives have been saved.

Several facilities in Los Angeles, Virginia and Georgia have begun advertising CT screening as a means of finding out what medical problems may be lurking in a patient’s future. Mobile screening booths also have been opening in some shopping malls and health clinics, Stanley said.

So far, no medical-care providers in Colorado offer the service. One reason may be the cost. Representatives of Kaiser Permanente, Aetna US Healthcare, PacifiCare, Blue Cross Blue Shield of Colorado and United Health Care said that without a doctor’s orders, they provide no coverage for CT screenings.

“Most insurance companies require a doctor’s authorization because (health care) is so highly regulated,´ said Cindy Evans, an agent for Kaiser Permanente.

The cost of a CT screening ranges from about $345 for a heart scan to $700 for the colon; the colon is time-intensive for the technician. Some facilities charge as much as $2,400 for a screen of the whole body.

“That is one of the drawbacks,´ said Dr. Bharath Kumar of San Gabriel Valley Diagnostic Center in West Covina, Calif. “You’ve got to pay for it.”

University of Alabama-Birmingham’s Stanley said that the only criterion for people to be screened is their ability to pay. “Offering whole-body CT scans on asymptomatic, healthy adults is bad medicine,” he said.

He also said it is a misuse of CT equipment. “It’s like taking a Boeing jet fighter for joy rides,” Stanley said. “It’s a misappropriate use of high technology.”

MRI & CT Diagnostics’ Itzhak said, “We’re not trying to go around doctors,” and that her facility offers patients “peace of mind that they’ve done everything to find a silent killer.”

Other members of the medical community aren’t sold on all of the screening techniques. San Gabriel Valley Diagnostic Center, for example, offers only coronary screening because Kumar isn’t “100 percent convinced that whole-body screening works,” he said. “Artery calcification (imagery) comes out very sharply.”

Brain screening is another practice under fire. “We don’t do brain scanning because it doesn’t make sense to do it,” Itzhak said. “You’d have to inject intravenous contrast (fluid).” This fluid highlights abnormalities, and without it, the contours of the brain can easily be mistaken for a tumor, Itzhak said. Injecting the fluid would necessitate obtaining a doctor’s orders and patient’s records; the other screening procedures require no invasive procedures.

Some people worry about the safety of unnecessary exposure to radiation, but Itzhak said it is equivalent to “one day’s exposure to the sun.”

Stanley agreed, provided a person is screened only every few years “If you were dealing with a wealthy hypochondriac who gets one every six months, that’s when you should start worrying about radiation,” he said.

Stanley also objects to CT screenings for healthy patients because of the quality of what he called “salon treatments.”

“It’s a superficial scan, and they look at lumps and bumps and try to analyze them,” he said. “The compelling, intuitive notion is that if you catch a cancer very early, then you have cured that person.

“It seems very attractive and appealing, but this isn’t the case,” Stanley said.

Kim Miller, a staff technologist at Denver Medical Imaging Center, said her facility requires a doctor’s orders for performing CT scans and that patients must have symptoms before requesting scans.

“Not many people can (pay) for these scans,” she said. “I’m not sure how many people know they can just get a CAT scan.

“And I’m not sure how many doctors would OK this without symptoms,” she said. “They’re the gatekeepers nowadays.”

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