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Body Scans becoming more popular
The ads come at you from every direction, TV, radio, newspapers and their message gets your attention:
With a quick, painless CT scan, they say, you can check the health of your heart or other vital organs, detect disease early or rest assured that all is well. And you don't even need a doctor's referral.
Sources of the ads are two independent imaging centers, Health-Scan in Bellevue and Scan Quest in Renton. Both opened last fall, and Scan Quest says response has been so strong it plans to open two additional centers in the Seattle area later this year.
They're part of a small but growing contingent of CT scanning centers springing up around the country and getting lots of buzz in such settings as "The Oprah Winfrey Show" and the Internet.
For a hefty price, the centers will scan your heart, lungs or all vital organs together a "full-body scan" looking for such things as cancer or heart disease.
Among the newer uses is a colonography, which scans the colon for possible cancer minus the invasiveness of a traditional colonoscopy.
The idea for these screening scans, advocates say, is to catch disease before it gets a death grip on you.
Doctors' opinions divided
Useful as that sounds, the services prompt sharp criticism from many doctors ý along with support from some.
"CT (computed tomography) scans are among the greatest medical advances of the past century," says Dr. Terence Quigley, a vascular surgeon and immediate past president of the King County Medical Society.
Yet he contends the independent imaging centers are primarily money-making operations whose tests are largely unnecessary, expensive and usually not covered by insurance.
Prices range from about $300 for a lung scan to about $1,400 for a full-body-plus-colon scan.
Beyond cost, Quigley argues, the tests can give patients either a false sense of security or needless worry.
At the same time, some local doctors refer patients to the centers or even get the scans themselves.
In addition, both Swedish Medical Center and University of Washington Medical Center offer CT heart screening (plus lung screening at UW). As at the independent centers, patients usually must pay out of pocket and can self-refer.
A success story
Proponents of CT screening point to patients such as Laurel Nebel, 58, of Bellevue. Though Nebel had high cholesterol, her treadmill test was normal.
Still concerned, she decided to have a CT scan, and the results pointed to arterial-plaque buildup, later confirmed by an angiogram, a more invasive test.
Upshot: A cardiologist performed angioplasty to correct the clogging.
Conversely, Kimberly Hoyt wonders if her father would be alive today if he'd had a full-body CT scan two or three years ago. A urine test done last spring as part of a routine physical found blood in his urine, she says. Further tests revealed a grapefruit-sized cancer on his kidney, though he'd had no symptoms. The discovery came too late ý he died in December, at 59.
Hoyt, president of Scan Quest, says his late diagnosis helped inspire her to co-found the company.No one disputes that CT screening can detect disease. Critics argue, however, that while occasional cases seem to "prove" the value of CT scanning, the vast majority of patients could be guided to good health through regular checkups and traditional, insurance-covered tests, such as blood pressure, cholesterol and treadmill tests for the heart.
The major medical groups ý such as the American Heart Association, American Cancer Society, American College of Radiology ý generally either don't favor them or are neutral, saying there's not enough evidence or track record to justify them as a widespread screening tool.
How the scans work
CT scans combine X-rays with computerized digital imaging, yielding images in the form of multiple, thin, virtual "slices" of an organ for viewing on a screen. The images can reveal assorted abnormalities, from kidney stones to aortic aneurysms, cancer and heart disease.
To be scanned, the patient (usually fully dressed) lies on a table that slides partway into an open, doughnut-shaped imaging machine.
The two local independent centers say they transmit the images to board-certified radiologists for a detailed interpretation and report, though a staffer a doctor at Health-Scan, a physician's assistant at Scan Quest offers a preliminary review immediately after the scan.
CT scans have been around for years, but the technology keeps improving, with newer, high-speed machines creating sharper images.
Consumer-driven testing
Getting just as much attention are these features of the independent screening centers:
Marketing. Bypassing doctors, imaging centers are advertising directly to consumers.
"These groups are marketing to a general public that does not have the medical understanding to know whether or not they need this diagnostic test," says Dr. Benjamin Anderson, an oncologist who heads the breast-care program at UW Medical Center.
But Dr. Thomas Gianulli, Health-Scan's CEO, says some doctors simply dislike having patients make their own decisions, or aren't well-informed about the scans.
Scanning sans indications. Unlike with most medical tests, you can be scanned at these centers even if you have no symptoms, no elevated disease risk and no doctor's referral, although Gianulli says he has turned down some people in their 30s that he considered too young and indication-free to need a scan.
Scans performed without medical indications, Quigley says, pose a high chance of anxiety-causing false-positive results.
"These machines are so sensitive, they pick up everything: scar tissue from an old infection, benign masses, congenital abnormalities. Once you know it's there, you're obligated to find out what it is. So you end up with a patient who goes through a whole battery of tests" only to learn it was unnecessary, he says. False-positives are especially common with lung scans, experts say.
It's unclear just how often disease is found by non-medically indicated screening scans. Hoyt, the Scan Quest president, says 14 percent of scans performed at her center reveal some type of abnormality, but she did not know how many of those later prove to be either harmless or actual disease, since there's no universal followup.
The scanning centers urge a patient to see a doctor if an image looks suspicious.
Incentive for change
In the case of heart disease, cardiologist Dr. Gary Oppenheim, of the Swedish Heart Institute, is convinced that CT scans can be lifesavers.
Oppenheim is director of the institute's scanning program, which uses an ultra-fast electron-beam tomography (EBT) machine to produce an ultra-clear image. For now, it's the only one of its type in the state.
About 8 percent of heart-attack victims have no known risk factors, says Oppenheim.
And, as with Nebel (who was scanned elsewhere), treadmill tests on asymptomatic patients frequently miss heart disease, he said.
"A stress test usually reveals (heart disease) only when you've got at least a 60 percent closure of an artery," he says, yet studies show that heart attacks can occur in patients with only a 30-percent or 40-percent closure. That argues for scanning, he says.
Scanning reveals calcium deposits in arteries closely associated with plaque build-up.
Oppenheim says such an image can be a powerful incentive for a patient to improve health habits.
Things to consider
If you're considering having a CT screening scan, experts say to do so with your eyes wide open as to cost and limitations.
More specifically:
Know that getting a "clean" scan doesn't mean it's OK to resume or continue bad habits, such as smoking or high-fat eating. It also doesn't mean you'll be disease-free in the future.
Remember that with or without a scan, you need your doctor's ongoing health advice.
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