Moral of the story: Vaccines are GOOD. get vaccinated.

Source: AMA Morning Rounds 3/15/2010

US court rules thimerosal does not cause autism.

The New York Times (3/13, A11, McNeil) reported, "In a further blow to the antivaccine movement, three judges ruled Friday in three separate cases that thimerosal, a preservative containing mercury, does not cause autism." The rulings "are the second step in the Omnibus Autism Proceeding begun in 2002 in the United States Court of Federal Claims," which "combines the cases of 5,000 families with autistic children seeking compensation from the federal vaccine injury fund." The fund pays "families of children hurt by vaccines," but it "has never accepted that vaccines cause autism."

        The Los Angeles Times (3/13, Maugh, Zajac) reported, "The cases that three judges, called special masters, chose to rule on as test cases were considered among the strongest, so the outlook appears grim for others making the same claim." In one case, Special Master Denise K. Vowell wrote that "petitioners propose effects from mercury in [vaccines] that do not resemble mercury's known effects in the brain, either behaviorally or at the cellular level."

        "The cases had been divided into three theories about a vaccine-autism relationship for the court to consider," the AP (3/13, Schmid) reported. The court previously "rejected a theory that thimerasol can cause autism when combined with the measles-mumps-rubella vaccine," and "a theory that certain vaccines alone cause autism." But, Friday's "ruling doesn't necessarily mean an end to the dispute...with appeals to other courts available."

Moral of the story: Donating a kidney is safe for the donor and obviously of huge benefit to the recipient. Donate today.

Source: AMA Morning Rounds 3/16/2010

Long-term health risk for kidney donors appears to be low.

The New York Times (3/16, Rabin) reports in "Vital Signs" that "having only one kidney does not appear to affect the long-term survival of live kidney donors, and the risk of dying from the surgery itself is very low, according to" a study published March 10 in the Journal of the American Medical Association. In a study of 80,347 US adult kidney donors "followed for an average of 6.3 years" whose "survival was compared with a group of 9,364" matched, healthy controls, researchers found that "live kidney donors were no more likely to die than the comparison group."

Smokers who quit may experience improved arterial health within one year.

Moral of the story: 1 YEAR! that is amazing. quit smoking and you will see benefits almost immediately

Source: AMA Morning Rounds 3/16/2010

Smokers who quit may experience improved arterial health within one year.

NBC Nightly News (3/15, story 8, 0:20, Williams) reported that there is a "new incentive for smokers to quit" considering a "big new study...says quitting can improve artery function" and "actually make blood vessels healthier."

        Indeed, the work coming out of the University of Wisconsin-Madison indicates that people tend to "pick up pounds" when they quit smoking, the AP (3/16, Marchione) reports. But "a year after kicking the habit, smokers' arteries showed signs of reversing a problem that can set the stage for heart disease," according to the paper in the Journal of the American College of Cardiology.

        In fact, the "benefit was the equivalent of a 14% reduction in the risk of cardiovascular disease," the Milwaukee Journal Sentinel (3/15, Fauber) noted. Investigators reached that conclusion by using "a test known as flow-mediated dilation, which uses ultrasound to look at the ability of the brachial artery to relax." Participants who "who quit smoking had an improvement in flow-mediated dilation from 6.2% to 7.2%."

Moral of the story: Warfarin has a very narrow therapeutic index and genotyping will help to prevent complications that are so very common.

Source: AMA Morning Rounds 3/17/2010

Data indicates warfarin genotyping may reduce hospitalization rates.

USA Today (3/17, Sternberg) reports, "Doctors who used a genetic test to personalize treatment with warfarin, the world's most widely prescribed blood thinner, cut their patients' hospitalization rates by almost a third," according to a presentation made during the American College of Cardiology meeting. The study, led by Medco Health Solutions' Robert Epstein, "marks the first nationwide attempt to incorporate genetic testing into the routine use of a drug whose effects vary so much from one person to another that it carries a 'black box' warning, the government's most urgent safety alert."

        Apparently, "too much warfarin can lead to bleeding, too little can lead to clots, and either one can kill," the AP (3/17, Marchione) reports. Even "certain foods can throw it off," and "up to 20 percent of patients wind up in the hospital in their first six months on the drug." But Mayo Clinic trial participants "given gene tests to set their initial warfarin dose had about a 30 percent lower risk of being hospitalized than similar patients whose doses were set by trial and error."

        And, "Epstein said that the cost of the genetic testing -- $250 to $400 -- would be justified by reduced hospitalization costs," HealthDay (3/16, Preidt) reported. Notably, the "study included 896 people who, shortly after beginning warfarin therapy, gave a blood sample or cheek swab that was analyzed for expression of two genes -- CYP2C9 and VKORC1 -- that revealed sensitivity to warfarin."

Survey finds many Americans drink, smoke, and don't exercise.

Moral of the story: Stop smoking, stop drinking, EXERCISE! Encourage others to do the same.

Source: AMA Morning Rounds 3/17/2010

Survey finds many Americans drink, smoke, and don't exercise.

USA Today (3/17, Hellmich) reports that, according to data from "the National Health Interview Survey, based on telephone interviews with 79,000 adults over three years," the US "is not a nation of teetotalers or regular exercisers." In fact, "61% of people in the USA drink alcohol," while "31% of people do enough regular leisure-time physical activity to get health benefits -- that is, moderate exercise for 30 minutes five times a week or vigorous activity for 20 minutes three times a week." Health statistician Charlotte Schoenborn, of the National Center for Health Statistics, said, "There has been no progress at all in increasing physical activity since we started doing this report in 1997."

        "Overall, researchers say that since 1997, rates of cigarette smoking have declined by several percentage points, rates of obesity have climbed, and rates of alcohol use, exercise, and sleep have remained relatively unchanged," WebMD (3/16, Warner) reported. The survey also found that "one in five adults were smokers," while "six in 10 adults were obese or overweight," and "three in 10 adults averaged six hours of sleep or fewer per night."

Surgery Information and Videoes

If you are curious about a certain surgery check out this resource from a trusted source (NIH)

Aggressive measures to treat cholesterol, hypertension in diabetes not beneficial.

Moral of the story: The guidelines are correct.  Meet the recommended levels and you are good to go (if you have diabetes).

Source: AMA Morning Rounds 3/17/2010

Aggressive measures to treat cholesterol, hypertension in diabetes not beneficial.

The Los Angeles Times (3/15, Maugh) reports that for diabetics, "two new reports from a major nationwide trial called ACCORD released Sunday show that lowering either blood pressure or cholesterol levels below current guidelines do not provide additional benefit and, in fact, increase the risk of side effects." And, "a third arm of the study, released two years ago, shows that lowering blood sugar levels excessively actually increases the risk of heart disease." Despite being disappointing, "the findings 'reduce the cost and potential side effects of drug therapy' and mean that patients will not have to work as hard at reducing blood sugars, lipids, and blood pressure, said Dr. Denise Simons-Morton of the National Heart, Lung and Blood Institute, which funded the trial."

Spending on cancer care more than doubled since 1990.

Moral of the story: This is quickly becoming a moral issue about access to care due to its insane costs with a low benefit ratio in comparison to other treatments. People should take this into consideration.

Source: AMA Morning Rounds 3/17/2010

Spending on cancer care more than doubled since 1990.

USA Today (3/17, Szabo) reports that, according to research published in the Journal of the American Medical Association, "the cost of cancer treatment is 'skyrocketing' -- both for individual patients and the nation." Data indicate that "from 1990 to 2008, spending on cancer care soared to more than $90 billion from $27 billion." The trend may be due to advances in treatment that allow "older, frailer patients" to "have less invasive operations or more tightly focused radiation treatments...says" one analysis.

        The increase in spending on "cancer research and care...is straining the US health system and needs to be restrained, commentators said" in "six journal reports," Bloomberg News (3/17, Gibson) reports. Researchers suggested lowering the price of drugs by combining drug costs and other care in a single provider payment. They "also suggested...that doctors and hospitals should be grouped into accountable-care organizations" to "nudge physicians to act more cohesively."

        But, "in a commentary that accompanied" the "wide-ranging March 17 issue," MedPage Today (3/16, Frieden) reported that Susan Gapstur, PhD, MPH, and Michael Thun, MD, both of the American Cancer Society, "argued that comparing cancer rates in the US at any two time points 'can be misleading,'" because "such comparisons should 'take into account the more than 30% increase in the US population...since 1970.'" Gapstur and Thun concluded that "it is essential to move forward on multiple fronts simultaneously." AFP (3/16, Zeitvogel) also covered the story.

        Findings raise questions of cost-effectiveness of new colon cancer treatments. HealthDay (3/16, Preidt) reported, "New chemotherapy agents for metastatic colon cancer improve patient survival, but are costly," according to a study published online in the Archives of Internal Medicine. Researchers found that, "compared to those who received older chemotherapy agents, patients who received one or more of the six chemotherapy agents approved in the United States between 1996 and 2004 lived an average of 6.8 months longer." The investigators "calculated that the cost for each quality-adjusted life-year (a year of life in perfect health) gained was $99,100."

        Older colon cancer patients may be less likely to receive postoperative chemotherapy. The Los Angeles Times (3/16, Maugh) "Booster Shots" blog reported that a paper appearing in the Journal of the American Medical Association reveals that the "elderly are not treated as aggressively for colon cancer as younger people." UCLA researchers, alongside investigators at the Rand Corp., say that reality may be the result of "misguided compassion on the part of oncologists, who do not wish to subject older patients to the side effects associated with the most powerful treatments."

        There is also a pervasive feeling that older patients may not have much time left, according to Reuters (3/17, Allen). Some physicians are also leery of taking such measures because there is a dearth of data regarding chemo's efficacy in the elderly population.

Hearing aid with no externally visible components receives FDA approval.

Moral of the story: A hearing aid no one else can see.  cool. necessary?

Source: AMA Morning Rounds 3/18/2010

Hearing aid with no externally visible components receives FDA approval.

The Los Angeles Times (3/17, Healy) "Booster Shots" blog reported, "For several decades, people with hearing loss due to noise, viral infections or aging have had hearing aids to help maintain an aural tie to the world." Now, after a receiving approval from the FDA, "these patients will" have access to "a surgically implantable hearing system called Esteem." What's more, the "new device is considered to be the first hearing aid that has no externally visible components."

Moral of the story: Listen, ask questions, stay informed.

Source: AMA Morning Rounds 3/18/2010

Parents of children having surgery may not understand, remember risks of procedures.

HealthDay (3/17, Preidt) reported, "Even detailed counseling by doctors doesn't seem to help parents of children having surgery understand or remember all the risks of the procedures," according to research published in the Archives of Otolaryngology -- Head & Neck Surgery. In a study of "34 parents whose children were having a tonsillectomy or having tubes placed in their ears," researchers found that the parents "recalled about 58 percent of the nine surgical risks immediately after counseling and 57 percent on the day of the surgery." But, those "who had also received detailed information aids did better at remembering the risks both before and on the day of surgery."

Women with swine flu 13 times more likely to suffer critical illness if they are pregnant

Moral of the story: GET VACCINATED

(6) Women with swine flu 13 times more likely to suffer critical illness if they are pregnant
(Research: Critical illness due to 2009 A/H1N1 influenza 2009 in pregnant and postpartum women: population based cohort study)
http://www.bmj.com/cgi/content/full/340/mar18_3/c1279 (Editorial: Critical illness as a result of influenza A/H1N1 infection in pregnancy )
http://www.bmj.com/cgi/content/full/340/mar18_3/c1235
Pregnant women in Australia and New Zealand who had swine flu were 13 times more likely to be admitted to hospital with a critical illness, according to research published on bmj.com today.
The authors conclude that 11% of mothers and 12% of babies died as a result of being admitted to intensive care with swine flu. However they emphasise that given the small numbers included in their research, there are limits to the conclusions that can be drawn from the results.
It has already been established that pregnant women are at a higher risk of developing influenza complications. The recent swine flu pandemic was the first "to occur in an era of modern obstetric and intensive care management", says the study.
The research describes what happened to pregnant women with swine flu who were admitted to intensive care units (ICU) in Australia and New Zealand during the winter of 2009.
The authors, led by Dr Ian Seppelt from the Australian and New Zealand Intensive Care (ANZIC) Influenza Investigators in collaboration with the Australasian Maternity Outcomes Surveillance System, assessed the data relating to all women with swine flu who were pregnant or who had given birth in the last 28 days and were admitted to an ICU in Australia or New Zealand between 1 June and 31 August 2009.
During the study period, 209 women of child-bearing age (15 to 44) were admitted to an ICU with confirmed swine flu. Sixty-four of these (30.6%) were either pregnant or had recently given birth, 57 were admitted to an ICU in Australia and 7 to an ICU in New Zealand.
The results show that women who were more than 20 weeks pregnant were 13 times more likely to be admitted to an ICU than non-pregnant women who had swine flu. Forty-four (68.7%) of the women had to be put on ventilators to assist with breathing and of these, nine women (14.1%) needed further assistance to help oxygen reach their heart and lungs.
Overall seven (11%) of the mothers and seven (12%) of the babies died and Dr Seppelt argues that "although a mortality of 11% seems low when compared to usual outcomes of respiratory failure in intensive care … a maternal morality of 11% is high when compared with any other obstetric condition."
The authors highlight the fact that none of the women in the study had been immunised against seasonal flu despite recommendations that pregnant women should be immunised.
In an accompanying editorial, Dr Stephen Lapinsky from the Mount Sinai Hospital in Toronto, applauds the ANZIC team for their foresight and planning in investigating how swine flu affected pregnant women and those who recently gave birth.
He says the study "provides detailed data to enhance our understanding of maternal risk as well as the maternal and neonatal outcome".
Contacts:
Research: Ian Seppelt, Senior Staff Specialist, Department of Intensive Care Medicine, University of Sydney, Australia
Email seppelt@med.usyd.edu.au Editorial: Stephen Lapinsky, Site Director, ICU, Mount Sinai Hospital, Toronto, Canadabr/> Email stephen.lapinsky@utoronto.ca

Staples lead to higher risk of infection after joint surgery than traditional stitches

Moral of the story: with JOINT surgery staples are a BAD idea. Ask for traditional stitches (they take longer but decrease your risk of infection)

(1) Staples lead to higher risk of infection after joint surgery than traditional stitches
(Research: Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis)
http://www.bmj.com/cgi/content/full/340/mar16_1/c1199 (Editorial: Staples for skin closure in surgery)
http://www.bmj.com/cgi/content/full/340/mar16_1/c403
Using metal staples to close wounds after orthopaedic (joint) surgery can lead to a greater risk of infection than using traditional nylon sutures, concludes a study published on bmj.com today.
Orthopaedic surgeons are therefore advised to reconsider their use of staples to close wounds after hip or knee surgery while further trials are carried out to confirm these findings.
Wound complications are one of the major sources of illness following orthopaedic procedures like knee and hip surgery. They can prolong a patient's stay in hospital or lead to re-admission. There is also a link between superficial wound infection and deep infection.
Orthopaedic surgeons use both metallic staples and nylon sutures to close wounds. Staples are regarded as quicker and easier than sutures, but some have suggested that staples are more likely to cause infection and may also be more expensive.
The optimal method of skin closure still remains unclear, so researchers at Norfolk and Norwich University Hospital analysed the results of six trials that compared the use of staples to sutures following orthopaedic procedures in adults.
The trials involved 683 wounds; 322 patients underwent suture closure and 351 staple closure. Overall, the risk of developing a superficial wound infection was over three times greater after staple closure than suture closure.
For hip surgery only, the risk of developing a wound infection was four times greater after staple closure than suture closure. There was no significant difference between sutures and staples in the development of inflammation, discharge, dehiscence (re-opening of a previously closed wound), necrosis and allergic reaction.
The authors point out that the quality of evidence was generally poor and they call for high quality, well designed trials to confirm their findings. However, based on the current evidence, they suggest that patients and doctors should think more carefully about the use of staples for wound closure after hip and knee surgery.
These results fit with evidence from other specialties, says Consultant Orthopaedic Surgeon, Bijayendra Singh, in an accompanying editorial. He points out that the most consistent benefit of staples is more rapid skin closure, yet the time saved is rarely more than two to three minutes. The saving may also be reduced by the increased costs of removing the staples (compared with absorbable stitches) and reduced even further by the costs of treating the increased number of infections.
Contacts:
Research: Toby Smith, Research Physiotherapist in Orthopaedics, Honorary Lecturer, Norfolk and Norwich University Hospital, Norwich, UK
Email: toby.smith@nnuh.nhs.uk Editorial: Bijayendra Singh, Consultant Orthopaedic Surgeon, Medway Foundation NHS Trust, Gillingham, UK
Email: bisortho@doctors.org.uk

Aspirin associated with decreased risk for breast cancer recurrence and death

Source: ACP Internish 2/23/10

Aspirin associated with decreased risk for breast cancer recurrence and death

Women with breast cancer who take aspirin after their diagnosis may be less likely to experience recurrence or die of the disease, a new study reports.

Researchers used data from the Nurses’ Health Study to perform a prospective observational study of aspirin use in 4,164 women diagnosed with stage I, II, or III breast cancer between 1976 and 2002. Patients were observed until June 2006 or until death. The study’s main outcome measure was risk for death from breast cancer, according to number of days that aspirin was taken per week. Aspirin use was first assessed 12 months after cancer diagnosis because it is contraindicated during chemotherapy. The study results were published online Feb. 16 by the Journal of Clinical Oncology.
 
During follow-up, 341 women died of breast cancer. The adjusted relative risks (RRs) for breast cancer death with one, two to five, and six to seven days of aspirin use per week versus no use were 1.07 (95% CI, 0.70 to 1.63), 0.29 (CI, 0.16 to 0.52) and 0.36 (CI, 0.24 to 0.54), respectively. The association was not affected by adjustment for stage, menopausal status, body mass index, or estrogen-receptor status. The adjusted RRs for recurrence were 0.91 (CI, 0.62 to 1.33), 0.40 (CI, 0.24 to 0.65), and 0.57 (CI, 0.39 to 0.82) for the same aspirin use categories compared with no use.

The study was limited because some data were obtained by self-report and because the authors did not have information on aspirin dose, among other factors. However, the authors concluded that aspirin may have a beneficial effect on survival after a breast cancer diagnosis. They called for additional studies on aspirin’s mechanism of action in this population, including a possible randomized trial.

Obesity may delay onset of puberty in boys.

Source: AMA Morning Rounds 2/2/10

Obesity may delay onset of puberty in boys.

The Los Angeles Times (2/1, Healy) "Booster Shots" blog reported, "While obesity has been shown to bring on puberty earlier in girls," a paper appearing in the Archives of Pediatrics and Adolescent Medicine reveals something quite different: "Male children whose body-mass index (BMI) is consistently highest through early and mid-childhood are significantly more likely than thinner boys to have delayed puberty."

        In fact, after "analyzing the records of 401 boys from diverse socioeconomic backgrounds in ten regions of the US," University of Michigan researchers discovered that "at 11.5 years, boys with the highest body mass index (mean BMI z score=1.84) were 165% more likely to be prepubertal than the thinnest boys," MedPage Today (2/1, Emery) reported. Notably, "rates of obesity among American girls and boys have nearly tripled since the 1960s."

        Surgeon General's obesity plan said to be "sensible." In "The Checkup" blog of the Washington Post (2/1), Jennifer LaRue Huget writes that the Surgeon General's plan to combat obesity "got surprisingly little press coverage." Huget attributes this to it being a "sensible, seemingly heart-felt document" that doesn't call for governmental intervention. "Instead, it talks about personal responsibility, about communities working together, about grassroots efforts," and "places the onus for weight loss squarely on the shoulders of individuals." Huget asserts that "is not what many people want to hear -- or expect to hear in these paternalistic days."

Medical community turning to new obstructive sleep apnea treatments.

Moral of the story: Less traditional methods are being examined to help with sleep apnea- a common comorbidity of obesity.

Source: AMA Morning Rounds 2/2/10

Medical community turning to new obstructive sleep apnea treatments.

The Wall Street Journal (2/2, Mahrer) reported that as manufacturers work on streamlining the often bulky and expensive breathing masks used during CPAP treatments to help patients with obstructive sleep apnea, some dentists are turning to appliances that reposition the jaw. Meanwhile, physicians are either practicing various surgical techniques or encouraging their patients to make certain lifestyle changes, such as losing weight or changing one's sleep position. As a last resort, an Australian paper appearing in the BMJ indicates that learning to play the didgeridoo may actually help too.

Postmenopausal women taking antidepressants may be at higher risk for stroke, death

Moral of the story: Postmenopausal women on antidepressants are 45% more likely than those not on such medication to have a stroke, and 32% more likely to die of any cause.

AMA Morning Rounds 12/15/09

Postmenopausal women taking antidepressants may be at higher risk for stroke, death.

The Los Angeles Times (12/14, Healy) "Booster Shots" blog reported that, according to a study published in the Archives of Internal Medicine, "postmenopausal women taking antidepressants are at higher risk of suffering a stroke or of dying of any cause than are those who do not take such medications." Investigators "followed 136,293 post-menopausal women, age 50 to 79, for just under six years," during which time "5,496 developed depression and were treated with antidepressant medication." Researchers found that over the course of "follow-up, the women on antidepressants were 45% more likely than those not on such medication to have a stroke, and 32% more likely to die of any cause."

        HealthDay (12/14, Edelson) reported that while the study found that "women on selective serotonin uptake inhibitors," such as "Celexa [citalopram], Paxil [paroxetine], Prozac [fluoxetine], and Zoloft [sertraline]," as well as "tricyclic antidepressants," had an increased risk for stroke and death, "the overall risk for any one woman remained very small."

High coffee, tea intake may reduce chances of developing type 2 diabetes

Moral of the story: Drinking coffee and tea reduces chances of developing type II (late onset) diabetes

Source: AMA Morning Rounds 12/15/09;  Arch Intern Med. 2009;169(22):2053-2063.

High coffee, tea intake may reduce chances of developing type 2 diabetes.

Bloomberg News (12/15, Gibson) reports that, according to a study published in the Archives of Internal Medicine, "drinking four cups of coffee, decaf, or tea daily can reduce the chances of getting type 2 diabetes by about 25 percent to 35 percent." Harvard University "researchers reviewed 18 studies of almost 500,000 people" and discovered that "for each cup of coffee people drank, their likelihood of getting diabetes dropped by seven percent."

        "Even better results were found for bigger coffee and tea consumers -- drinking three to four cups a day was associated with about a 25% reduced diabetes risk, compared with those who drank between none and two cups day," the Los Angeles Times (12/15, Stein) reports. In addition, investigators found "positive results with decaf coffee and tea." Specifically, those "who drank more than three to four cups of decaf a day had about a one-third lower risk than those who didn't drink any," while "tea drinkers who consumed more than three to four cups a day had about a one-fifth lower diabetes risk than non-tea drinkers."

        HealthDay (12/14, Gordon) and MedPage Today (12/14, Fiore) also covered the story.

Coffee, Decaffeinated Coffee, and Tea Consumption in Relation to Incident Type 2 Diabetes Mellitus
A Systematic Review With Meta-analysis
Rachel Huxley, DPhil; Crystal Man Ying Lee, PhD; Federica Barzi, PhD; Leif Timmermeister; Sebastien Czernichow, MD, PhD; Vlado Perkovic, MD, PhD; Diederick E. Grobbee, MD, PhD; David Batty, PhD; Mark Woodward, PhD



Background  Coffee consumption has been reported to be inversely associated with risk of type 2 diabetes mellitus. Similar associations have also been reported for decaffeinated coffee and tea. We report herein the findings of meta-analyses for the association between coffee, decaffeinated coffee, and tea consumption with risk of diabetes.
Methods  Relevant studies were identified through search engines using a combined text word and MeSH (Medical Subject Headings) search strategy. Prospective studies that reported an estimate of the association between coffee, decaffeinated coffee, or tea with incident diabetes between 1966 and July 2009.
Results  Data from 18 studies with information on 457 922 participants reported on the association between coffee consumption and diabetes. Six (N = 225 516) and 7 studies (N = 286 701) also reported estimates of the association between decaffeinated coffee and tea with diabetes, respectively. We found an inverse log-linear relationship between coffee consumption and subsequent risk of diabetes such that every additional cup of coffee consumed in a day was associated with a 7% reduction in the excess risk of diabetes relative risk, 0.93 [95% confidence interval, 0.91-0.95]) after adjustment for potential confounders.
Conclusions  Owing to the presence of small-study bias, our results may represent an overestimate of the true magnitude of the association. Similar significant and inverse associations were observed with decaffeinated coffee and tea and risk of incident diabetes. High intakes of coffee, decaffeinated coffee, and tea are associated with reduced risk of diabetes. The putative protective effects of these beverages warrant further investigation in randomized trials.

Author Affiliations: The George Institute for International Health, The University of Sydney, Sydney, Australia (Drs Huxley, Lee, Barzi, Czernichow, Perkovic, Batty, and Woodward and Mr Timmermeister); Department of Public Health, Avicenne Hospital, University of Paris 13, Paris, France (Dr Czernichow); The Julius Center for Health Sciences and Primary Care, Utrecht University Medical Center, Utrecht, the Netherlands (Dr Grobbee); Medical Research Council Social & Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland (Dr Batty); and Mount Sinai School of Medicine, New York, New York (Dr Woodward).

Radiation overexposure from CT scans may be more widespread than previously estimated

Moral of the story: Again, watch out for those CT settings.

Source: AMA Morning Rounds 12/15/09

Radiation overexposure from CT scans may be more widespread than previously estimated.

The CBS Evening News (12/14, story 3, 2:20, Lapook) reported, "The problem of too much radiation during CT scans may be more widespread than anyone thought." In fact, "new research...found a wide variation in radiation dose for the most common CT scan like abdomen, pelvis, and chest. A survey of four hospitals found some patients received 13 times more radiation than others for the same type of scan."

        NBC Nightly News (12/14, story 8, 2:10, Bazell) reported, "Depending on the part of the body being scanned, each CT exposes a patient to an amount of radiation equal to between 30 and 440 chest X-rays." But, in a separate study, "researchers calculated that 72 million CT scans are performed in this country a year and concluded that could lead to 29,000 excess cancers and 15,000 excess deaths a year in the future."

        In that study, published in the Archives of Internal Medicine, researchers at the National Cancer Institute "found that people may be exposed to up to four times as much radiation as estimated by earlier studies," USA Today (12/15, Szabo) reports.

        Meanwhile, the second study, appearing in the same journal, of over 1,000 patients at four hospitals, showed that one woman out of 270 and one man out of 600 would suffer from cancer after undergoing a single heart scan at age 40, the Wall Street Journal (12/15, A3, Wang) reports. Researchers noted that the differences in radiation doses may be due to a lack of standardized settings and disparities in technology use.

        The Los Angeles Times (12/15, Maugh) reports that, in an accompanying editorial, Dr. Rita F. Redberg, editor of the journal, noted that "the articles...make clear that there is far more radiation from medical CT scans than has been recognized previously." Redberg said, "Even many otherwise healthy patients are being subjected to the radiation...because emergency [departments] are often sending patients to the CT scanner before they see a doctor."

        Bloomberg News (12/15, Ostrow) reports that in the National Cancer Institute study, "the authors predicted that lung cancer will be the most common radiation-related cancer followed by colon cancer and leukemia." For its part, the FDA "issued interim regulations Dec. 7 requiring closer monitoring of CT scans after more than 250 cases of exposure to excess radiation were reported since October."

        WebMD (12/14, Doheny), MedPage Today (12/14, Neale), NPR (12/15), Modern Healthcare (12/15, Rhea), HealthDay (12/14, Pallarito), and Reuters (12/15, Steenhuysen) also covered the story.

FDA investigates 300 radiation overdoses from CT scans.

Moral of the story: Just something to be aware of.  The CT might not be set correctly.

Source: AMA Morning Rounds 12/16/09

FDA investigates 300 radiation overdoses from CT scans.

NPR's (12/15, Neighmond) All Things Considered reported, "More than 300 patients may have received an overdose of radiation from a special type of CT scan used to image the brain. The Food and Drug Administration says the radiation overdoses occurred at three hospitals in Los Angeles County and one hospital in Huntsville, AL. FDA officials say there could be many more cases at hospitals nationwide as their investigation unfolds." Dr. Jeffrey Shuren, "acting director of the FDA's Center for Devices and Radiological Health," explained that "a regular CT scan to the brain is the equivalent of about 100 chest X-rays," whereas "a perfusion CT scan of the brain is equal to several hundred chest x-rays. Patients at the four hospitals who received excess radiation were exposed to the equivalent of several thousand X-rays instead -- three to eight times the expected radiation dose."

New, Higher Cancer Risk Estimates for CR Scans

Moral of the story: CT scans are being reevaluated for their cancer risk, which was underestimated in the past based on theoretical values and not actual practice data.

Source: ACP Internist Weekly 12/21/09

New estimates on cancer risk of CT scans

Two new studies warn of the cancer risk posed by CT scans and suggest some risk-reduction strategies.
A retrospective cross-sectional study calculated the radiation doses delivered by computed tomography (CT) scans performed at four different California hospitals. Doses ranged from 2 millisieverts (mSv) for a routine head CT to 31 mSv for a multiphase abdomen and pelvis scan. Many of the scans provided more radiation than is usually assumed to be the case; the median dose for a routine abdomen and pelvis scan was 66% higher than the expected 8 to 10 mSv. Even within each type of study, the effective dose varied significantly within and among the hospitals. There was a mean 13-fold variation between the highest and lowest doses for each procedure.
Extrapolating from these data, researchers calculated cancer risks, such that 1 in 270 women who underwent CT coronary angiography at age 40 would develop cancer from the scan. Risks were lower for men than women, and higher for younger than older patients (20-year-olds faced double the risk, 60-year-olds only half). The study was published in the Dec. 14/28 Archives of Internal Medicine.
Another study in the same issue used risk models to calculate how many cancers could eventually be attributed to CTs based on current scanning rates. Overall, they estimated that 29,000 future cancers could be caused by CT scans performed in the U.S. in 2007. Scans of the abdomen and pelvis contributed the most to the tally, and one-third of the cancers would be due to scans performed on patients between the ages of 35 and 54.
The authors of the studies and an accompanying editorial offered a number of solutions to this problem, including standardized protocols (such as have been applied to mammography), fewer multiple series examinations, dose reduction and registration, and greater use of American College of Radiology accreditation and criteria. The experts also called for a reduction in the number of inappropriate and unnecessary CT scans.