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DOI: 10.1148/radiol.2283030475
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(Radiology 2003;228:901-902.)

Letters to the Editor

CT Screening [letter]

E. Stephen Amis, Jr, MD

Department of Radiology, Albert Einstein College of Medicine/Montefiore Medical Center, 111 E 210th Street, Bronx, NY 10467-2490. e-mail: amis@aecom.yu.edu

Editor:

I read with interest the editorial by Dr Earnest and colleagues in the March 2003 issue of Radiology (1). They suggest that the American College of Radiology (ACR) reconsider its current statement on whole-body computed tomographic (CT) screening (2) to include a suggestion that informed patient consent be obtained before such screening is performed.

I personally concur with this suggestion and have actually recommended obtaining patient consent in prior presentations on this topic. Far more important, however, is the necessity for addressing the additional cost of health care in the United States, which will result from referral of screened patients for further evaluation of detected abnormalities. This concern is raised in the ACR statement on screening CT and is confirmed by the finding by Casola et al (3) that 32% of screened patients had findings that required such evaluation.

A solution to this problem was set forth by Hillman and agreed to by Brant-Zawadzki at the opening session of the 2002 Radiological Society of North America Scientific Assembly and Annual Meeting (4): There should be a moral imperative for the patient undergoing screening to assume the cost of all additional imaging and intervention needed to establish a final diagnosis. This fiscal responsibility should be made clear in the consent agreement. Only when the final diagnosis has been established should third-party payers become liable for the cost of therapy, if indeed therapy is needed.

We live in a consumer-driven society. Neither I nor the ACR wishes to edict that screening be refused. If, however, the patient can be informed of the ratio of risk to benefits and the strong possibility of abnormalities being detected, which will require further work-up, and if the patient then assumes responsibility for the associated costs, we could all have a greater comfort level for this procedure.

REFERENCES

  1. Earnest F, IV, Swensen SJ, Zink FE. Respecting patient autonomy: screening at CT and informed consent (editorial). Radiology 2003; 226:633-634.[Free Full Text]
  2. Board of Chancellors. ACR statement on total body CT screening. Available at: www.acr.org/frames/f-search.html?words=CT+screening. Accessed March 11 2003.
  3. Casola G, Furtado C, Stamato S, Lee P, Dang D, Sani F. Whole body CT screening: spectrum of findings and recommendations (abstr). Radiology 2002; 225(P):317.[Free Full Text]
  4. Hillman B, Brant-Zawadzki MN. Screening examinations: who benefits and who pays—the individual and society, and role of CT. Presented at the 88th RSNA Scientific Assembly and Annual Meeting, Chicago, Ill, December 1–6 2002.



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G. M. Kalish, M. Bhargavan, J. H. Sunshine, and H. P. Forman
Self-referred Whole-Body Imaging: Where Are We Now?
Radiology, November 1, 2004; 233(2): 353 - 358.
[Abstract] [Full Text] [PDF]

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