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Full-body CT Screens on Healthy Patients are Not Advised

Some health-care providers are promoting full-body CT scans as a way to track down hidden health problems. They are finding a willing audience of consumers who believe in early detection and are willing to pay $600 to $1,500 out of pocket for a clean bill of health.

Instead, the patients may be buying a false sense of security or may be unknowingly stepping onto a slippery slope of follow-up testing. Several physician's organizations have questioned the use of CT scans on seemingly healthy people because the test has not been validated by research and the subsequent follow-up testing may waste health-care resources that could be better used on proven treatments.

CT scans (also known as CAT scans) combine X-ray and computer technology to give physicians cross-sectional images of the body's internal structures. In most cases, CT scans are used to help diagnose the cause of a patient's symptom, like headache, persistent cough or abdominal pain. Before the scan is performed, the patient usually receives an injection and a drink of contrast dye, which makes blood vessels, organs or abnormalities show up more clearly on the scan.

It is a relatively new and growing trend to use whole body CT scans to detect problems that are not yet causing symptoms. Companies promoting the test point to patient examples where life-threatening aneurysms or early warning signs of heart disease were uncovered.

CT scanning has been proven useful for diagnostic purposes, but despite anecdotal evidence, there is no research that shows CT screening would detect illnesses more effectively than methods we have now or improve long-term patient outcomes.

Some people may wonder: Why wait for the research if this technology could potentially uncover a life-threatening condition like an aneurysm? One reason to wait is that, until research proves its usefulness, we believe the miniscule risk of a deadly aneurysm is outweighed by the real risks of CT screening and the follow-up testing that may result.

Every medical test and treatment comes with risks and benefits. An individual who has symptoms of a brain tumor may accept the small risk of radiation exposure from a CT scan to gain the useful diagnostic information. The radiation exposure of a full-body scan - especially if performed regularly - may not be worth the risk.

Another risk is a false positive result. As opposed to diagnostic CT scans, the full-body screens are performed without contrast dye, so the resulting images are not as clear. The scan might show things that are not ultimately significant, but may need further evaluation. For example, adjacent bowel loops may appear to be a mass.

Many people have benign cysts or masses in their livers and kidneys that will never cause any symptoms or health problems. If these spots are detected by a full-body screen, an additional CT scan, with contrast dye, will be needed to clarify the finding. Contrast dye itself entails risks; a small percentage of patients have allergic reactions to the dye. A few patients have suffered kidney failure or even death.

A CT screen that shows calcification of the coronary arteries may lead a patient to have more invasive heart testing even though the plaque is causing no symptoms and may not be a significant health issue for 15 years or more.

While consumers pay for full-body CT scans out of pocket, follow-up tests are covered by health insurance. Many physicians are concerned that the testing to chase down false positives will put a strain on an already overburdened health-care system. Those health-care dollars could be better spent on proven treatments.

For these reasons, several organizations including the American College of Physicians, the American Society of Internal Medicine, the American College of Cardiology and the American Heart Association have discouraged the use of full-body CT scans.

Some day, CT scanning may be perfected to the point that it could be proven useful as a regular screening tool for healthy patients, like mammography or colonoscopy. Until that day comes, my best advice for patients is that full-body CT screens are not recommended at this time. Individuals who are concerned about a specific health issue, should discuss it with their primary care physicians.

Mary Olson, M.D., is professor and chairperson of radiology at Loyola University Chicago Stritch School of Medicine.

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