CT Scans.

[themalteser]

Hello all,
I have a question. During my life I already had around 5 CT scans. The surgeon wants another CT scan, so naturally I am now getting concerned about radiation. I prefer to have an ultrasound or an MRI, but for the PEARS these are not an option.

May I ask your opinion please on whether I'm overly concerned or whether I should be concerned. Not sure how much MsV there is with each CT, but I read somewhere between 8 and 16 for heart, while normal X-ray is about 0.3. This level seems quite high to me.

Thank you,
Brian.

 

[Protimenow]

I'd balance the low risk of radiation-induced cancers or other problems against the benefit of getting a CT scan (or multiple scans) to assist the doctors in getting the data needed for your PEARS procedure.

The risk of radiation-induced cancers seems to be somewhat overstated.

If it was me, I'd go for whatever tests the doctors preparing for the procedure request - but you can always ask your doctor about your fear of getting too much radiation.

 

[Keithl]

When I was diagnosed with aneurysm in 2007 they did a CT and then did one every 6 months for 2 years. Then I was diagnosed with Basal cell carcinoma in my arm pit. It confused the dermatologist as usually that cancer occurs where your skin is exposed to sun. We hypothesized that all the CTs May have contributed. A CT is the equivalent of 50+ normal xrays. Also there was some investigation a while back that many CT machines are not properly calibrated and maintained and the ones they tested were over the dose of radiation needed. I went to MRi after that as it is just as reliable. I am claustrophobic so they give me 1-2mg of Xanax 20 min before and I just zone out for the 15 minutes in the tube.

This year I did have 3 CTs, this year, 1 when they determined it was time for surgery, one a few days after surgery then 1 last month to get a good view of the results. I will be back on MRI next year.

Odldly this year the iodine dye in the first one triggered an anaphylactic allergic reaction that scared the crap out of me. My throat started closing and they had to epi pen me, then shoot all sorts of steroids in the IV. Now when I go for a CT with dye I need to take a bunch of stuff ahead of scan to,avoid the reaction.

 

[Astro]

According to the study, "Recurrent CT, Cumulative Radiation Exposure, and Associated Radiation-induced Cancer Risks from CT of Adults" (free journal article if you google it):
For a 40 year old male, a CT scan causes about 0.6 extra cancers per 1000 patients.

This would mean that 6 scans would cause less than 4 extra cancers per 1000 patients (this is a 0.4% risk).

The risk of not managing your aorta correctly is undoubtedly much higher.

 

[Protimenow]

Maybe he's just one of the unlucky ones.

 

[pellicle]

myself I would not worry about that risk ... its minute, I've had so many old school X-Rays when I was a kid (to monitor my heart) I frankly find the whole debate ludicrous.

Firstly the risk of cancer from a CT scan is so much less than that of injury from driving that if you were worried about that then you should never get into a car. Secondly the risk from the cancer is that it will increase your possibility of getting a cancer in 15 years time, unlike the car which will increase your risk of physical injury immediately.

Sure, don't have them weekly like an ice-cream treat but without a CT scan to make proper diagnostic assessments your surgery will be more risky.

Its not Bubba-Jaeger

Worry more about a hospital acquired infection ... far more real and higher risk

 

[Astro]

Worry more about a hospital acquired infection ... far more real and higher risk

Best not to swab the doctors. There will be none left.

 

[pellicle]

Best not to swab the doctors. There will be none left.

Don't forget the nurses.

 

[bizinsider]

Hi, I'm on the every 3-month scan plan for echos/CT or MRI - alternating each every 6 months. I had the same concerns and so did my cardiologist so we switched to MRIs. At Scripps in San Diego there is ONE MRI with the software that gives a good picture of the aorta WITHOUT using dye.

That's the other thing - dye. Too much, for some people, can lead to kidney issues. CT dye is considered more potentially problematic on that front than MRI dye. But if you do a quick search, you will see that in recent years there has been growing concern about MRI dye on the Brain. (I also hear you have a risk of getting killed by a car if you cross the street!)

The view my doc and I (he is an interventional cardiologist who also happens to head of Integrative Medicine at Scripps) have taken is to alternate the echos with non-dye MRIs. The results at my level of 4.7-4.9 are close enough. When they're both at or near the magic 5 level (assuming that my left ventricle or regurgitation haven't reared their "it's time for surgery NOW" heads first, I'll head to Cleveland or Mayo (haven't decided which, yet) and get the CT, angio etc.

And you're right: Surgeons pretty much demand CTs. There is no perfect answer and everybody's body reacts differently to these things and, unfortunately, you only know after-the-fact. If I was given the choice of CT or nothing I would choose CT b/c cancer is treatable, dissection, less so.

Best of luck,

Herb

 

[pellicle]

... That's the other thing - dye. Too much, for some people, can lead to kidney issues. CT dye is considered more potentially problematic on that front than MRI dye.

Good point about the dye

 

[Protimenow]

And some people are EXTREMELY allergic to it.

 

[Keithl]

My allergy came 10 years after having 4-5 CTs. I went to an allergy doctor and they said it is not uncommon to develop the allergy. It was scary as hell. And once you have the allergy you have it forever.

 

[pellicle]

My allergy came 10 years after having 4-5 CTs. I went to an allergy doctor and they said it is not uncommon to develop the allergy. .... And once you have the allergy you have it forever.

Interesting 10 years huh ... I have the same with Photographic Fixer (Black and White chemistry) ... right now its just at the rash from contact stage ...

Happily I'm as yet allergic to not much else (well except bullsh1t, which makes my job difficult for me, I'm surrounded by it), I've been very fortunate in my life.

 

[DachsieMom]

I’ve had this same question. I had surgery in April 2015 at age 41 (almost 42) and have an aortic mechanical valve conduit. My surgeon wants ct scans every 2 years. However, I am guessing his average patent is much older. I went for the first “2 year post-op” ct scan in 2017, but didn’t go last year. I am very concerned about the radiation, as I had two pre-op (heart and brain) ct scans and one ct scan 6 weeks post op, so I have now had four (and it will cost me almost 6,000 or 7,000 for the ct scan, until I hit my crazy deductible). I see my cardiologist every year and occasionally have echos. I have had a few echos, but I think my cardiologist generally does them every ten years. My surgeon agreed I could go for a ct scan every three years so I will have less radiation exposure (so next year) but I’m not sure I want to go. Each scan is with contrast. Not sure if it matters but I’m only 4 ft 10 and 100 lbs and I doubt they adjust for my kid-like size when dosing. I’m sorry I am no help, but I am interested in the responses you receive.

 

[Astro]

I’ve had this same question. I had surgery in April 2015 at age 41 (almost 42) and have an aortic mechanical valve conduit. My surgeon wants ct scans every 2 years. However, I am guessing his average patent is much older. I went for the first “2 year post-op” ct scan in 2017, but didn’t go last year. I am very concerned about the radiation, as I had two pre-op (heart and brain) ct scans and one ct scan 6 weeks post op, so I have now had four (and it will cost me almost 6,000 or 7,000 for the ct scan, until I hit my crazy deductible). I see my cardiologist every year and occasionally have echos. I have had a few echos, but I think my cardiologist generally does them every ten years. My surgeon agreed I could go for a ct scan every three years so I will have less radiation exposure (so next year) but I’m not sure I want to go. Each scan is with contrast. Not sure if it matters but I’m only 4 ft 10 and 100 lbs and I doubt they adjust for my kid-like size when dosing. I’m sorry I am no help, but I am interested in the responses you receive.

What can you do? Keep asking every time. Also ask the radiology staff. They might know about some new technique that your referring doctor doesn't yet know about.
Hopefully they are taking into account your body size. Less radiation is required to penetrate a smaller body. Usually the radiographer takes this into account. Ask.
While it makes sense to minimise radiation exposure, your exposure sounds like it is nowhere like the astronauts who stay on the International Space Station. If a spider creeps into the scanner while you're being scanned, maybe you will develop super powers.

Good luck reminding your team to keep the radiation doses down. It is a fair question, they should be thinking about it as well. Despite all the radiation, your risk is still low.

 

[Protimenow]

You probably don't have to worry much about the 'contrast' (aside from allergic reactions). It's made to block radiation from going through - so it doesn't add any radiation to the scans. It's also probably dosed by body weight. The radiation, though, may be a different issue.

 

[mecretired]

I have had 12 ct scans in the last 9 years. My cardiologist was alternating echoes and ct yearly. But I had lung cancer (stage 1) 2 years ago that was actually caught by the cardiologist’s ct scan. Upper lobe of right lung was removed but no treatment was necessary. Now I have annual echoes with my cardiologist and annual ct’s with my oncologist. So I guess you have to weigh the good and bad. They never would have found my lung cancer until it was probably too late without the ct scan.

 

[DachsieMom]

Interesting that you have alternating ct scans. I think I’ve asked this before but I don’t recall the answer - what do most people have post surgery with respect to ct scans regularly? I don’t mean to take over the thread. I can start a new one later.

 

[almost_hectic]

I have had 12 ct scans in the last 9 years. My cardiologist was alternating echoes and ct yearly. But I had lung cancer (stage 1) 2 years ago that was actually caught by the cardiologist’s ct scan. Upper lobe of right lung was removed but no treatment was necessary. Now I have annual echoes with my cardiologist and annual ct’s with my oncologist. So I guess you have to weigh the good and bad. They never would have found my lung cancer until it was probably too late without the ct scan.

Wow, that’s a LOT of CT scans. One CT scan is the radiation equivalent to having 200 chest X-rays!

 

[hx77]

I could not find any hard number but my cardiologist told me half-life of CT radiation is very long. Meaning the radiation stays within the body for a long time.

If the purpose of CT scan is to track the progression of aneurysm, I would do MRA. The difference of insurance cost is only $300-$400. I would also consider repair the aorta sooner than later to avoid additional scans.