Frequency OF Follow Up CT Scans

[skeptic49]

The surgery department at my university hospital wants a CT scan with contrast every two years. I'm eight years post surgery so I've had a few of these so far. I am concerned about radiation exposure, which is cummlative. How often are others getting CT scans post surgery?

 

[Superman]

Forgive me for not recalling off hand. Is your valve tissue or mechanical? Did you already have an aortic aneurysm repair, or is your ascending aorta dilated?

I have a mechanical valve. After my aneurysm repair, I had maybe two or three follow up CT’s then my surgical team left me to my cardiologist and I hope to never see the surgical team again. Probably 10 years since I’ve had a CT.

 

[skeptic49]

Forgive me for not recalling off hand. Is your valve tissue or mechanical? Did you already have an aortic aneurysm repair, or is your ascending aorta dilated?

I have a mechanical valve. After my aneurysm repair, I had maybe two or three follow up CT’s then my surgical team left me to my cardiologist and I hope to never see the surgical team again. Probably 10 years since I’ve had a CT.

Thanks for your reply, Superman.

I have a tissue valve with hemiarch aortic replacement, so some significant work was done. I can understand the need for follow up echos, but waht would the surgeon be looking for with a CT scan? I really worry about the radiation and the hit the kidneys take from contrast.

 

[Superman]

Thanks for your reply, Superman.

I have a tissue valve with hemiarch aortic replacement, so some significant work was done. I can understand the need for follow up echos, but waht would the surgeon be looking for with a CT scan? I really worry about the radiation and the hit the kidneys take from contrast.

And I totally identify with your chosen moniker here. Part of me wants to chalk it up to billable hours on an expensive machine. I also would think an echo would be sufficient until things start to indicate a need for closer scrutiny.

 

[vitdoc]

Odd story. I don’t think that is routine standard of care s/p aneurysm repair. Maybe there is something odd that was seen in the past that warranted close scrutiny. You should ask. Otherwise I agree that the irradiation exposure and the contrast would be nice to avoid. I had an aneurysm repair in 2006 and I have never had a CT just echos.

 

[pellicle]

The surgery department at my university hospital wants a CT scan with contrast every two years. I'm eight years post surgery so I've had a few of these so far. I am concerned about radiation exposure, which is cumulative. How often are others getting CT scans post surgery?

you're correct that the effects of radiation can be cumulative. However you're neglecting most of the other facts.

1. so first, you're the correct the radiation dose is low but not insignificant.
2. imortantly you don't rupture into a cancer immediately but there is a increased risk of cancers developing over time. Many cancers will not begin to show for 10 years.
3. The biggest risk group are children who are in a period of fast tissue growth and will have (one expects) decades of time for growth and for the DNA errors possibly introduced by the exposure to ionising radiation to not be destroyed and to begin growing. I'm suspicious that its possible you don't have >20 years left (correct me if I'm wrong) and so the risk is reduced by that
4. IF a cancer growth is stimulated by the CT scan it can be treated

Myself I've had quite a few CT's and (at least) hundreds of X-Rays dating back to the days when they were 10 or more times the power of modern gear. I've even had a PET scan where I'm injected with a radio labelled sugar (yes, it emits radiation, which the scanner then locates in 3D to mm levels of accuracy.
http://cjeastwd.blogspot.com/2017/10/radio-labelled.html
I'm expecting to have another one soon as part of my process in dealing with my bugs (you remember them right?).

I am anticipating another CT soon because of a conversation with my Cardio about exploring any physical causes for my recent emergence of arrhythmias.

Summary
Diagnosis is always a slightly risky thing, but then we weight the risks against the risks of not knowing what the diagnostic tools elucidate. We call it medical imaging because humans need to see things to understand them. Its like turning on a light to find something in a dark room and we know from biology that vision confers advantages.

Best Wishes

 

[pellicle]

PS: an interesting historical vignette
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520298/
and in dealing with any cancers
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5535674/
oh, and of course showing how cautious we are with the standards, have a look at naturally occuring background radiation levels

http://large.stanford.edu/courses/2018/ph241/lance2/
NB: The effective doses from diagnostic CT procedures are typically estimated to be in the range of 1 to 10 mSv. so, put that in context of living in Ramsar, where the background radiation is around 260 mSv per year in places of the city,

 

[tom in MO]

The surgery department at my university hospital wants a CT scan with contrast every two years. I'm eight years post surgery so I've had a few of these so far. I am concerned about radiation exposure, which is cummlative. How often are others getting CT scans post surgery?

I'd ask the doctor who prescribed it what about you condition requires it. You are unique and other's experiences may not be pertinent.

 

[pekster11]

I had a CT scan a few months after my operation in April 21, and another one in Summer 22 and another one in April 23...all at the request of surgical team. I believe they intend to ask for me to have a CT scan next year aswell
I have been told that there is no problem with the mechanical valve or aneurysm repair
I am unsure also why I they keep asking for CT scans if there is no problem, so I've fired off an email to my consultant this evening

 

[Chuck C]

As others have pointed out, there could be a specific reason specific to your case leading them to do CT scans every 2 years. I have follow up echos. My last one was a little over a year ago. My cardiologist indicated that because I am mechanical, we can go to echos every 5 years, if I want, but he is happy to do them more frequently if I prefer. My call. I'll probably get them about every 2 to 3 years. The nice thing about echos is that there is no radiation exposure. Tissue is a totally different kettle of fish. I would probably want annual echos if I had a tissue valve. Once SVD starts, things can progress quickly.

On the bright side, many have to wrestle with their providers to get CT scans- they're expensive. You team seems eager to do them frequently. But, if they don't have some reason specific to your condition, as to why they are doing CTs every 2 years, I would push for echos instead. It makes me wonder if they have their eyes on another potential aneurysm which the echo can't see. There are some parts of the aorta which are better viewed by CT, rather than echo.

 

[pekster11]

I got a reply back from my consultant.....it seems regular CT scans are part of the standard follow up procedure for me:

"It is good to hear from you. The surgical team carefully monitor your aorta for any uncommon long term aortic complications related to the bicuspid aortopathy and its repair. The echocardiogram you get in clinic when I see allows me to assess the valve and the heart function. This does not show the aorta in its entirety and only in 2 dimensions. The surgical team request the CT and they carefully do side by side assessment with serial scans to make sure nothing has changed. They have great expertise. They do not necessarily need to see you face to face as clinical examination would not show what is needed to safely monitor you and that I see you in person. We work as a team with them to ensure you carefully monitored lifelong. If you had any new symptoms, please get in touch through ACHD helpline or with Donna if you have any querries/concerns."

 

[Chuck C]

I got a reply back from my consultant.....it seems regular CT scans are part of the standard follow up procedure for me:

"It is good to hear from you. The surgical team carefully monitor your aorta for any uncommon long term aortic complications related to the bicuspid aortopathy and its repair. The echocardiogram you get in clinic when I see allows me to assess the valve and the heart function. This does not show the aorta in its entirety and only in 2 dimensions. The surgical team request the CT and they carefully do side by side assessment with serial scans to make sure nothing has changed. They have great expertise. They do not necessarily need to see you face to face as clinical examination would not show what is needed to safely monitor you and that I see you in person. We work as a team with them to ensure you carefully monitored lifelong. If you had any new symptoms, please get in touch through ACHD helpline or with Donna if you have any querries/concerns."

Glad to see that your consultant communicates with you and welcomes it. The explanation. makes good sense and glad that they are being so thoughtful about monitoring your condition so well with your follow ups.

 

[ottagal]

I can only "speak to my personal case".
Every situation is different and it depends on the cumulative amount of radiation one has had over the years.

In my case, I had started at the tender age of 3 having my first heart catheterization. I stopped counting how many x-rays, CT scans, CT angiograms etc. I have had over the years . However, I did develop breast cancer 10 years after my AVR and my current radiologist (who deals with breast cancer) feels strongly the cancer was in part due to the past history of radiation from my cardiac situation. There are always trade offs. I have been advised to ask for MRI's, echos etc. before undergoing any more investigations that emit radiation due to my cancer history. It is a balancing act.

 

[skeptic49]

I learned something interesting when I asked the surgical personnel what they were looking for in these repetitive CT scans. I was told that my replacement ascending aorta has sutured joints, it is not a continuous section of hose. So they check for the status of these joined sections to see if they are not leaking, etc. That I did not know.

 

[pekster11]

I learned something interesting when I asked the surgical personnel what they were looking for in these repetitive CT scans. I was told that my replacement ascending aorta has sutured joints, it is not a continuous section of hose. So they check for the status of these joined sections to see if they are not leaking, etc. That I did not know.

I assumed the same thing about why I'm being CT scanned every year. They're checking to see the suture line between the native aorta and the dacron graft is not leaking or forming an aneurysm

 

[carolinemc]

The surgery department at my university hospital wants a CT scan with contrast every two years. I'm eight years post surgery so I've had a few of these so far. I am concerned about radiation exposure, which is cummlative. How often are others getting CT scans post surgery?

They do the echo to check on the ejection of the valve. No radiation is used. And for cardiac Catherization, they are also checking for blocked arteries. NO CT scan, no radiation. I have never had CT done of the chest area.

 

[skeptic49]

They do the echo to check on the ejection of the valve. No radiation is used. And for cardiac Catherization, they are also checking for blocked arteries. NO CT scan, no radiation. I have never had CT done of the chest area.

Have you had surgery? They want a CT scan in my case to check on the status of the Dacron replacement ascending aorta.

 

[carolinemc]

Have you had surgery? They want a CT scan in my case to check on the status of the Dacron replacement ascending aorta.

Yes, had surgery in 2001 as I stated in my comment. I get echo scans to check on aorta valve (St. Jude's leaflet). Been 22 years,

 

[pekster11]

Here is a paper I've found that explains the sort of thing they're looking for when they do CT scans on people who have had an ascending aortic graft
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067394/

 

[skeptic49]

Here is a paper I've found that explains the sort of thing they're looking for when they do CT scans on people who have had an ascending aortic graft
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067394/

That's interesting. So having an ascending aortic graft puts a strain on the rest of the native (distal, descending) aorta. This would seem to indicate the need to monitor the descending aorta, perhaps by CT scan.