Reimbursement and Managed Care News for February 2008

By Stanton R. Mehr
Published: Wednesday, Jun 23, 2010
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A Need to Better Manage Use of CT Scans to Avoid Excess Cancer Risk?

The development of cancer in patients who do not seem to be at high risk has always been a mystery. For instance, how does lung cancer appear in a person who never smoked and whose exposure to second-hand smoke had been negligible? Are there genetic factors that have not been identified? Often, scientists ascribe these cases to environmental factors. These potential causes, for which little has been quantified or virtually nothing is known, range from air pollution to electromagnetic fields. One environmental factor is perhaps responsible for cancers than most researchers are willing to admit: the increasing use of diagnostic imaging and the harmful radiation it uses.

An article in the New England Journal of Medicine points out that perhaps as many as 2% of all future cancers in the United States may be directly the result from the use of computed tomographic (CT) scanning. This report, from Columbia University, New York, states that medical radiation is responsible for more than 50% of our total radiation exposure, and that in 1980, medical radiation accounted for only 15% of the total. This means that medical radiation exposure, largely from the skyrocketing use of CT scans, is now even a greater contributor to population-wide radiation exposure than natural sources, such as soil-based radon and cosmic or solar particles.

Approximately 62 million CT scans were performed in 2006 in the United States, a 20-fold increase from 1980, when the technology was first becoming available. The researchers believe that ultrasound and magnetic resonance imaging are far safer options, as they do not rely on radiation exposure to obtain images.

Health plans and insurers have sought to decrease the amount of unnecessary and costly diagnostic scanning used in private practice, clinics, and hospital emergency rooms. This report may provide more fodder to require stricter prior authorization criteria before reimbursing for diagnostic CT imaging.

  Typical organ radiation doses from various

  radiologic studies

  Relevant Organ and Dose*

                    (mGy or mSv)
Posterior–anterior chest x-ray                       Lung   0.01
Lateral chest radiography                       Lung   0.15
Screening mammography                     Breast    3.0
Adult abdominal CT                  Stomach  10.0
Barium enema                      Colon   15.0
Neonatal abdominal CT                   Stomach  20.0

CT= Computed tomographic.

The radiation dose, a measure of ionizing energy absorbed per unit of

mass, is expressed in grays (Gy) or milligrays (mGy); 1 Gy = 1 joule p/kg.

The radiation dose is often expressed as an equivalent dose in sierverts

(Sv) or millisierverts (mSv). For x-ray radiation, which is the type used

in CT scanners, 1 mSv = 1 mGy.

   Adapted from Brenner DJ, Hall EJ: Computed tomography—

An increasing source of radiation exposure. N Engl J Med


Brenner DJ, Hall EJ: Computed tomography—An increasing source of radiation exposure. N Engl J Med 2007;357:2277-2284.

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