Whole-body CT screening: edging toward commerce

Whole-body computed tomography: a new point of view in a hospital check-up unit? Our experience in 6516 patients

BACKGROUND

There is a growing awareness that prevention and early diagnosis may reduce the high mortality associated with cancer, cardiovascular and other diseases. The role of whole-body computed tomography (WB-CT) in self-referred and asymptomatic patients has been debated.

AIM

To determine frequency and spectrum of WB-CT findings in average-risk subjects derived from a Medical-Check-Up-Unit, to evaluate recommendations reported and distribution according to sex and age-groups.

MATERIALS AND METHODS

We retrospectively reviewed 6516 subjects who underwent WB-CT (June 2004/February 2015). All were > 40 years and referred by Medical-Check-Up-Unit of our hospital. The main findings were categorized and classified as normal or not. Its distribution according to sex and age-groups was evaluated using Chi-square test and linear-by-linear association test, respectively. Number of recommendations, type and interval of follow-up were recorded. Descriptive statistics were used.

RESULTS

WB-CT performed in 6516 patients (69% men, 31% women, mean age = 58.4 years) revealed chest (81.4%), abdominal (93.06%) and spine (65.39%) abnormalities. Only 1.60% had completely normal exploration. Abnormal WB-CT in men was significantly higher than women (98.64% vs. 97.87%; p = 0.021), with significant increase as age was higher (40-49 years: 95.65%; 50-59 years: 98.33%; 60-69 years: 99.47%; > 69 years: 99.89%) (p < 0.001). Although most findings were benign, we detected 1.47% primary tumors (96, mainly 35 kidneys and 15 lungs). 17.39% of patients received at least one recommendation predominantly in chest (78.19%) and follow-up imaging (69.89%).

CONCLUSION

The most common WB-CT findings in asymptomatic subjects are benign. However, this examination allows identifying an important number of relevant and precocious findings that significantly increase with age, involving changes in lifestyle and precocious treatment.

Benign ancient schwannoma of the abdominal wall: an unwanted birthday present

Background

There has been a recent growth in the use of whole body Computerised Tomography (CT) scans in the private sector as a screening test for asymptomatic disease. This is despite scant evidence to show any positive effect on morbidity or mortality. There has been concern raised over the possible harms of the test in terms of radiation exposure as well as the risk and anxiety of further investigation and treatment for the large numbers of benign lesions identified.

Case Presentation

A healthy 64 year old lady received a privately funded whole body CT scan for her birthday which revealed an incidental mass in the right iliac fossa. This was investigated with further imaging and colonoscopy and as confident diagnosis could not be made, eventually excised. Histology demonstrated this to be a benign ancient schwannoma and we believe this to be the first reported case of an abdominal wall schwannoma in the English literature

Conclusions

Ancient schwannomas are rare tumours of the peripheral nerve sheaths more usually found in the head, neck and flexor surfaces of extremities. They are a subtype of classical schwannomas with a predominance of degenerative changes. Our case highlights the pitfalls of such screening tests in demonstrating benign disease and subjecting patients to what turns out to be unnecessary invasive investigation and treatment. It provides evidence as to the consequences of the large number of false positive results that are created by blind CT scanning of asymptomatic patients i.e. its tendency to detect pseudodiesease rather than affect survival rates. Should the number of scans increase there may be an unnecessary burden on NHS resources due to the large numbers of benign lesions picked up, that are then referred for further investigation.

Patient Expectations of Full-Body CT Screening

OBJECTIVE

Despite limited scientific evidence about its risks and benefits, full-body CT screening is available to self-referred individuals. The purpose of this study was to develop a scientific knowledge base about patient expectations of the procedure and to determine whether characteristics of patients influence their expectations of its health benefits.

MATERIALS AND METHODS

Facilities from six diverse, geographically representative U.S. regions performing full-body CT screening were used as the study sites. A pretest only descriptive survey design was used to study 94 patient volunteers scheduled to undergo full-body CT screening. Descriptive statistics were used in examining information about the demographics, health, and knowledge characteristics of the patients. The chi-square test for independence and Spearman's correlation coefficient for ranked data were used to analyze associations among patient characteristics and responses to expectation statements. An alpha value of 0.05 was the level of significance.

RESULTS

Survey participants were 35-65 years old, predominantly white, married, and health conscious with income and educational levels several times above the national averages. The patients' highest expectations related to consumer empowerment and their lowest expectations related to the limitations of the procedure. The five patient characteristics found to have significant associations with patient expectations were patient sex; referral method; level of personal health concern; number of other health screening procedures patient had undergone; and patients' self-estimations of their current health status.

CONCLUSION

This study provided quantitative and descriptive data that are consistent with and add to the existing, primarily anecdotal, knowledge base about patients' expectations of full-body CT screening. These findings can be used to educate patients before they provide informed consent for the procedure.

Cost accounting in radiology: new directions and importance for policy

OBJECTIVE

The purpose of this article is to promote insight into radiology costs through improvements in assessing patient-level cost data. Accurate patient costing is a prerequisite for establishing a proper payment system-one where the price paid for a service approximates the cost of delivering that service. In the absence of an accurate payment scheme, margins can vary significantly from one patient to the next.

CONCLUSION

The resulting financial incentives skew the radiology marketplace away from the provision of efficient and appropriate care toward the selection of patients whose costs are low relative to reimbursements.