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19 December 2007

COMARE 12th Report: The impact of personally initiated X-ray computed tomography scanning for the health assessment of asymptomatic individuals

 

Scanning of the asymptomatic individual by using a computed tomography (CT) X-ray machine is a practice that has implications for public health, despite the fact that CT scanning of the asymptomatic individual may provide benefits to that person. The committee has reviewed the literature regarding both the benefit and detriment associated with CT scanning in the health assessment of asymptomatic individuals. We have considered the detriment caused by radiation from the CT scan but also the subsequent psychological effects and potential physical detriment from further investigations. Furthermore, we have considered the economic implications for the NHS which may become liable for further tests and examinations. While reviewing this type of practice, alternative techniques using lower doses of ionising radiation or non-ionising radiation have been considered.

 

COMARE recommends that regulation of these commercial CT services should be reviewed. We also recommend that clients should be provided with comprehensive information regarding dose and risk of the CT scan, as well as rates of false negative and false positive findings. Commercial CT services should have well developed and confidential mechanisms for integrating examination results into an established care pathway. Scans and data relating to any individual should be in formats consistent with national NHS IT programmes. We have also recommended that any individual displaying symptoms and requesting a CT scan from a commercial service should not be scanned and should be referred back to their GP. There is a regulatory requirement that all medical exposures using ionising radiation should be optimised, and from our review it is not possible to optimise exposure parameters for CT scans of the whole of the body, and we have strongly recommended that services offering whole body CT scanning of asymptomatic individuals should discontinue to do so. In addition, CT should not be used in assessment of spinal conditions, body fat and osteoporosis in asymptomatic individuals. 

Scanning of three specific anatomical regions have been considered in detail in this report. We have concluded that there is no evidence that CT scanning for lung conditions is of benefit. However, cardiac CT scanning has been shown to have value for predicting cardiovascular risk and similarly CT colonography has the potential to detect small lesions. Both cardiac CT scanning and CT colonography should only be carried out in certain asymptomatic individuals.

 

Press enquiries to Professor Alex Elliott, Chairman of COMARE:

Tel No: 0141-211-2942

 

COMARE 12th Report "The impact of personally initiated X-ray computed tomography scanning for the health assessment of asymptomatic individuals".  Chairman: Professor A Elliott.  ISBN: 978-0-85951-611-2 (£30.00).   Downloads available from www.comare.org.uk and hard copies are available from the Information Office at the Radiation Protection Division of the Health Protection Agency.

 

SUMMARY OF THE 12th COMARE REPORT

 

In this, the 12th COMARE report, the benefits and detriments associated with computed tomography (CT) scanning in the health assessment of asymptomatic individuals are reviewed. This report does not consider the relevance of such scanning techniques to a population screening programme. Medical exposures constitute approximately 14% of the average annual dose of radiation to the UK population. While technical innovations promise greater diagnostic accuracy and an increased range of clinical applications, there is also the potential for greater radiation doses to individuals, from interventional techniques and from changes of practice within CT. Scanning of the asymptomatic individual by using CT is a practice that has implications for public health, despite the fact that CT scanning of the asymptomatic individual may provide benefits to that person. COMARE recommends that regulation of these services and the ensuing care pathway should be investigated, and information provided by the companies to the client should be reviewed. We recommend that any individual displaying symptoms should be referred back to their GP and scans should be optimised for different body areas. To this end, COMARE recommends that services offering whole body CT scanning should discontinue doing so and CT should not be used for assessing spinal conditions, body fat and osteoporosis in asymptomatic individuals. COMARE concludes that there is no evidence that CT scanning for lung conditions is of benefit. However, cardiac CT scanning has been shown to have value for predicting cardiovascular risk and similarly CT colonography has the potential to detect small lesions. Both cardiac CT scanning and CT colonography should only be carried out in certain asymptomatic individuals.

 

COMARE

The Committee on Medical Aspects of Radiation in the Environment (COMARE) was established in November 1985 in response to the final recommendation of the report of the Independent Advisory Group chaired by Sir Douglas Black (Black, 1984). Its terms of reference are to "assess and advise Government and the Devolved Authorities on the health effects of natural and man-made radiation and to assess the adequacy of the available data and the need for further research". Over the last 20 years COMARE has published many reports and statements relating to radiation health risk, many of which are available on its web site www.comare.org.uk

 

Download the 12th Report in Portable Document Format PDF Document

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