Hospitals analyzing the radiation risk

Dr. Paul Gabriel saw a young man in the Grant Medical Center emergency department last week who had kidney pain and blood in his urine.

The default step for the ER director would be to order a CT scan. But the patient had undergone six scans — including one the month before — that all confirmed kidney stones.

To send him for another was probably a waste of time and resources, but more important, it was going to increase the man’s lifetime exposure to radiation.

So they agreed to skip the test.

“He was extremely appreciative,” Gabriel said. “He said, ‘I don’t want to have cancer in 20 years,’ and I said, ‘I don’t want you to.’ ”

Americans are increasingly asking whether medical professionals are doing all they can to limit patients’ exposure to CT scans and X-rays.

Doctors and hospital leaders say they’re investing time and money making sure that decisions are medically wise and err on the side of protecting patients.

“There’s everywhere in America a growing awareness,” said Dr. Richard White, chairman of radiology at the Ohio State University Medical Center. “The awareness is justified, but some of the fear isn’t.”

Patients with cancer, gastrointestinal disorders or repeated kidney stones, for example, have repeated scans and should be most concerned, White and others said.

And if the scans begin early in life, there’s more reason to be cautious, as radiation exposure over many years poses more risk.

Two years ago, news that Cedars-Sinai Medical Center in Los Angeles gave hundreds of patients about eight times the normal amount of radiation during diagnostic scans drew the attention of patients, doctors and regulators, and it has served as a catalyst for improvements nationwide.

Last month, the Joint Commission, which accredits hospitals and often prompts quality-improvement efforts, sent a notice urging health-care providers to find new ways to avoid repeated doses of harmful radiation.

In the past 20 years, Americans’ radiation exposure has nearly doubled because of increased use of imaging.

“CT scanning has become the single-most-important source for radiation exposure in humans,” said Dr. Pablo Ros, chairman of radiology at University Hospitals in Cleveland.

“It’s very successful, very powerful and provides a lot of information, but particularly our nonradiology colleagues may not realize the significance of the radiation exposure,” he said.

At times, those tests aren’t necessary, or the patient might be better served by other diagnostic tools, such as ultrasound or MRI.

If a patient does need a CT scan, the dose can be limited. Other times, no scan is really needed, but doctors feel obligated to order one to guard against legal problems.

“We order way too many CT scans. There’s tremendous pressure,” Gabriel said.

To reduce exposure, hospitals are buying better equipment and educating referring physicians about how best to determine whether CT scans or X-rays are really needed, White said.

At Ohio State and other centers, technicians have been trained to better tailor the scans to patients.

“A little tiny lady won’t get the same strength of the power of the beam as a larger person,” White said.

This practice “takes some more time and effort, but once it’s put into the daily grind, the techs respond well and the patients like it,” Ros said.

Michelle Hamilton, director of radiology at Mount Carmel West, said conversations with patients about the risks and benefits of scans are routine.

And the hospital continues to evaluate changes it can make to reduce exposures, including recently lessening the dosing for cardiac CT scans.

One important advance within the OhioHealth system has been a viewing program that allows radiologists to look at all the scans a patient has had within the system, said Dr. Harlan Meyer, radiology medical director at Grant.

They can see all exams since 2003, and if a patient has had 25 since then, it qualifies as a “ radiation alert,” prompting more evaluation. In some cases, those patients go on to undergo a different diagnostic approach, such as MRI, Meyer said.

Warning: Radiation risks from medical imaging

Ever since the Fukushima nuclear reactor disaster in Japan in March, there has been a lot of interest in the media about the health effects of exposure to radiation  including those from medical imaging such as X-rays and CT (computed tomography) scans. Many patients want to know if radiation from mammograms, bone density tests, nuclear imaging, PET scans, and so forth will increase their risk of developing cancer.

The ability to peer inside the body is nothing short of miraculous and has saved countless lives since X-rays were discovered more than a century ago. Today, the array of imaging tests available is bewildering, the technology intimidating, and circumstances and possible outcomes (Is it cancer? A stroke? A heriniated disc?) often terrifying. For most people, there’s very little risk from routine X-rays such as chest X-rays or dental X-rays. But experts have become increasingly concerned about the overuse of many types of scans, not only because of the huge and growing expense, but even more of the potential risk posed by the cumulative exposure to radiation. They are used to diagnose diseases, trauma, and abnormalities, as well as to guide and monitor treatment.

The radiation you get from X-ray, CT, and nuclear imaging is ionizing radiation — high-energy wavelengths or particles that penetrate tissue to reveal the body’s internal organs and structures. Ionizing radiation can damage DNA, and although your cells repair most of the damage, they sometimes do the job imperfectly, leaving small areas of “misrepair.” The result is DNA mutations that may contribute to cancer years down the road.

Exposure to ionizing radiation from natural or background sources hasn’t changed for the past 30 years, but in many industrialized countries, total per capita radiation has nearly doubled, and experts believe the main reason is increased exposure that comes from medical sources which has grown from 15 percent in the early 1980s to 50 percent today. CT alone accounts for 24 percent of all radiation exposures.

Most of what we know about the risks of ionizing radiation comes from long-term studies of people who survived the 1945 atomic bomb blasts at Hiroshima and Nagasaki. These studies show a slightly but significantly increased risk of cancer in those exposed to the blasts, including a group of 25,000 Hiroshima survivors who received less than 50 mSv of radiation  an amount you might get from two or three CT scans.


Because they’re so commonly used today, CT scans are the biggest source of radiation of all imaging technologies. A special type of X-ray that produces cross-sectional images, or “slices,” of the body, CT scans are used to diagnose everything, from heart diseases and cancer to brain tumors, kidney stones, and injuries. Abdominal CT scans tend to produce the most radiation — averaging about 500 times more radiation than a simple chest X-ray, and 1,000 times more than a dental X-ray or bone mineral density test (DEXA). Other types of imaging that use radiation include nuclear diagnostic tests, such as PET scans, as well as fluoroscopy. MRI and ultrasound, in contrast, do not use radiation.

The risk from a single CT scan, when appropriately done, is miniscule, but radiation exposures add up over a lifetime. A study in the Archives of Internal Medicine in 2009 estimated that 72 million scans were done in the US in 2007. After excluding scans done following a diagnosis of cancer and those performed during the last five years of a person’s life, the researchers projected that CT scans in the US would cause about 29,000 extra cases of cancer in the future and about 14,5000 deaths. That’s about two percent of all annual cancers.

Hope for inquest after Westminster debate

THE brother of a woman who died following a routine operation at a private hospital

is hopeful a police investigation will be launched after the case was debated in

Parliament.

Carmel Bloom, who was 54 and lived in Snakes Lane East in Woodford Green, died after

an operation to remove a kidney stone at the BUPA (now Spire) Roding Hospital in

2002.

Her brother, Bernard, of High Road, Chigwell, has spent the past nine years and more

than 1 million trying to establish how she died.

Lee Scott, MP for Carmel's constituency, Ilford North, debated the circumstances

surrounding her death with health minister Anne Milton MP in Westminster Hall in the

Houses of Parliament on Tuesday.

Mr Bloom, 59, said: "It went so well in so far as Lee Scott articulated the pain and

the suffering our family has had to endure while we've been unable to get closure

over this.

"Lee went through each stage over the last nine years. I know the case inside out but

just hearing it read out like that was horrifying.

"The hope is that this will put pressure on the police to launch an investigation

into Carmel's death."

In February 2010, two doctors involved in Ms Bloom's care – consultant John Hines

and anaesthetist Dr Paul Timmis – were allowed to continue practising despite

admitting several failings to the General Medical Council (GMC).

Last month Mr Bloom met assistant attorney-general Kevin McGinty to request a fifth

inquest into his sister's death, raising the prospect of having her body exhumed, and

is waiting to hear back within the next few weeks.

Mr Scott said: "I want the family to get closure and justice and I'm just trying to

help them in any small way that I can.

"We got a positive response from the minister. She has agreed to meet me again and to

look into matters for me."

Fruits for weight loss

Kiwi:  Tiny but mighty, and a good source of potassium, magnesium, vitamin E and fiber. Its vitamin C content is twice that of an orange.

Apple. Although an apple has a low vitamin C content, it has antioxidants and flavonoids which enhances the activity of vitamin C, thereby helping to lower the risk of colon cancer, heart attack and stroke.

Strawberry. Also known as protective fruit because strawberries have the highest total antioxidant power among major fruits and protect the body from cancer-causing, blood vessel-clogging free radicals.

Oranges. Two to four oranges may help keep colds away, lower cholesterol, prevent and dissolve kidney stones, and reduce the risk of colon cancer.

Watermelon. Coolest thirst quencher this summer. Composed of 92 percent water, it is also packed with a giant dose of glutathione, which helps boost our immune system. Watermelons are also a good source of lycopene, the cancer-fighting oxidant. Also found in watermelon is Vitamin C and potassium.

Guava and Papaya. They are the clear winners for their high vitamin C content. Guava is also rich in fiber, which helps prevent constipation. Papaya is rich in carotene, good for your eyes.

Researchers also said that drinking cold water after a meal could lead to cancer. Though it is refreshing to have a cold drink after a meal, however, the cold water will solidify the oily stuff of the food which slows digestion.

Once this reacts with the acid, it will break down and be absorbed by the intestine faster than the solid food. It will line the intestine. Very soon, this will turn into fats and lead to cancer It is best to drink hot soup or warm water after a meal.

Boy who says he visited heaven draws crowd at Lexington church

A child who is the subject of a New York Times best-selling book made a quiet visit to

Lexington on Sunday to talk about his experience with the afterlife.

Colton Burpo is like any normal 11-year-old but finds himself thrust into the national

spotlight. Stiff and shy, he generally keeps his eyes low, speaking in short, excited bursts

when a subject comes up in which he's well-versed, such as computers.

But when he was 3 years old, Colton had a near-death experience on an operating table in

Nebraska during an emergency appendectomy. He pulled through, and during the ensuing months

and years, his family said they came to realize that Colton's seemingly childlike

observations about heaven and angels had more substance than they could have imagined.

What Colton calls his face-to-face meeting with Jesus is documented in the book Heaven Is for

Real, written by his father, Pastor Todd Burpo, and published by Thomas Nelson, a Christian

publishing company in Nashville.

Since hitting shelves in November, Heaven Is for Real has found national recognition, mostly

through word of mouth. The book is No. 1 on The New York Times best-seller list in paperback

non-fiction and has been for 10 weeks. Todd Burpo said his publisher has printed 1.5 million

copies to meet demand.

The Burpos flew to Lexington from Imperial, Neb., on Sunday to speak at The Bridge Church, a

congregation that worships in a former storefront on Dennis Drive.

Colton nervously sang an inspirational hymn before departing to the Sunday school class. His

parents, Todd and Sonja, sat down with The Bridge's pastor, Lee Claypoole, for a roundtable

discussion.

What has become the most inspirational moment in the family's lives began with one of their

worst years, Todd Burpo said.

Burpo had broken his leg, suffered kidney stones and had a serious operation, preventing the

self-described workaholic from working at his garage-door business.

Once he finally recovered, the family took a trip to Colorado to celebrate. It was there that

Colton and his sister, Cassie, got sick. Doctors thought it was the flu.

"The problem is, his sister got better. He didn't," Burpo said.

Time and again, doctors diagnosed Colton with the flu. During the next two weeks, his

condition worsened until doctors finally ran tests and discovered he had appendicitis. By

that time, doctors estimated Colton's appendix had burst five days earlier.

"His little body was just full of poison," Burpo said.

In his role as a pastor, Burpo has held the hands of many dying people.

"You can see the organs start to shut down, their skin color start to change. You can see the

dark circles under their eyes, and I was starting to watch that in my kid," he said, fighting

tears.

Miraculously, Colton pulled through after an operation at Great Plains Regional Medical

Center. Months later, as the family was driving by the hospital, they said they were

surprised when, from his car seat, Colton, then 4, said, "That's where the angels saved me,"

Sonja Burpo recalled.

The family had noticed what appeared to be an increased spirituality from the boy since he

recovered, but that was the first time they paid attention, Burpo said. She and her husband

began asking more questions, pressing Colton for information.

"What happened to our son during those 17 days? What did he see, and what did he hear, and

how does he know about angels and Jesus so close?" Sonja Burpo said.

Colton eventually revealed more details that the family couldn't explain. He said he had met

his great-grandfather, who died long before he was born. He suddenly had knowledge of his

sister, who died in the womb; his parents had never told him about the miscarriage, they

said.

Colton told his father that he watched Dr. Timothy O'Holleran operating on him from Jesus'

lap. He said he saw his father praying alone in a hospital room during the operation.

"My wife didn't know I prayed that prayer. She didn't know where I was, and here my son was

telling me about it," Todd Burpo said.

He acknowledged there are many skeptics about the book.

"If you Google my name, you'll see the f-word beside it so many times," he said.

Burpo was skeptical, too, he said, until his son spoke of things he should have had no way of

knowing.

"Sometimes you need the miracle-working God in your life," he said.

Throughout the presentation in Lexington, Burpo regularly spoke directly to the congregation

about lessons he learned from the tragedy-turned-blessing and gave sermons that led many

church members to cry and hold hands over their hearts.

The event drew about 150 new visitors to The Bridge Church. Some drove from West Virginia,

Illinois and Tennessee to see the Burpo family speak, Claypoole said.

The church regularly has an attendance of about 300 people, a significant leap since

Claypoole started the church in a hotel room with 18 members two years ago, he said.

After the discussion, Colton sat silently in Claypoole's office, waiting for his family. When

asked if he felt blessed to be able to inspire so many people, he smiled, looked up briefly

and nodded.