Resources
HARVARD HEALTH, RADIATION RISK FROM MEDICAL IMAGING
Over 80 million CT scans are performed in the United States each year, compared with just three million in 1980. There are good reasons for this trend. CT scanning and nuclear imaging have revolutionized diagnosis and treatment, almost eliminating the need for once-common exploratory surgeries and many other invasive and potentially risky procedures. The benefits of these tests, when they’re appropriate, far outweigh any radiation-associated cancer risks, and the risk from a single CT scan or nuclear imaging test is quite small.
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People as young as 45 years old should now get screened for colon and rectal cancer, down from 50 years old, according to an independent, government-backed panel whose recommendations usually lead to insurance coverage of such preventive services.
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Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. One person dies every 37 seconds in the United States from cardiovascular disease. About 647,000 Americans die from heart disease each year—that’s 1 in every 4 deaths. Heart disease costs the United States about $219 billion each year from 2014 to 2015.3 This includes the cost of health care services, medicines, and lost productivity due to death.
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In this quality improvement study of all US adults aged 65 years and older, the total size of this population increased from 41.4 million to 50.9 million between January 1, 2011, and December 31, 2017. Overall, the number of deaths increased by 8.5% for heart disease and 38.0% for heart failure, most of which were in the 65 years and older age group. Meaning with the population of adults aged 65 years and older projected to increase an additional 44% from 2017 to 2030, innovative and effective approaches to prevent and treat heart disease are needed.
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THE WASHINGTON POST, I THOUGHT MY HEART ATTACK RISK WAS LOW. A CORONARY CALCIUM SCAN TOLD ME OTHERWISE.
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Computed tomography (CT), sometimes called “computerized tomography” or “computed axial tomography” (CAT), is a noninvasive medical examination or procedure that uses specialized X-ray equipment to produce cross-sectional images of the body. Each cross-sectional image represents a “slice” of the person being imaged, like the slices in a loaf of bread. These cross-sectional images are used for a variety of diagnostic and therapeutic purposes. CT scans can be performed on every region of the body for a variety of reasons (e.g., diagnostic, treatment planning, interventional, or screening). Most CT scans are performed as outpatient procedures.
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There’s a strong argument that things we search for and gain information on encourages us to take action which prevents a further death. There are several examples where I can imagine this to be true. People who are concerned about cancer may search online for guidance on symptoms and be convinced to see their doctor. Some people with suicidal thoughts may seek help and support online which later results in an averted death from suicide. We’d therefore expect that both intended or unintended exposure to information on particular topics could prevent deaths from a given cause. Some imbalance in the relative proportions therefore makes sense. But clearly there is some bias in our concerns: most people die from heart disease (hence it should be something that concerns us) yet only a small minority seek [possibly preventative] information online.
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A heart scan uses a specialized X-ray technology called multidetector row or multislice computerized tomography (CT), which creates multiple images of plaque deposits in the blood vessels. The imaging test provides an early look at levels of plaque. Plaque is made up of fats, cholesterol, calcium and other substances in the blood. It develops gradually over time, long before there are any signs or symptoms of disease. These deposits can restrict the flow of oxygen-rich blood to the muscles of the heart. Plaque also may burst, triggering a blood clot that can cause a heart attack.
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Doctors use “effective dose” when they talk about the risk of radiation to the entire body. Risk refers to possible side effects, such as the chance of developing a cancer later in life. Effective dose takes into account how sensitive different tissues are to radiation. If you have an x-ray exam that includes tissues or organs that are more sensitive to radiation, your effective dose will be higher. Effective dose allows your doctor to evaluate your risk and compare it to common, everyday sources of exposure, such as natural background radiation.
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This document contains a few key statistics about heart disease, stroke, other cardiovascular diseases and their risk factors, in addition to commonly cited statistics about the American Heart Association’s research program. This At-a-Glance document is based on the association’s 2019 Heart Disease and Stroke Statistics Update, which is compiled annually by the American Heart Association, the National Institutes of Health and other government sources. The years cited are the most recent available for each statistical category.
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The main reason to have an angiogram is to locate a narrowed heart artery that is causing chest pain or other symptoms. For the test, a cardiologist injects a dye that is visible on x-rays into the blood vessels of your heart, then takes a series of x-ray images. This is done in preparation for angioplasty, in which a narrowed artery is opened, or as a prelude to referral for coronary artery bypass surgery.
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“The new cholesterol guidelines now have the benefit of more scientific studies that show the difference a CAC score can make in homing in on a person’s future risk of cardiovascular disease – and whether to start on cholesterol-lowering drugs such as statins.
The test isn’t recommended universally for everyone but is most helpful for those whose risk falls in an intermediate zone.”
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“Doctors have a real dilemma sometimes,” Budoff said. “We have the Framingham Risk Score, but sometimes patients come out in the middle, in the gray zone, and we really don’t know if they are high risk and should have statins and aspirin for the rest of their life, or if they can be managed through diet and exercise. Half will go on to have a heart attack and half will not. The risk calculators we have now are only correct about 60 percent of the time. So instead of using a coin to decide if patients should get statins and aspirin, we used personalized medicine to look at each individual’s heart. We have found that calcium scoring is the best way to assess their risk.”
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The following are key points to remember from this review of coronary calcium score and cardiovascular (CV) risk: 1. Coronary artery calcium (CAC) is a highly specific feature of coronary atherosclerosis. CAC scoring has emerged as a widely available, consistent, and reproducible means of assessing risk for major CV outcomes, especially when planning primary prevention interventions such as statins and aspirin. CAC testing in asymptomatic populations is cost-effective across a broad range of baseline risks, and has been shown to positively impact patient compliance.
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About two-thirds of patients older than 65 who experience a myocardial infarction (MI) die within eight years, according to a new study—and nearly half die in that timeframe even if they receive percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery.
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Researchers from the Harvard T.H. Chan School of Public Health conducted a massive study of the impact of health habits on life expectancy, using data from the well-known Nurses’
Health Study (NHS) and the Health Professionals Follow-up Study (HPFS). This means that they had data on a huge number of people over a very long period of time. The NHS included over 78,000 women and followed them from 1980 to 2014. The HPFS included over 40,000 men and followed them from 1986 to 2014. This is over 120,000 participants, 34 years of data for women, and 28 years of data for men.
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Cancer that’s diagnosed at an early stage, when it isn’t too large and hasn’t spread, is more likely to be treated successfully. If cancer spreads, effective treatment becomes more difficult, and generally a person’s chances of surviving are much lower.
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Title 10, Part 19, of the Code of Federal Regulations (10 CFR Part 19), “Notices, Instructions, and Reports to Workers: Inspection and Investigations,” provides instructions to radiation workers. Specifically, 10 CFR Part 19 requires that all individuals who, in the course of their employment, are likely to receive a dose of more than 100 millirem in a year, must receive adequate training to protect themselves against radiation. Also, these individuals have the right to know the amount of radiation to which they have been exposed. In addition, radiation workers have the right to ask the NRC to conduct an inspection if they believe their working environment has safety problems.
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But screening has a dark side: research shows that over three years of annual scans, 40 percent of people will have an abnormal finding that often leads to follow-up tests such as a lung biopsy, and complications of those can be fatal, said Dr. Otis Brawley, the American Cancer Society’s chief medical officer. “I’m committed to telling people the truth and letting people decide for themselves,” Brawley said, but added that if he were a candidate for screening, “I don’t think I would do it.”
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The calcium-score screening heart scan is a test used to detect calcium deposits found in atherosclerotic plaque in the coronary arteries. State-of-the-art computerized tomography methods, such as this one, are the most effective way to detect early coronary calcification from atherosclerosis(hardening of the arteries), before symptoms develop. The amount of coronary calcium has been recognized as a powerful independent predictor of future heart problems and is useful in making lifestyle changes and guiding preventive care to reduce their risk.
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Cancer has a major impact on society in the United States and across the world. Cancer statistics describe what happens in large groups of people and provide a picture in time of the burden of cancer on society. Statistics tell us things such as how many people are diagnosed with and die from cancer each year, the number of people who are currently living after a cancer diagnosis, the average age at diagnosis, and the numbers of people who are still alive at a given time after diagnosis.
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Early detection refers to measures that can be taken to diagnose cancer as early as possible, when the disease is easiest to treat. As researchers discover more about what early stages of cancer look like – under the microscope, in scans, or even on our own bodies – we can learn more about what signs or symptoms to look out for and what other measures we can take to be vigilant about recognizing cancer in its earliest forms.
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Staging can be “clinical” or “pathological.” Clinical staging is based on the results of tests done before surgery, such as physical examinations and imaging scans. Pathological staging is based on what is found during surgery. Clinical stage is often indicated with a lowercase “c” before the TNM classification. The pathological stage is indicated with a lowercase “p.” In general, pathological staging provides the most information to determine a patient’s prognosis.
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Since CAC is helpful in predicting future heart risk, experts wonder if more frequent testing could help identify high-risk patients in need of treatment. But based on study results published in the American Heart Association journal Circulation, such frequent testing may only be beneficial for specific patients.
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Should you be screened? Like any other medical procedure, there are risks involved. Before undergoing this exam, be sure to read all the sections of this web site. Consider further that the FDA has never approved CT for screening any part of the body for any specific disease, let alone for screening the whole body when there are no specific symptoms of disease at all. No manufacturer has submitted data to FDA to support the safety and efficacy of screening claims for whole-body CT screening.
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Pushed by patient advocates who want earlier access to medications, the Food and Drug Administration has approved a flurry of oncology drugs in recent years, giving some people with cancer a renewed sense of hope and an array of expensive new options. A few of these drugs
have been clear home runs, allowing patients with limited life expectancies to live for years. Many more drugs, however, have offered patients only marginal benefits, with no evidence that they improve survival or quality of life, said Dr. Vinay Prasad, assistant professor of medicine at the Oregon Health and Sciences University, who has written extensively about the FDA’s approval process for cancer drugs.
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Quantification of coronary calcium(e.g., Agatston method, calcium mass and volume) is readily detected using helical CT scanners. Large multicenter cohort studies have enabled a better understanding of the relevance of coronary calcium detection. The purpose of this review is to review the methods for quantification of coronary artery calcium, as well as to present current and future perspectives on calcium scoring for cardiovascular risk stratification.
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Cancer has long inspired fear. Despite advances in early diagnosis and treatment of many cancers, a third to half the general population in the United States and United Kingdom say they fear cancer more than any other disease.1, 2 Population‐based studies have consistently shown that about a quarter to half the population worry to some extent about getting cancer, with 5%–10% experiencing extreme worry.2, 3, 4On a population level, even these modest percentages equate to a great number of people experiencing significant cancer worry. Fear in itself is unpleasant and burdensome, but it may also affect behaviour, although its behavioural effects are not well understood.
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Radiologic imaging is claimed to carry an iatrogenic risk of cancer, based on an uninformed commitment to the 70-y-old linear no-threshold hypothesis (LNTH). Credible evidence of imaging-related low-dose (<100 mGy) carcinogenic risk is nonexistent; it is a hypothetical risk derived from the demonstrably false LNTH. On the contrary, low-dose radiation does not cause, but more likely helps prevent, cancer.
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Coronary artery disease (CAD) is the most common cause of heart attack and death in the world. Since CAD imposes a high economic burden to the health system, it is important to identify the best accurate test for diagnosing CAD in order to reduce time and cost consumption. Recently, coronary computed tomographic angiography (CCTA) which is a noninvasive imaging method with high diagnostic accuracy (2) is used for detecting coronary artery stenosis. Coronary artery calcium (CAC) which is a good marker of atherosclerosis is evaluated at the beginning of CCTA with less radiation and it is an established predictor of cardiovascular events.
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In a way, CT scans are like standard x-ray tests. But an x-ray test aims a broad beam of radiation from only one angle. A CT scan uses a pencil-thin beam to create a series of pictures taken from different angles. . The information from each angle is fed into a computer, which then
creates a black and white picture that shows a slice of a certain area of the body – much like looking at a single slice from a loaf of bread.
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The researchers found that the CAC score was highly predictive of all-cause mortality after adjustment for risk factors for coronary artery disease (P < 0.001). For CAC scores from 0 to 1,000 or greater, overall 15-year mortality rates ranged from 3 to 28% (P < 0.001). For all-cause mortality, the relative hazard ranged from 1.68 for a CAC score of 1 to 10 (P < 0.001) to 6.26 for a score of 1,000 or greater (P < 0.001). Using cut points of less than 7.5% to 22.5% or greater, the categorical net reclassification improvement was 0.21.
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“Earlier diagnosis saves lives and it could save critical NHS funds. And in the face of an overstretched NHS and a projected growing number of cancers diagnosed in the years ahead, we need to do everything we can to ensure that all patients have access to the best treatment as early as possible”, he added. The Department of Health said it had invested £450m to improve earlier diagnosis, including giving GPs better access to tests such as CT and MRI scans.
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Coronary artery disease (CAD) and lung cancer have several important features in common. First, their dramatic increases are in large part attributable to societal ills, including worsening dietary patterns, obesity, and tobacco use. Secondly, as these behaviours permeate the
world, the diseases are disproportionately increasing in the poorer societies with limited resources for healthcare. Consequently, it is necessary to develop cost-effective strategies. Both disease states may be amenable to early detection by a single low radiation dose CT scan.
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As part of the campaign, Abbott partnered with Men’s Health Network to sponsor and conduct one of the largest men’s health assessments to date to uncover insights into the attitudes of men when it comes to seeking medical advice. The survey found that most men take a casual approach to their health. In fact, 61 percent of men say they are “semi-proactive about health,” responding to medical emergencies when needed and admittedly are not proactive about annual doctor visits and preventative medicine.
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Cardiovascular disease remains the leading cause of mortality in the US and worldwide, and no widespread screening for this number one killer has been implemented. Traditional risk factor assessment does not fully account for the coronary risk and underestimates the prediction of risk even in patients with established risk factors for atherosclerosis. Coronary artery calcium (CAC) represents calcified atherosclerosis in the coronary arteries. It has been shown to be the strongest predictor of adverse future cardiovascular events and provides incremental information to the traditional risk factors. CAC consistently outperforms traditional risk factors, including models such as Framingham risk to predict future CV events.
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“The amount of calcium in the coronary vessels, as measured by CT, is of high predictive value for subsequent serious or fatal heart attack in these patients, independent of the patient’s age, sex and other coronary risk factors,” said the study’s lead author, Marcus Hacker, M.D., resident physician in the Department of Nuclear Medicine, leader of the research unit for nuclear cardiology and assistant medical director at Ludwig Maximilians University in Munich, Germany. CAD is the most common type of heart disease. According to the National Heart, Lung and Blood Institute, it is the leading cause of death in the U.S. for both men and women, killing more than 500,000 Americans each year.
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In patients with low pre-test probability of coronary artery disease who present for admission with chest pain, CT coronary angiography has a high negative predictive value (95%-100%) for excluding coronary stenosis as a cause. However CT angiography should not replace cardiac catheterization in high-risk patients, particularly those with prior coronary stenting.
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Radiation biology is an interdisciplinary science that examines the biological effects of radiation on living systems. To fully understand the relationship between radiation and biology, and to solve problems in this field, researchers incorporate fundamentals of biology, physics, astrophysics, planetary science, and engineering. The major goal of NASA’s Space Radiation Project is to enable human exploration of space without exceeding an acceptable level of risk from exposure to space radiation. Space radiation is distinct from common terrestrial forms of radiation.
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The average cost of a CT scan in the United States is $3,275, though prices can range from $300 to $6,750. One factor that can greatly affect the cost of your CT scan is whether you have it performed in an inpatient facility, like a hospital, or an outpatient surgery center. Outpatient centers are just as safe as hospitals but could save you thousands on your medical bill. Your doctor may recommend a CT scan for a variety of reasons. Below, you’ll learn the costs associated with each type of CT scan, as well as what factors into the cost of a CT scan and how to find a fair price for your procedure.
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Coronary heart disease is often caused by the buildup of plaque, a waxy substance, inside the lining of larger coronary arteries. This buildup can partially or totally block blood flow in the large arteries of the heart. Some types of this condition may be caused by disease or injury affecting how the arteries work in the heart. Coronary microvascular disease is another type of coronary heart disease. It occurs when the heart’s tiny blood vessels do not work normally.
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A calcium score (sometimes called an Agatston score) is calculated based on the amount of plaque observed in the CT scan. It may be converted to a percentile rank based on your age and gender. The results from your cardiac scoring will be sent to your doctor. Your likelihood of having heart disease or a heart attack correlates with your calcium scoring. The lower your calcium score and percentile rank, the less likely you are to have a cardiac event compared to other men or women your age.
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Recognizing possible warning signs of cancer and taking prompt action leads to early diagnosis. Increased awareness of possible warning signs of cancer, among physicians, nurses and other health care providers as well as among the general public, can have a great impact on the disease. Some early signs of cancer include lumps, sores that fail to heal, abnormal bleeding, persistent indigestion, and chronic hoarseness. Early diagnosis is particularly relevant for cancers of the breast, cervix, mouth, larynx, colon and rectum, and skin.
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Coronary calcium scoring (CCS) is arguably the best method to screen for coronary artery disease. The most interesting part of this test is the direct-to-consumer advertising that occurs to the public. There are not too many medical tests (especially those with radiation exposure) that anyone can purchase at an affordable price without a doctor’s order. Vascular screening is another example. Is it really appropriate for hospitals and offices to allow anyone to walk in and have a coronary calcium score performed? Hmmm … good question.
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