ACC responds to NEJM study: CT could cause 2% of U.S cancers

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Kim Williams, MD, professor of medicine and radiology, director of nuclear cardiology at the University of Chicago and ACC representative, responded in an email interview with CVB News about the recent study published in the New England Journal of Medicine, suggesting that CT scans have caused up to 2 percent of cancers in the United States.

Do you think we are an “imaging-crazed” culture as Nancy Snyderman, NBC chief medical editor, has suggested? 

“Crazed” is not an appropriate term in my opinion.  There are multiple forces that make imaging very attractive for healthcare providers and patients, but they revolve mainly around the ability to make diagnoses quickly, accurately and relatively noninvasively for many patients.

Do you concur with the findings and summation of Brenner and Hall?  

Not to argue against their point, but to equate x-radiation with the high energy charged particle  radiation exposure from atomic bombs requires some careful consideration, since nuclear explosions give off alpha particles that are associated with a higher degree of “linear energy transfer” and radiobiological (DNA) damage.  The distribution of the radiation damage would also be completely different with CT vs. atomic bomb exposure. Perhaps they have performed translational studies and have considered these variables, but I haven’t seen their data discussing this difference.

Do the benefits of CCTA outweigh the risks? 

Making diagnosis on people so that they live long enough to die of something else later has to be considered here.  However, this only applies when patients are appropriately referred for these examinations where the benefits do outweigh the risks.  In cardiac imaging, we have guidelines and appropriateness criteria to help ensure that the right patient gets the right test at the right time.
What do you think the effects of this widely-publicized study will be — in the short term, or in the long-term? 

Hopefully, short and long-term, clinician awareness about the importance of considering magnetic, chemical or radiation exposure and their potential consequences when ordering or performing diagnostic tests. 

Do you foresee organizations, like the ACC, implementing stricter imaging recommendations to reduce over-utilization by cardiologists?

The American College of Cardiology has made great strides in the assessment and publication of criteria for appropriate use of all modalities of cardiac imaging, including cardiac CT.  However, I can say with certainty that widespread “over-utilization” of cardiac CT has NOT occurred since reimbursement policies of third parties has been restrictive to an unprecedented degree relative to the adoption of other imaging modalities such as nuclear cardiology or echocardiography.

Williams is associated with the ACC as a trustee of the College; chair of its cardiovascular imaging collaborative; member of the CT advocacy taskforce and its imaging spokesperson.