Study warns of too much medical testing

Americans may be receiving too much radiation from medical tests whose value has not been proven, researchers reported Wednesday in the New England Journal of Medicine.

More than two-thirds of Americans underwent at least one such imaging procedure in the three years covered by the study, reported Dr. Reza Fazel and colleagues at Emory University School of Medicine.

The two biggest contributors to the radiation exposure are CT scans, which use a series of X-rays to produce a three-dimensional image of the body, and heart perfusion scanning to measure blood flow through the arteries leading to the heart. In that test, radioactive technetium-99m is injected into blood vessels and its progress through the heart is monitored with external radiation detectors.

Radiation is known to cause cancer, typically years after exposure. By some estimates, medical testing radiation contributes 2 percent of all cancer cases, but experts fear that it may be higher in the future as more and more patients are exposed to these relatively new procedures. They are also concerned because increasing numbers of tests are being performed on younger people, which allows more time for tumors to develop, and on women, who normally live longer than men.

The researchers studied medical records of 952,420 adults between the ages of 18 and 64 who were insured by United Healthcare plans in Arizona, Texas, Florida and Wisconsin. Between 2005 and 2007, 655,613 of the adults underwent at least one procedure that exposed them to radiation. The mean dose of radiation was 2.6 milliSieverts (mSv), a relatively low dose. A dose of 3 to 20 mSv is considered moderate, from 21 to 50 mSv is considered high and a dose over 50mSv is considered very high. Federal regulations put the maximum annual safe dose at 50 mSv.

Cardiac stress testing was the procedure that exposed patients to the highest radiation levels, an average of 15.6 mSv, and accounted for 22 percent of all radiation exposure. CT scans of the abdomen, which typically produce about 8 mSv, accounted for more than 18 percent of exposure. A mammogram – a single X-ray – produces about 0.4 mSv.

If the findings are extrapolated to the entire population, more than 4 million Americans are receiving a dose greater than 20 mSv each year, the authors said.

“It is important to note that we are talking about radiation doses that are incurred in one year,” said Dr. Brahmajee Naliamothu of the University of Michigan, senior author of the study. “Cumulative doses over a lifetime may be much higher.”