Is Chest CT Performed Too Often?

Abstract

We have had very similar experience with computerized tomography to that described by Dr. DiMarco in the April 1993 issue of Chest. (103:985-86). We appreciate his succinct editorial comments, but there is one area of encouragement. Those coin lesions being approached as potential clinical and roentgenographic T1N0M0 neoplasms of the chest have already been evaluated. The T1N0M0 lesion does not require chest CT due to the “unnecessary evaluation of false-positive studies and the delay in diagnosis associated with false-negative studies.”1Becker GL Whitlock WL Schaefer PS Tenholder MF The impact of thoracic computed tomography in clinically staged T1, N0, M0 chest lesions.Arch Intern Med. 1990; 150: 557-559Crossref PubMed Google Scholar Dr. DiMarco outlined the cost and radiation risk of the chest CT, but the cost and radiation risk in evaluating false-positive results is alarmingly additive.1Becker GL Whitlock WL Schaefer PS Tenholder MF The impact of thoracic computed tomography in clinically staged T1, N0, M0 chest lesions.Arch Intern Med. 1990; 150: 557-559Crossref PubMed Google Scholar We agree that chest CT often produces “no new clinical information” and “no impact on patient care” when the chest x-ray and previous films are analyzed in conjunction with the patient's history. We are often consulted about a CT result when no effort to create the patient's roentgenographic history has been attempted. We wonder if it is really legitimate for the x-ray report to read, “no old films for comparison, suggest chest CT.” Prospective studies should address the number of CT scans being ordered to evaluate lesions that are already established by roentgenogram as benign. It is also alarming to us that a CT scan can precede the Gram stain or tuberculosis smears on patients with infectious histories and new infiltrates. Our colleagues at Dartmouth2Black WC Welch HG Advances in diagnostic imaging and overestimations of disease prevalence and the benefits of therapy.N Engl J Med. 1993; 328: 1237-1243Crossref PubMed Scopus (455) Google Scholar are equally aware of how the advances in diagnostic imaging are not always the best way to “deal with uncertainty.”3Mold JW Stein HF The cascade effect in the clinical care of patients.N Engl J Med. 1986; 314: 312-314Crossref PubMed Scopus (247) Google Scholar We hope that Dr. DiMarco's important editorial message will hit home before the next ACCP section report on clinical staging of patients with non-small-cell lung cancer comes to press.