CT Screening
AmeriScan, a for-profit chain of imaging centers offerring CT whole body and MRI breast screening closes. The state of California has sued Dr. Bittner for false advertising. AmeriScan included statements that breast MRI was nearly 100% accurate, was the best method for early detection, and could differentiate between benign and malignant lesions. The ACR also filed a complaint of unfair advertising with the Federal Trade Commission.
Only a few months before, the future for screening seemed bright. Dr. Bittner, a Johns Hopkins trained radiologist, had the business savy and smarts to make imaging work. With $30 million in capital (from Siemens), the business model seemed sound.
Screening by radiologists is controversial and condemned by all major medical organizations. What most radiologists ignore (denial?) is that we all screen and do so nearly every day. Who competes with the independent screening centers? The ER! A flood of examinations of the "chest-abdomen-pelvis" comes from the ER, screening patients for a wide variety of vague and nonspecific ailments. No, this is different than screening patients with no symptoms - but not much. X-raying has replaced physical exams and listening in the armementarium of many physicians - who have too little time and incentive for old fashioned medicine.
It's not uncommon to screen for cancer without even knowing it. A patient goes to his doctor with the concern that his past smoking habit may result in lung cancer. The physician orders a chest CT, fudging the history so that insurance will pay. It wasn't that long ago that I asked a patient when he started coughing up blood (CT request was hemoptysis). The patient was a little confused by the question because he had never coughed up blood. That's screening.
We should all realize that we screen and have been doing so for several years in various guises. For years common practice dictated that all patients admitted to the hospital had a chest x-ray, Whether we like it or not, we're evolving into a practice where all patients will have a whole body CT before they go to their room.
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