In their first paper on self-referred imaging, biomedical ethicists from Stanford University explore the burgeoning world of whole-body CT and other screening exams, recommending the adoption of guidelines for such services. But their current concerns are tame compared to what they envision for the future.
"I think there will be an emergence of self-referral for functional brain scans, and I hope the work we’ve done in anatomical body scanning will work for brain scanning services before they are in the open marketplace and used and abused in ways that they shouldn’t be," said Judy Illes, Ph.D., in an interview with AuntMinnie.com.
Screening of children for aggressiveness and brain scans in airport security are among the potential scenarios foreseen by Illes, a senior research scholar with Stanford’s Center for Biomedical Ethics and the Stanford Medical Center’s radiology department in Stanford, CA.
"The potential use and misuse of information that might represent human thought is at another level than a small lesion on the liver," said Illes, describing the focus of her work in "neuroethics" and imaging. "It brings with it a host of other very passionate and important issues -- healthcare and human issues -- which we’re trying to address proactively."
But while small liver lesions may be a more conventional medical concern, discovering them in the context of self-referred imaging nonetheless raises issues outlined by Illes and co-authors in a study published in Radiology, entitled "Self-referred Whole-Body CT Imaging: Current Implications for Health Care Consumers" (August 2003, Vol. 228:2, pp. 346-351).
"One of the problems these (whole-body CT) services raise is the issue of having a finding that may not have clinical significance," Illes noted. Her group would like to see clinical trials that examine CT screening of asymptomatic individuals before such services become more widely used.
Interestingly, the Stanford group is also concerned about equitable access to whole-body CT services, even though they prefer not to see greater utilization in the absence of guidelines and protocols. The research included in their paper indicates that facilities for self-referred CT are currently concentrated in predominantly white and wealthy communities.
Via an Internet search, the researchers identified 88 separate facilities offering self-referred CT screening in 21 U.S. states. Of those, 53% offered whole-body scans, 70% had heart scans, 58% lung scans, 40% offered head scans, and 41% provided CT colonography. Brain scan services were focused on imaging for strokes and tumors.
Only 30% of the centers offering whole-body scans were standard radiology offices or departments. The quoted price for a neck-to-pelvis scan ranged from $795 to $995; those including a head scan averaged $850. Web sites promoted electron beam CT for the full-body scans at 47% of the locations and helical CT at 28%. The other centers advertised multislice, ultrafast, and unspecified CT technology.
Only 65% of the centers described their procedures for delivering patient results, and many (44%) offered only to mail a hard copy of the report to the patient.
Overall, Illes said, "we’d like to see guidelines for frequency and number of repeat scans, population more or less likely to benefit, (and the) types of qualifications for radiologists providing these services and reading the exams. We’d like to see guidelines for fair access for all people, and we’d like to see guidelines as well for reporting out of information to patients."
Perhaps most importantly, the group would like to see guidelines for the direct-to-consumer advertising of whole-body CT services. The use of such advertising is the focus of an upcoming paper by Illes et al.
Despite these issues -- and the question of whether the benefits of whole-body CT outweigh the risks -- the Stanford researchers don’t think self-referral facilities should be shut down.
"It’s very difficult to remove healthcare services from the open marketplace once they’re placed out there," Illes said. "So rather than advocate that -- which we could have -- we thought that perhaps a much more reasonable approach would be to bring all the stakeholders together as quickly as possible and create a framework."
"The radiology and bioethics community are working hand in hand" on guidelines, Illes said. "We would be happy to partner with the providers of these services and even consumers themselves."
By Tracie L. ThompsonAuntMinnie.com contributing writer
August 14, 2003
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