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CT Scans and Radiation: On-going Consequences for One Patient

In my past posts, I've described the exposure of one of my patients to the radiation from three CT Scans in the span of one-year and hypothesized on the possible physical consequences from such high dosage of radiation in such a small time interval. Well, it has surfaced that this patient has experienced one unanticipated consequence, which otherwise is uncommon in men in their early thirties who engage in limited physical activity. This patient requires a hip replacement.

After multiple visits to his PCP and specialists to relieve the persistent pain in his lower abdomen, a simple X-Ray was able to discover significant bone atrophy in his pelvic area. As it was described to him by the specialist who identified it, his hip is "wasted away." I believe the medical term is Avascular Necrosis, although my patient did not know the diagnosis he was given.

Avascular necrosis is a condition that occurs when there is a loss of blood to the bone. If it is not stopped, it can lead to the death of the bone, and especially vulnerable is the femoral head where restricted access to local blood supply is limited. Avascular necrosis is associated with excessive alcohol use and high-dose steroid medications. It is also associated with Radiotherapy or radiation treatment for cancer treatment.

A successful hip replacement will withstand fifteen to twenty years of use, which for this patient will serve, perhaps, into his fifties. At that time, he will again need to be subjected to surgery, if he has not already been treated for cancer in the interim. The travesty is the patient did not require such repeated exposure to high doses of radiation, and, if fact, most people do not require it, yet many patients are repeatedly exposed to the risk. In countries such as Mexico, alternatives are used that can produce equally reliable data for less cost when done by a skilled physician/specialist who can make an accurate diagnosis with data that was obtained without exposing the patient to unnecessary risk.

Protect yourself and your family from the deleterious effects of unnecessary radiation exposure. I will tell you what I told my patient who was too afraid to ask.

  1. If you had a CT Scan in the past year, do not get another one. Refuse and expect a sound explanation. If your doctor gets angry or rude because you question him/her, then search for another doctor. This is your health on the line.

  2. If your doctor insists, ask for it to be done at a hospital unaffiliated with your doctor's practice. This will ensure there is no profit motive associated with the decision. Otherwise, get a second opinion from a doctor unaffiliated with the company/organization whom your doctor has an affiliation. Doctors, for ethical purposes, are asked to disclose their hospital affiliations.

  3. Prior to the second opinion, research alternative methods used to identify possible disease without the use of a CT Scan. For example, MRIf is a reliable alternative for many exploratory procedures, but may cost out of pocket, which is worth it considering the alternative.

There is no shame or need for embarrassment when you question practices that are done by people who you have confidence will treat you to the best of their ability. Keep in mind that the consequences from errors are carried by us, sometimes for the rest of our lives, as well as the unintended consequences of our blind trust. For this patient, the issues I will be addressing following the surgery will be related to the physical and emotional adjustment to the new hip and the withdrawal symptoms from the opiate the patient was given to manage his pain for months. Both areas of focus would likely not be needed had the patient not been given two additional CT Scans.

Radiotherapy induced hip joint avascular necrosis—Two cases report. Łukasz Michalecki,⁎ Dorota Gabryś, Roland Kulik, Jerzy Wydmański, and Krystyna Trela. Rep Pract Oncol Radiother. 2011 Sep; 16(5): 198–201.Published online 2011 May 31. doi: 10.1016/j.rpor.2011.04.004

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