The Professors' Posts

CAT Scans

 

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TERRY HAMBLIN

The only reason that I can think of for doing a CAT scan in CLL early in diagnosis is to look for retroperitoneal nodes which are difficult to feel clinically. The clinical staging of CLL does nor refer to these and therefore they are not routinely looked for. In patients with del 11q by FISH there is reportedly a higher incidence of such nodes.

If there are systemic symptoms such as fever, weight loss, night sweats, then retroperitoneal nodes should be looked for. In these circumstances Richter's syndrome is a possibility.

TERRY HAMBLIN

A lot of comments about CAT scans

There is a good deal of hysteria about low levels of radiation. Back in the 1950s anything to do with nuclear physics was held in high regard - the atom bomb had just won us the war.

In the 1960s and 70s there was a reaction against this hubris when the dangers of radiation became apparent and everyone withdrew with shock and horror.

Three Mile Island, Windscale and Chernobyl really frightened people.

Ever since that time there has been a small industry damning everything to do with radiation. Irradiated food was withdrawn from Supermarket shelves in Britain because people were terrified of the word 'radiation', even though the food was not radioactive and the process protected against food poisoning. In a hilarious clip a TV news program showed a young woman puffing at a cigarette while swearing that she would never feed her child irradiated food. People generally have no idea of how to assess risk. If they did no-one would by a lottery ticket.

Are we right to be scared of CAT scans? There is no doubt that the X-irradiation involved is a lot more than you get from a chest X-ray. However, used sensibly the benefit of a CAT scan far outweighs the risk. It is not practical to substitute an MRI scan for CAT scans. The image is not so good and they are complementary not competing techniques. Also while a CAT scan takes just a few minutes, MRI takes 45 claustrophobic minutes.

We should never take unnecessary X-rays of any kind, and I do not approve af a CAT scan as a screening process, but when it is necessary, don't deny yourself the benefit.

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