Full-body CT scan

A full-body scan is a scan of the patient's entire body as part of the diagnosis or treatment of illnesses. If computed tomography (CAT) scan technology is used, it is known as a full-body CT scan, though many medical imaging technologies can perform full-body scans.

"Full-body scan" redirects here. For full-body scanners found in airport-security, see Full body scanner. For 3D body scanners, see 3D body scanning.

Indications

Full-body CT scans allow a transparent view of the body. For polytrauma patients, aggressive use of full-body CT scanning improves early diagnosis of injury and improves survival rates, [1] with widespread adoption of the technique seen worldwide.[2] Full-body CT scans are not indicated in patients with minor or single system trauma, and should be avoided in such patients.[1]

Many possible malignancies are discovered with a full-body scan, but these are almost always benign.[3][4] These may not be related to any disease, and may be benign growths, scar tissue, or the remnants of previous infections. CT scanning for other reasons sometimes identifies these "incidentalomas".

However, the significance of radiation exposure as well as costs associated with these studies must be considered, especially in patients with low energy mechanisms of injury and absent physical examination findings consistent with major trauma.

A full-body scan has the potential to identify disease (e.g. cancer) in early stages, and early identification can improve the success of curative efforts. Controversy arises from the use of full-body scans in the screening of patients who have no signs or symptoms suggestive of a disease.[5] As with any test that screens for disease, the risks of full-body CT scans need to be weighed against the benefit of identifying a treatable disease at an early stage.[6]

An alternative to a full-body CT scan may be Magnetic resonance imaging (MRI) scans. MRI scans are generally more expensive than CT but do not expose the patient to ionizing radiation and are being evaluated for their potential value in screening.[7]

Risks and complications

Compared to most other diagnostic imaging procedures, CT scans result in relatively high radiation exposure. This exposure may be associated with a very small increase in cancer risk. The question is whether that risk is outweighed by the benefits of diagnosis and therapy[8]

The procedure has a low rate of finding disease.[3][4] It can cause confusion regarding incidentalomas. It is uncertain how to treat some of them, or if treatment is even necessary.[9] The test also cannot detect colors, unlike for example a colonoscopy.

Society and culture

These procedures are relatively expensive. Possibly high cost: At a cost of US$600 to $3000, full-body scans are expensive, and are rarely covered by insurance.[10][11] However, in December 2007, the IRS stated that full-body scans qualify as deductible medical expenses, without a doctor's referral. This will likely lead employer-sponsored, flexible-spending plans to make the cost of the scans eligible for reimbursement.[12]

  • In the Scrubs episode "My Fault", released April 22, 2004, Dr. Kelso decides to offer full-body scans at Sacred Heart Hospital, despite the objections of Dr. Cox, in his words: "I think showing perfectly healthy people every harmless imperfection in their body just to scare them into taking invasive and often pointless tests is an unholy sin." Kelso's offer is almost taken by Harvey Corman, who is an "admittedly frugal hypochondriac".
  • In the episode "Role Model" of the TV show House, released April 12, 2005, the lead character Dr. Gregory House refers to full-body scans as "useless" because, in his words, "you could probably scan every one of us and find fifty doo-dads that look like cancer". This issue was revisited in a later episode, "The Social Contract", where a full-body scan was successfully used to identify a tumor and diagnose Doege-Potter syndrome. Then in "Black Hole", House orders a full-body scan over the objections of his team, followed by a different scan on a pineal gland.
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See also

References
  1. American College of Surgeons (September 4, 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American College of Surgeons, retrieved 14 February 2017, which cites
    • Huber-Wagner, S.; Lefering, R.; Qvick, L. M.; Körner, M.; Kay, M. V.; Pfeifer, K. J. R.; Reiser, M.; Mutschler, W.; Kanz, K. G.; Working Group on Polytrauma of the German Trauma Society (2009). "Effect of whole-body CT during trauma resuscitation on survival: A retrospective, multicentre study". The Lancet. 373 (9673): 1455–1461. doi:10.1016/S0140-6736(09)60232-4. PMID 19321199.
    • Ahmadinia, K.; Smucker, J. B.; Nash, C. L.; Vallier, H. A. (2012). "Radiation exposure has increased in trauma patients over time". The Journal of Trauma and Acute Care Surgery. 72 (2): 410–415. doi:10.1097/TA.0b013e31823c59ee. PMID 22327983.
  2. Maclean D, Vannet N. Improving trauma imaging in Wales through Kotter's theory of change. Clinical Radiology 71 (5): 427 - 431
  3. Brant-Zawadzki MN (November 2005). "The role of computed tomography in screening for cancer". Eur Radiol. 15 Suppl 4: 52–54. PMID 16479647.
  4. Berlin L (February 2003). "Potential legal ramifications of whole-body CT screening: taking a pesek into Pandora's box". AJR Am J Roentgenol. 180 (2): 317–322. doi:10.2214/ajr.180.2.1800317. PMID 12540423.
  5. "U.S Food and Drug Administration Whole body CT scans, DHHS Publication No: (FDA) 03-0001". March 2003. Retrieved August 30, 2006.
  6. MacLean CD (January 1996). "Principles of cancer screening". Med Clin North Am. 80 (1): 1–14. doi:10.1016/S0025-7125(05)70423-5. PMID 8569290.
  7. Lauenstein TC, Semelka RC (August 2006). "Emerging techniques: Whole-body screening and staging with MRI". J Magn Reson Imaging. 24 (3): 489–498. doi:10.1002/jmri.20666. PMID 16888774.
  8. Full-Body CT Scans - What You Need to Know. Fda.gov. Retrieved on 2010-09-26.
  9. Grumbach MM, Biller BM, Braunstein GD, Campbell KK, Carney JA, Godley PA, Harris EL, Lee JK, Oertel YC, Posner MC, Schlechte JA, Wieand HS (March 2003). "Management of the clinically inapparent adrenal mass ("incidentaloma")". Ann Intern Med. 138 (5): 424–429. doi:10.7326/0003-4819-138-5-200303040-00013. PMID 12614096.
  10. Meyer M. (October 2002). "Behind the Body Scan Craze". Retrieved August 30, 2006.
  11. "Whole-body Scans More Marketing Than Science, Say Medical Physicists. American Institute of Physics". 2002-08-26. Archived from the original on May 1, 2006. Retrieved August 30, 2006.
  12. "Diagnosis? It's Deductible".
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