Friday, February 06, 2009


After years of debating and discussing the role of the 64-MSCT, the practitioners in Malaysia are still not following the evidence and guidelines. 64 MSCT are still being rampantly done, to all and sundry, as long as they can pay ( sometimes paid by insurance ). I have written on this many times before. Since, there is alot of money and " powerful boys " involved, I have chosen to quote directly from the Heart Org website, so that I will not be accused of misquoting. The latest report appeared in " " recently. A new American Heart Association (AHA) science advisory says there are no data to support the use of cardiac computed tomography angiography (CCTA) in asymptomatic, low-risk patients, so the albeit-small risk of cancer from radiation currently outweighs the lack of any demonstrable benefit in such people . Dr Thomas C Gerber (Mayo Clinic, Jacksonville, FL) and colleagues discuss the subject in a paper published online February 2, 2009 in Circulation.
I suppose, I take two important point from this evidence base statement. Firstly, there is no point doing 64MSCT in asymptomatic, low risk individuals, as the risk of cancers, outweigh the benefit, even is there is some disease shown ( remember " Courage trial" ). Secondly, there is a real, small risk of cancers, from the radiation. If you read the small print in the article, you will also understand that radiation risk varies from machine to machine, and patient should be made aware of that. Of course, this involves calibrating the machine and checking the radiation risk at periodic intervals ( something not routinely done here ).
Balanced against this , is the fact that it is a money spinning industry, which also drives some cardiologist, interventional program. You see and blockage, you do the angiogram, and if you see anything, you dilate with the balloon and you stent ( all on very flimpsy evidence ). The pictures can be made so seductive, that the patient is convinced that the cardiologist has saved his life ( even some of my very well educated golf " kakis " have been duded ), when there is no evidence to suggest that. In fact, the medical evidence may be to the contrary.
What to do? It is all about money, isn't it?

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