Seeing Imaging Facts Clearly
Jeffrey Rosengarten, MD is a Board-certified Radiologist and Medical Director of Northwestern Lake Forest Hospital's seven Diagnostic Imaging Centers. Here he provides some context for recent questions about radiologic imaging.
Q: Recently, national media reported the U.S. Preventive Services Task Force (USPSTF) recommendation that screening mammograms begin at age 50 instead of 40, and be repeated every other year instead of annually. Women are confused—what’s your opinion?
A: I talked with our radiologists who specialize in women’s imaging, and they believe the USPSTF recommendation is “based on flawed analysis and should be retracted.” USPSTF originally reviewed data from a Canadian study that used older X-ray film screening with a single view. The trial wasn’t performed within the current standard of care, which includes digital X-ray screening and multiple views. So there’s no real news here.
In fact, just this summer, the U.S. Department of Health and Human Services (HHS) issued new regulations based on screening at age 40. The task force recommendation is “not considered current” by HHS.
Q: So which mammogram guidelines should women over 40 follow?
A: Timing for mammograms varies depending on age, family history and health. But for most women with no family history of breast cancer, we recommend a screening mammogram every year, beginning at age 40. You can reduce breast cancer death (by 30-48%) if the cancer is detected early, when treatment is more effective and less harmful.
There is no magic cut-off point—the risk rises steadily from age 40 through 75. But if you detect it in a woman who’s still in her 40s, you’ve added many more good years to her life. The risk from the radiation is minimal; the likelihood that the mammogram will detect cancer is much higher.
Q: Radiologists can be specialists—similar to a cardiologist or gastroenterologist. What is the advantage for patients?
A: Every physician who becomes a radiologist has five years of training enabling him or her to interpret any kind of radiologic test result, and these generalists read most tests. But a radiologist can pursue optional fellowship training in a specialization, such as women’s or pediatric imaging, or brain and spine imaging.
Simply put, specialized training means a more accurate reading and more collaboration. Consider an orthopedic surgeon who orders a test from a radiologist with orthopedic sub-specialty training—they’re talking the same language, and it’s better for the patient.
And yet, it’s still uncommon to have as many specialists as we do on staff. We have more fellowship-trained sub-specialized radiologists than any hospital in Lake County, including five fellowship-trained women’s imaging specialists.
Q: Patients often don’t know how imaging technology works. What are the differences between X-rays, magnetic resonance imaging (MRI), computed tomography (CT) scans or other tests?
A: To view organs and “see” deep into the body, CTs and X-rays use ionized radiation; MRIs use a magnetic field; and ultrasounds use high-frequency sound waves. It’s good to know these basic differences, and patients should always take an interest in their care. But rest assured that a good primary care physician will consult with the radiologist about the most appropriate test. Our imaging centers take many calls from physicians every day, and our level of specialization makes for a good consulting relationship.
Q: Radiation exposure has increased sevenfold since the 1980s, according to the National Council on Radiation Protection. This has raised concerns about the heavier doses of radiation from CT scans. What’s your opinion?
A: Among physicians, it’s well known that CT scans can be overused. However, most physicians use good judgment, and if you need this test, then you need it—the clinical value far outweighs the theoretical risk of exposure from a single scan. An MRI (which uses magnetic waves, not radiation) may be an appropriate alternative, but it depends on the individual patient and health condition.
At Northwestern Lake Forest Hospital, we’ve voluntarily begun tracking and analyzing the CT scan dosages in our Diagnostic Imaging Centers. As a result, we’ve developed new protocols that reduce the amount of radiation by 40 percent.