To Scan or not to Scan

Editor’s Note: There is a great deal of conflicting information in the press these days about the use, overuse, and underuse of scans, contrast media, and radiation.  While there are certainly valid concerns, as with so many areas of life we have to balance the need to know versus the cost of not knowing – the risks attached to the imaging versus the risks of not doing the imaging – the need for a good picture of what is going on, balanced against the potential side effects of the procedure.

When they talk about the overuse of imaging in the press, they are usually talking about a child who comes in with a skinned knee and they do 20 or more scans to check that leg.  Were those really necessary?  Or could the doctor have applied some hands-on evaluation and common sense?  Especially in children, we need to be careful not to over-use radiation. 

Having lived with VHL for 45 years, I can tell you that the single most dramatic beneficial difference between managing VHL today and managing VHL in 1970 is the existence of medical imaging.  Thanks to scans, we can see VHL issues brewing, make a good plan of action in a calm manner, and truly manage VHL.  The benefits in most cases far outweigh the risks.  Nonetheless it is important for you to understand the risks so that you can manage them appropriately in your own case and keep them in proportion to the benefit.

We are privileged to have two excellent articles from the University of Michigan to help you understand two important issues.

First, Dr. N. Reed Dunnick, one of the leading radiologists in the country, and Dr. Mitchell M. Goodsitt, a radiation physicist on his team, explains how the amount of radiation is calculated, and how to understand the amount of radiation you are subjected to – both in daily life and in medical scanning. (see: Radiology Examinations - Weighing the Radiology Risk.)

Second Dr. Richard Cohan, a member of Dr. Dunnick’s department who specializes in abdominal radiology, helps us calculate our risk of developing a rare but nasty complication -- nephrogenic systemic fibrosis (NSF). (see: Issues in Imaging the Kidney.)

There are no simple answers to either of these questions.  We hope that this additional information will help you have a constructive conversation with your physician and your imaging department about the best approach for you.

As printed in the VHL Family Forum 17:2, May 2009. For permission to reprint, please contact VHL Family Alliance, editor@vhl.org. Further information is available from the VHL Family Alliance, info@vhl.org.