Significant advances in medicine and nutrition over the past 50 years have helped to extend both the length and quality of life. Most Americans born today can look forward to a healthy, fulfilling and active life after retirement. This is due in part to the fact that people are now taking an active role in their health and nutrition. In addition to exercise and eating better, people are more educated about disease and the benefits of certain screening studies, such as mammography screening for breast cancer, PAP smears for cervical cancer cholesterol screening for heart disease and PSA screening for prostate cancer. Patients understand that if disease is detected early, there is a much better chance for cure or at least increased survival. Recently, it has been proposed that Computed Tomography (CT) could be used as a screening modality to image asymptomatic people in hopes of detecting subclinical disease.
As a result, they are coming soon to a neighborhood near you: storefront scanning centers offering whole-body imaging, coronary calcium scoring, and lung scans to asymptomatic, health-conscious individuals seeking the peace of mind that comes from knowing they are not about to be ambushed by arterial plaque or unsuspected tumors. Retail imaging boutiques where individuals can indulge their desire for a clean bill of health by selecting from a price-fixed menu of imaging tests that will detect medical problems before any symptoms appear.
No referral from a primary care physician is needed. These are elective screening services.
What is the impetus behind these new imaging applications?
Historically, you go to your internist once a year and he thumps on your chest, takes out his stethoscope, draws some blood to send to a laboratory, sends you for a chest x-ray, and asks how your golf game is doing. Diseases were often not detected until late in their course, if at all. Now, the rapid rise in technology makes disease processes detectable at a very early stage. The development over the past 12 months of ultrafast, $1.2-million, subsecond, submillimeter helical CT scanners now makes it possible to do a neck-to-pelvis body in 15 minutes or less.
Another major reason, however, that the popularity of whole-body scanning is exploding is because Americans are fed up with the nation's health care system and are willing to dig into their wallet to get answers to questions that they believe they cannot get from an HMO gatekeeper or a PPO internist. People are dissatisfied with the health care system and are looking for ways to bypass it. “Patients are looking for either reassurance that everything is well or an opportunity to find disease that wouldn't ordinarily be detected before it's too late”, according to Alan J. Heideman, M.D., Medical Director at Millburn Medical Imaging.
Computed Tomography (CT) was introduced in the late 1970's and even in its early days, the diagnostic capabilities of CT were well recognized. For the first time, it was possible to non-invasively image the internal organs. CT was quickly accepted as an essential diagnostic tool for the detection and staging of many diseases. Advancements in scanner and computer technology have lead to significant improvements in CT imaging. With the newest scanners, it is now possible to scan the entire body by 1mm slices in 30 seconds. This speed, combined with the higher resolution possible on current imaging systems and the availability of sophisticated 3D imaging software has resulted in unparalleled CT capabilities. CT has become so successful in detecting disease in symptomatic patients that it was only logical to wonder if CT could be used as a screening tool to detect disease in healthy, asymptomatic people.
The whole body CT scan has therefore developed. This includes detailed images of the heart and coronary arteries in addition to a high resolution scan of the neck, chest (lungs), abdomen and pelvis. The detection of conditions specifically addressed during the whole body screen include, but are not limited to, abdominal aortic aneurysm, sizable hiatal hernia, dense gallstones, dense kidney stones, prostate enlargement, large ovarian masses/ cysts, adrenal masses, lung masses/ effusions/ pneumonia, large pancreatic masses, and prominent bone masses.
Lung cancer is a growing global epidemic. No other cancer is as deadly and widespread. Every year 3.5 million people die worldwide from tobacco-related diseases - a third of them attributable to lung cancer. By 2030, that figure will climb to 10 million people. Every year, lung cancer kills more people than breast, prostate, and colorectal cancers combined. Currently, 85 percent of lung cancer victims are diagnosed in late-stage disease "Lung cancer is the major cancer killer of both men and women in the United States. The 5-year survival rate is about 14%, and it hasn't changed in the last 50 years”, said Dr. Heideman.
Several studies have found that routine chest X rays in smokers don't save lives, since the tumors are seldom visible on X ray at an early, curable stage. The new CT scans can identify lung cancer much sooner than X-rays can A CT scan of the lungs can detect many diseases including emphysema and lung cancer. CT scans can detect lung cancer even before a person develops symptoms.If you screen chests, you will pick these [tumors] up so early that the survival rate could be 80%.
A heart scan is a detailed CT scan of the heart which is used to detect the presence of calcification in the blood vessels which supply the heart, the coronary arteries. Calcifications in the coronary arteries indicate that there is atherosclerotic disease (plaques) which increases the risk of heart attack. People may have significant coronary artery disease even without symptoms. These people need to be identified early, so they can receive appropriate treatment to decrease their risk of having a heart attack.
It is now possible to detect and quantify calcified atherosclerotic plaque in the coronary arteries. Coronary artery calcification is a marker for atherosclerosis and the coronary artery calcification score has been shown to be an accurate measure of coronary plaque burden and a potent predictor of future cardiac events. The calcium score can then be used to identify patients who are at risk for future "cardiac events" so that the appropriate interventions can be made. Similarly a negative coronary calcium score can rule out significant coronary artery disease in symptomatic patients with atypical chest pain.
In addition to images of the heart and lungs, whole body scans also include scans of the abdomen and pelvis. This is also a detailed examination of the internal organs including the liver, spleen, kidneys, pancreas and gastrointestinal tract. As in the lung, CT can detect cancers and diseases in these organs, even before symptoms develop.
The scans are painless and take only a few minutes. At Millburn Medical Imaging, for example, the entire session usually lasts about an hour. “We consult with the patient and review all the findings with them after the examination,” Dr. Heideman said, “They are given a copy of the test on a CD, and the report is sent to whichever physicians they like.”
Conclusions
As the population ages, people are becoming more concerned about health and fitness. Americans are more educated about their health and are now actively involved in health maintenance and disease prevention. Whole body CT screening is now an option for individuals who are interested in taking an active role in detecting disease early.