I need to have a CT Chest Scan, full dose, not low dose. I have 3 important questions I'd like to learn before I schedule:

1. My Insurance company wants me to go to a quick scan place for $200, instead of a nearby major regional hospital imaging center, which is $2,000. It will save the Insurance company lots of bucks, since I've already met my deductible. My original instincts were to have it done at a major hospital instead of a doc-in-the-scan-box imaging business. My concerns are 1. Better quality scan, 2. Better control of radiation dosage, 3. Better MD Radiologist to read the film.

Also, do I need contrast ? My Pulmonologist ordered a non-contrast scan to look at some suspicious spots on my lungs. I'd hate to go back later for a contrast scan, since a full dose CT Chest scan is a lot of radiation.

Any and all advice appreciated. So, major hospital or doc-in-the-scan-box business with washed out radiologist, and contrast vs non-contrast ? What say you ???

Thanks guys.

See if you can find out which radiology group reads for the imaging center. May we’ll be the same group. I order films at multiple hospitals and imaging centers in two states. The quality of the interpretation is always up to the individual radiologist. You’re pulmonologist will know who is good and who may need a second look. I call my trusted radiologist(s) frequently and go over films with them if I feel the need.

Contrast can be hard on your kidneys. If the pulmonologist ordered without start there IMO.

If the pulmonologist ordered the CT without contrast, it's unlikely a later one with contrast would be needed, unless something unexpected cropped up. In any case, contrast studies are usually done with and without contrast, so there would be extra radiation anyway.

I wouldn’t worry much about the dose of a single chest CT. Your concern about the quality of equipment from place to place is valid but not at all assured. While in most cases a larger medical center will often have newer equipment with better technology, including iterative reconstruction software that can reduce dose, that is not always the case.

What most people don’t realize for some reason when it comes to buying healthcare is that you are still a consumer. You have options of where to spend your money. As such, ask questions.

Call the imaging center and ask for the make, model and year of manufacture of their CT scanner. Ask them for the average dose for their machine on the study ordered on someone with your BMI. Do the same for the hospital. This is all information they have at their fingertips if you really want to know. As mentioned, you can also ask who reads for them.

With all of that said, if you get a scan done in a decent sized city at a reputable facility with a scanner made in the last 10 years you should feel good about your care. CT technology is very mature with only incremental reductions in dose or improvements in resolution over the past decade.

In the Early 90's a cat scan of the head used to take 30 to 45 minutes. Now Cat Scans are much faster where less than 5 minutes for the same head Cat Scan. So you get much less radiation. God Bless

Gee, I've had my share of Cats and never once had any of the questions you have.

It's always been, doc schedules scan, I show up, lay down, they do their thing, I go home.

I had no clue it could be so complicated.

Bob

quote:

Originally posted by VBVAGUY:
In the Early 90's a cat scan of the head used to take 30 to 45 minutes. Now Cat Scans are much faster where less than 5 minutes for the same head Cat Scan. So you get much less radiation. God Bless

Is a CAT scan typically 24 images for every 5mm or 7mm slice? I would expect that the CT scan radiation to have changed little or the last 20 years, but the digital processing is much faster.

I have state of the art x-ray, but the exposure is pretty much the same produced by HF or 3 phase equipment 20 years ago. Only the processing is faster.

For what it’s worth I had the same thing done a couple months ago and had contrast injected. Other then that no muss no fuss.

quote:

Originally posted by rbert0005:
Gee, I've had my share of Cats and never once had any of the questions you have.

It's always been, doc schedules scan, I show up, lay down, they do their thing, I go home.

I had no clue it could be so complicated.

Bob

You're probably right. It's just me. And the extra research and antagonizing details often pay off. But it's not antagonizing for me, I'm just that way. But it turns off people who don't appreciate details. The most stressful conversationalists are Millennials who think and execute in short bursts, and cannot endure a conversation of any detail for more than 60 seconds before they pull their own pin or hang up. I notice that technical professionals with high levels of educ and experience, like physicians and PEs for example, are not intimidated with detail. I appreciate people like that. And since engineers and doctors make the world go round quite literally, I couldn't be that crazy. And to all the engineers and physicians in the great Sigforum, my hat os off to you. If you guys weren't around, I would be dead a long time ago, and I couldn't drive to work in a nice vehicle and work on a safe and comfortable building. I should probably include pilots as well, all the pilots I've talked with are smart as hell, detail oriented, and of high character. I did not mention lawyers, though they are detail oriented, not Everyone can be perfect.

quote:

Originally posted by c1steve:

quote:

Originally posted by VBVAGUY:
In the Early 90's a cat scan of the head used to take 30 to 45 minutes. Now Cat Scans are much faster where less than 5 minutes for the same head Cat Scan. So you get much less radiation. God Bless

Is a CAT scan typically 24 images for every 5mm or 7mm slice? I would expect that the CT scan radiation to have changed little or the last 20 years, but the digital processing is much faster.

I have state of the art x-ray, but the exposure is pretty much the same produced by HF or 3 phase equipment 20 years ago. Only the processing is faster.

Dose for both X-ray and CT have improved significantly from 20 years ago. DR has significantly less dose than film radiography or CR.

CT slice thickness can be as thin as 2mm now and dose has been impacted positively by better reconstruction algorithms, better detectors and better technique.

I had one about a year and a half ago.... with contrast and such.... cost $17,500....

Not sure which way you should go... but I'd prefer the better scan if you are going to have to be sent through the box...

quote:

Dose for both X-ray and CT have improved significantly from 20 years ago. DR has significantly less dose than film radiography or CR.

CT slice thickness can be as thin as 2mm now and dose has been impacted positively by better reconstruction algorithms, better detectors and better technique.

2mm is incredibly thin, I can see now that the CT dose is very small. I used to have plain film XR, but with the best Kodak screens and the best chemicals, etc. My current digital system uses the same XR factors as my previous digital system and my previous plain film. Image quality is super though, thanks to digital processing.

So, do you think that something I read, that a Chest CAT scan has a 1 in 2000 chance of causing a fatal lung cancer due to the radiation used, is true, or an exaggeration ? Personally I don't like those odds, although the upside of an early lung cancer diagnosis must be incalculable depending.

Well if you met your deductible then you still may have a copay due.

I would contact your doctor to see what he thinks about you having it done where your insurance company wants you to have it done. He may be OK with it or he may suggest another non hospital place to have the imaging done that still could save considerable money but do a better job.

As far as radiation, I would not worry about it as IMO the benefit outweighs the very minimal risk. I have had several CT Scans done for that reason but these days I primarily get MRIs due to the need for very high resolution with most recent done for the pancreas where they could actually look inside the ducts. Discuss any concerns with your doctor also.

If something is found in your chest that appears benign, do not be surprised if your doctor wants you to follow up again for more imaging in a year.

I work in healthcare. I had my abdominal CT with contrast at a physician owned clinic. The radiologist went over the results immediately after. He explained that it would have taken all day at the hospital CT because of their procedures. See what your pulmonologist suggests. Where would he go?

quote:

Originally posted by ZSMICHAEL:
I work in healthcare. I had my abdominal CT with contrast at a physician owned clinic. The radiologist went over the results immediately after. He explained that it would have taken all day at the hospital CT because of their procedures. See what your pulmonologist suggests. Where would he go?

Weird, I have had several CT scans at hospitals for chest and abdomen with and without contrast including oral contrast and it never took me more than 15 minutes. I drank oral contrast at home though before going in. Of course protocols for CT and MRI differ depending on exactly what they are looking at.

Glad you saved yourself a bunch of time and money.

^^^^^^^^^^^
You are lucky. Here it is like cattle herding after filling out tons of paperwork and then being given the contrast to drink. Not organized at all.
I had to go the Womens Clinic to get my bone density scan. Lots of waiting and stares. That was only a half day.

My EGDs and colonoscopies are at an outpatient surgical clinic run by compulsive physicians. Very quick.