CT or not

4 weeks ago i had a semi sharp pain in my lower right abdomen, since the pain has shifted to my back on and off, and now seems to have steadied under the right rib cage.  I have had blood test and urine and Ultrasound, all with negative results.  I lift weights but have ceased since the pain started.  It is more like a pressure under the ribcage, not really pain.  My doctor now wants me to have an abdominal/pelvic CT scan.  My question is does the benefit outweigh the risk in this situation?  Are there other test that could be done first before submitting myself to a dose of radiation?

[donjoe341]

What kind of blood tests did they run? They should check your liver enzyme levels. This is done through a blood test. If you are having gall bladder attacks or pancreatic attacks your liver enzymes can become elevated. You could ask for an MRI of the abdomen instead of a CT. Tell your doctor that you are uncomfortable with that much radiation. If the doctor doesn't understand or has no concern, then I would see another doctor. If they suspect your gall bladder there is a test that could be done specifically for that and it is called a hyda scan. You could also have an ultrasound done of your gall bladder and pancreas. I am surprised that this wasn't offered. They usually do the ultrasound to rule out stones or inflammation before going to the big guns. I would definitely ask for an ultrasound, blood enzyme test, then MRI if these two tests are inconclusive, a hyda scan and last would be a CT scan. Good Luck I was in your shoes once.

[caregiver222]

Generally a 3T MRI can do all that a CT can do with less hazard.  There are several types of MRI. The 3T is the latest and most powerful version that provides the clearest imaging. The primary reason for using the CT is that the CT machines are expensive and have not yet been amortized.  One must remember medicine is a business and many physician's have a financial interest in the imaging facilities to which they send their patients. There are two types of dye available and the dye used with a CT has more adverse reactions that the dye utilized with the MKRI.

That being said, not all jurisdictions have MRI machines available. The CT does do the job.  If you have a head injury, there is a window of opportunity. I would not hesitate to get a CT if an MRI was not available. There is no such thing as a "harmless" dose of x-ray radiation. Unfortunately, many physicians don't believe this.

[Mishkins]

I think the benefit of having a CT scan is that it will put your mind at rest. Unless you're subjected to multiple CT scanning the minimal dose of radiation really isn't a problem.  My sister has cancer and has CT scans every 3 months!!!!!  So really - I think you should go ahead, better to have it checked out, it sounds like perhaps gall bladder pain - has it radiated up around your shoulder at all?  Or, it could simply be pain from a fatty liver or it could even be muscular.  Honestly - you have nothing to worry about from one CT scan - and agree to use the contrast dye so they get good pix so you dont' have to do it over again.  Cheers.  Mishk.

[caregiver222]

With due respects the "minimal dose of radiation" is a problem.

When a diagnostic evaluation can be made with equipment emanating no x-rays with one that emanates a high dose of x-rays for no other reason than the imaging facility has to amortize costs of an obsolete machine, the risk-benefit is not favorable.

Contrast dye has a specific use. Sometimes it is used, specifically when vascular imagining is important. At other times it is not appropriate. Dye is not used to get a "good" image. It is used to get a specific type on image.

[donjoe341]

The amount of radiation you receive from a CT scan is 400 times greater than having one ex-ray. Doctors fail to tell you this. My physician wanted me to get a CT scan every 6 months due to possible inflammation of the pancreas. After I had the second one with no conclusive diagnosis I told them no more. I would probably die from radiation poisoning or cancer before they come up with an answer to my problem. Now I do only MRI's if they want to check my pancreas.

[caregiver222]

I am a little more conscious of this issue than most, having been the subject of a high-dose radiation accident a long time ago, as well as having worked as an x-ray technician. As a result of the radiation incident I lost my sense of taste for a year.

In an emergency, if you are in a jurisdiction where there is no MRI available, I would not hesitate to get a CT.

Many physicians simply do not consider the CT to represent a hazard.  The answer is yes and no. A CT can save lives, but there is some risk.

Under other circumstances, where there are reasonable options, I would think carefully.