CT (computed tomography) - commonly called a “CAT scan”, uses x-rays to produce 3-dimensional images of the body. Doctors typically use CT exams to detect and diagnose injury or disease in symptomatic patients. However, recent advances in CT scanners have made “screening” exams possible for patients without any symptoms. These exams use new ultra-fast CT to take images of individuals who may be at risk for diseases such as lung or colon cancer, or hardening of the arteries of the heart, but who do not yet have any symptoms.

The purpose of the screening examination is to evaluate, or screen, a patient for disease based upon certain family, historical, or lab test risk factors. In essence, CT screening exams check for problems before symptoms appear.

Inland Imaging currently offers three CT screening exams:

• CT Cardiac Scoring
• CT Lung Cancer Screening
• CT Colon Cancer Screening

The purpose of these CT screening exams is similar to other screening examinations, such as mammography for breast cancer screening and PSA testing for prostate cancer – find disease earlier and begin treatment and / or lifestyle changes sooner.

This brochure is designed to help you understand the pros and cons of CT screening exams, and to identify key issues to discuss with your personal physician.

To test, or not to test…

Supporters of CT screening believe that early detection of disease improves the ability to successfully treat and manage disease. However, there are no large-scale and long-term studies that show CT screening leads to a longer life. Therefore, opinions vary among doctors about the effectiveness of CT screening. Another issue involves the fact that CT screening can detect abnormalities that may never actually pose a serious health risk. Recommended treatment options following screening could potentially include risky biopsies or surgery.
 
For these reasons, the involvement of your personal doctor is necessary for evaluating CT screening findings and how to best interpret those results in the context of your total health. Therefore, Inland Imaging requires a referral from your doctor before performing a CT
screening exam.

CT Cardiac Scoring

Heart disease is the leading cause of death in both men and women in the U.S. In 1995, over 58 million people were estimated to have heart disease that claimed over 960,000 lives; over half of those died from coronary artery disease (CAD). Most people do not know if they have coronary artery disease. Sixty percent of men, and 42% of women presenting with acute myocardial infarction or sudden death have no prior history of heart disease. Too frequently, the first encounter with heart disease is also the last.

A CT Cardiac Scoring exam provides a cross sectional view of the heart and blood vessels. A computer then measures the amounts of calcium in the arteries of the heart and generates a calcium score. A high score is associated with hardening of the arteries. CT Cardiac Scoring can determine whether or not underlying coronary artery disease (calcified plaque) is present, and the 'score' provides an estimate of the extent and severity of coronary disease.

Risk factors for heart disease

• Age – men 45 or older, women 55 or older
• Current or former smoker
• Family history of heart disease
• High cholesterol
• Hypertension (high blood pressure)
• Inactive lifestyle
• Overweight
• Diabetes or high blood sugar

If you answered yes to one or more of the above risk factors and are interested in having this test, you should discuss this exam with your doctor for a possible referral for CT Cardiac Scoring.

Pros

• Less costly than angiography (a diagnostic test in which dye is injected into an artery of the heart and x-rays are taken to determine if there are any blockages)

• Measurable: Calcification can be quantified, or measured, and calcium scores can be related to the extent or severity of disease

• Non-invasive and less risk than angiography

• Early detection

Cons

• Cost: no insurance coverage for exam; patient cost is $395
• Does not detect ‘soft plaque’
• A high score may lead to additional testing or higher risk procedures such as angioplasty (a medical procedure where a catheter with a balloon is inserted into a diseased artery and inflated to compress the plaque in the artery)
• Test results may create patient anxiety

CT Lung Cancer Screening*

Lung cancer is diagnosed in 178,000 Americans every
year, and kills about 160,000 – more than from colon, breast and prostate cancer combined. It is estimated that more than 80% of lung cancer is caused by smoking. Most people with lung cancer do not have symptoms and presently, only about 15% of lung cancers are caught in early stages.

CT scanning of the lungs is an emerging method of screening patients for lung cancer that has shown significant ability to detect early stage lung cancers in high-risk patients. The CT scan of the lungs has been shown to be six times more effective at detecting early lung cancer than
standard x-ray.

Risk factors for lung cancer

Smoking tobacco is a high risk factor for developing lung cancer. Although there are other risk factors that can contribute to the development of lung cancer, only a history of smoking warrants the potential use of a CT Lung Cancer Screening exam. CT screening for individuals exposed to second-hand smoke is not performed because the risk of developing lung cancer is minimal.

With your doctor’s referral, Inland Imaging will offer screening exams for lung cancer for people who smoke. Using CT to screen for lung cancer may be helpful, since CT can find tumors when they are very small.

If you are a current or former smoker and are interested in having this test, you should discuss this examination with your doctor.

Pros

• Early diagnosis – CT screening can detect small tumors at an early stage*

• Non-invasive – the lungs can be scanned in 15 to 20 seconds

• More effective than traditional chest x-ray at detecting small lung nodules

Cons

• Cost – no insurance coverage for exam. Patient cost is $350 per exam

• May show suspicious areas or nodules that may or may not be cancerous but require additional testing. Your physician could recommend immediate lung biopsy or even thoracic surgery. Both steps involve potentially risky procedures.

• X-Ray radiation higher than plain chest x-ray

• Test results may create patient anxiety

*Inland Imaging will begin offering CT Lung Cancer Screening exams in Spring 2002.

CT Colon Cancer Screening*

Colorectal cancer is the second leading cause of cancer related death in the United States. The American Cancer Society estimates that 135,000 people in the U.S. will be diagnosed with colorectal cancer in 2002. Nearly 60,000 people will die from colorectal cancer during the year.

Colon cancer can be prevented if polyps (masses of abnormal cells) are discovered and removed early. Tumors can take years to develop. Initially, a single colon cell starts to develop and multiply abnormally, forming a non-cancerous polyp, which can remain harmless for years before becoming an aggressive cancer. Once detected, polyps can be preventatively removed. The American Digestive Health Foundation reports a 95 percent chance for five years survival if cancer is confined to the colon at the time of diagnosis, as opposed to only a three percent chance if the cancer has spread beyond the colon. Even so, it is estimated that only 10 to 30 percent of Americans over the age of 50 years undergo any type of regular screening for colorectal cancer.

Risk factors for colon cancer

• Age 50 or older

• Family history of colorectal cancer or colorectal polyps increases the risk of developing colorectal cancer

• Intestinal Disease – certain diseases of the intestines, including inflammatory bowel disease (ulcerative colitis or Crohn’s disease), can increase the risk for colorectal cancer

• Overweight

• Diet – eat a high fat diet

• Recent changes in bowel habits

If you answered yes to one or more of the above risk factors, you should discuss the use of this exam with your doctor and possible referral for CT Colon Cancer Screening.

Patients receiving a CT Colon Cancer Screening examination are required to follow pre-exam preparations. The instructions will be provided when the appointment is made for the exam.

Pros

• Cost effective – less costly than a traditional colonoscopy

• Early diagnosis – colon cancer is one of the most preventable and curable cancers when detected early

• Less invasive and less risk than colonoscopy

Cons

• Cost: most insurance plans do not cover the exam; the patient’s cost for the exam is estimated between $795 - $900*

• Less sensitive than traditional colonoscopy for small (<10mm polyps)

• If polyps are discovered, additional testing and removal of polyps is usually performed at the time a traditional colonoscopy is performed

*Inland Imaging will begin offering and establishing pricing for CT Colon Cancer Screening in Summer 2002.

Other Information

Total Body Screening

Total Body Screening is a CT screening examination that images the entire body. However, very little clinical research is presently available to support adoption of this procedure. The American College of Radiology does not endorse Total Body Screening, and Inland Imaging does not currently offer this exam.&

To schedule an exam for CT Cardiac Scoring, CT Lung Cancer Screening, or CT Colon Cancer Screening:

1. Consult with your personal physician

2. Obtain a referral from your personal physician

3. Contact the Inland Imaging Scheduling Department at 455-4455. Please have the name and telephone number of your personal physician, and the type of screening exam ordered

If you are having a CT Colon Cancer Screening examination, you will be given instructions on important pre-exam preparations you must follow.

Important information

• You must have a referral from your personal physician for the screening exam

• All screening exams must be paid by the patient at the time of the appointment

• Results of examinations will be sent to your personal physician, and it is your responsibility to follow-up with him or her regarding the results and any subsequent healthcare choices

• All CT screening exams involve the use of radiation from x-rays

• If you are pregnant you should not have a CT screening exam

• CT screening exams cannot guarantee that cancer or other disease does not exist in your body

Payment

Insurance companies do not pay for screening exams. Payment for your exam is due at the time of your appointment, or you may pay at the time of scheduling with your  credit card.