o the Editor:

Re "Cheaper Body Scans Spread, Despite Doubts" (front page, May 27):

Cancer! That can be the legacy of an unnecessary CT scan.

CT scans are a valuable tool for saving lives and ameliorating suffering when indicated and requested by a doctor. If your doctor requests one for you, have it done. If you simply want one, and the allure of reduced price tempts you to have one, don't.

Each CT scan of the abdomen confers an increased risk of radiation-induced cancer of 12.5 per 10,000. This is a greater risk of cancer than one year of smoking. If the abdomen is scanned twice, the risk is 25 per 10,000.

Managed care has been tough on the radiologist's bottom line. Self-pay by patients for an unnecessary CT scan is a siren song for the radiologist. As the great physician said, "First, do no harm."
EVERETT M. LAUTIN, M.D.
New York, May 28, 2002
The writer is a professor of radiology, Albert Einstein College of Medicine.
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To the Editor:

No matter what people say about body scans, the positive aspect of their benefits far outweighs the negativity ("Cheaper Body Scans Spread, Despite Doubts," front page, May 27).

Last week, I was in India; my father-in-law was unwell and was being inconclusively treated for suspected malaria for almost five months. A tumor was detected only after a CT scan prescribed by a surgeon, and surgery was advised immediately.

Early diagnosis can lead to a cure; this will not only benefit the patient but the health care system as well from being burdened with future treatment and follow-up costs.

Where conventional diagnosis fails, a CT scan is the best solution, and with increased competition, affordability will soon be within the reach of the masses not only in the United States but also all over the world.  
ATUL M. KARNIK
Woodside, Queens, May 27, 2002
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To the Editor:

As a cardiologist who receives frequent panicked calls as heart scans have flourished, I must point out important problems created by the direct marketing of these scans (front page, May 27).

Driven by lucrative economics, many scans are performed ignoring a principal tenet of biostatistics, which considers pretest probability of disease. This approach minimizes falsely positive and negative results by recommending screening tests only to patients who are of moderate risk.

Bypassing the patient's doctor often leads to the panic witnessed by many cardiologists when a heart scan is labeled abnormal. Most of these centers do not have cardiologists available to make clinical sense of the results.

Whatever role research helps to define for heart scans as a screening test for coronary disease, the critical decisions of patient selection, test interpretation and patient counseling should be made by the patient's doctor or cardiologist, not initiated by the patient through an advertisement on TV or a highway billboard.
JONATHAN SCHARFSTEIN, M.D.
Shaker Heights, Ohio, May 27, 2002
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To the Editor:

Re "Cheaper Body Scans Spread, Despite Doubts" (front page, May 27):

Before Americans rush to fritter away their money on unnecessary high-tech scanning exams with pointless and costly (fiscal, physical and emotional) sequelae, let us find ways to improve access to basic primary care for the 40 million un-insured Americans.
GABRIELLE M. GUZMAN
West Orange, N.J., May 27, 2002