Spinal Xrays should be used with some discretion and surely Professor
Nesbit in Georgia can diagnose metastatic prostate cancer by other means.
X rays can be positively misleading and even delay a serious diagnosis
like this.
What about the elderly man with upper back pain who is otherwise well
and with no urinary symptoms. He is sent for a spinal Xray and the
radiologist reports that 'there is a thoracic wedge fracture typical of
osteoporosis'. The doctor and patient are happy to have a diagnosis except
that it's wrong. A doctor decides to do a 'prostate specific antigen'
(PSA) test; the result returns very high and the whole picture changes.
The Xray only served to delay the diagnosis and the appropriate treatment.
Another disabled man with new thoracic back pain returns a mild
anaemia and a raised alkaline phospatase. A subsequent raised PSA avoids a
25 mile ambulance trip for an unnecessary Xray.
Bad back pain for weeks, a negative lumbar spine Xray, relief all
round. Its just a shame the chest wasn't Xrayed instead and the primary
lung cancer found. Another not uncommon scenario.
Elderly men with persistent back pain need PSA's not Xrays. With a
little thought and lateral thinking unnecessary and wasteful investigation
can be avoided and resources freed up for the benefit of all in the NHS.
Perhaps the conservation of resources is not so relevant to American
society and its health systems today.
Rapid Response:
Re: A concern about your recommendations
Spinal Xrays should be used with some discretion and surely Professor
Nesbit in Georgia can diagnose metastatic prostate cancer by other means.
X rays can be positively misleading and even delay a serious diagnosis
like this.
What about the elderly man with upper back pain who is otherwise well
and with no urinary symptoms. He is sent for a spinal Xray and the
radiologist reports that 'there is a thoracic wedge fracture typical of
osteoporosis'. The doctor and patient are happy to have a diagnosis except
that it's wrong. A doctor decides to do a 'prostate specific antigen'
(PSA) test; the result returns very high and the whole picture changes.
The Xray only served to delay the diagnosis and the appropriate treatment.
Another disabled man with new thoracic back pain returns a mild
anaemia and a raised alkaline phospatase. A subsequent raised PSA avoids a
25 mile ambulance trip for an unnecessary Xray.
Bad back pain for weeks, a negative lumbar spine Xray, relief all
round. Its just a shame the chest wasn't Xrayed instead and the primary
lung cancer found. Another not uncommon scenario.
Elderly men with persistent back pain need PSA's not Xrays. With a
little thought and lateral thinking unnecessary and wasteful investigation
can be avoided and resources freed up for the benefit of all in the NHS.
Perhaps the conservation of resources is not so relevant to American
society and its health systems today.
Competing interests: No competing interests