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Americans’ exposure to radiation from medical procedures has exploded over the past few decades, to six times the level of 1980, a new report shows.

In 2006, almost 380 million diagnostic and interventional radiological procedures were performed in the United States, on top of 18 million nuclear medicine examinations.

“Back in about 1980, 15 percent of radiation that the U.S. population got was from medicine and the rest was predominantly from natural background radiation,” noted Dr. Fred Mettler Jr., U.S. Representative to the United Nations Scientific Committee on the Effects of Atomic Radiation and a professor of radiology at the University of New Mexico in Albuquerque. “In the last 20 years, medical exposure has gone up between 600 and 700 percent from what it was, and it is now the biggest source of radiation to the U.S. population.”

“The issue,” Mettler continued, “is that this is a controllable source. We regulate the effluent from nuclear power plants so the public doesn’t get exposure but medical exposure is essentially unregulated. The largest source in the U.S. is essentially unregulated, and it’s up to your family doctor or any other doctor to hand it out.”

Mettler is lead author of a paper appearing in the November issue of Radiology that summarizes the conclusions of two previous reports on radiation sources in the U.S. Those reports were issued by the U.S. National Council on Radiation Protection and Measurements and the United Nations Scientific Committee on Effects of Atomic Radiation.

The findings are in line with previous studies, one of which attributed up to two percent of all cancers to CT scans alone and another which concluded that cumulative exposure to radiation from CT scans increases the risk for malignancy by as much as 12 percent.

The last comprehensive assessment of radiation exposure was conducted in 1980-1982, a veritable eternity by medical and scientific standards.

“We needed to get a grip on how much radiation the U.S. was getting and where it was coming from,” Mettler said.

In the intervening years, the number of procedures performed has risen “by leaps and bounds,” he said. “The biggest chunk of that is CT scanning, which has been growing at better than 10 percent a year while the U.S. population is growing at less than 1 percent.”

Widely used as a diagnostic tool, CT scans provide detailed images of organs, allowing more accurate diagnoses of conditions such as cancer. But CT involves a higher radiation dose than most other imaging tests. According to this paper, CT provides half of the country’s total radiation dose, even though it represents only 17 percent of total procedures.

Emergency room physicians may be at the epicenter of the surge in scan use, Mettler said. “Twenty-five to 40 percent of CT scans are ordered out of the ER,” he noted. “The emergency physicians are in a tough box because they’re worried about getting sued. And they tend to get patients who they haven’t seen before. This is a one-time walk-in and their mantra is, ‘We can’t afford to miss anything.’”

Of course, the trend is not limited to the U.S., although it may be more extreme here. Globally, the per-capita annual dose from medicine has doubled in the past decade or so.

Still the U.S. leads the pack, with 12 percent of all radiologic procedures and half of nuclear medicine procedures performed here.

“We have a little under 5 percent of the world’s population and 25 percent of X-ray studies in the world and double and triple that of other developed countries,” Mettler said. “Nobody thought about how much radiation goes with this.”

But not all of uptick in scans has been unnecessary, said Dr. Robert Zimmerman, executive vice chair of radiology at Weill Cornell Medical Center in New York City.

“We don’t really know how much of it is overuse. We do know some of it is overutilization, but CT is a valuable imaging modality. CT is a great test. There’s no question that in the appropriate cases it’s going to save lives.”

There are things radiologists can do to curb its use, including reducing the doses, while manufacturers are working on new and improved machines, Zimmerman said.

Physicians can also tailor their use, thinking twice about using this type of technology in children, who are more sensitive to radiation and have longer to develop side effects.

“When I get a call for a CT scan, my first question is, ‘How old is the patient?’ If it’s 40 or under my antennas go up and if they’re 70 my antennas don’t get so excited. Mostly my idea is a CT might be a good thing but you would like to think about radiation beforehand,” Mettler said. “There’s a lot of stuff going on now that isn’t justified. Nobody’s ever shown that many of these things we do make a difference in outcome.”

Researchers are reporting that eight weeks of treatment with large doses of vitamin D2 can eliminate vitamin D deficiency, and twice-monthly doses can keep the condition at bay for up to six years.

The dosage — 50,000 international units (IU) every week or two — was large but did not appear to be toxic, according to the study published in the Oct. 26 issue of Archives of Internal Medicine.

Vitamin D is crucial for the body. Among its attributes, it strengthens bones by helping the body absorb calcium and phosphorus from food. Low levels of vitamin D can cause rickets in children and an adult bone disorder called osteomalacia.

A deficiency can also lead to osteoporosis, and research has suggested that it also has something to do with higher risks for such diseases as cancer, heart disease, diabetes, autoimmune diseases and flu, the study’s senior author, Dr. Michael F. Holick, director of the Bone Healthcare Clinic and the Vitamin D, Skin and Bone Research Laboratory at Boston University School of Medicine, said in a university news release.

For their study, the researchers treated 41 people who had low levels of vitamin D with 50,000 IU of the vitamin each week for two months. On average, their vitamin D levels nearly doubled after eight weeks, the study found.

Another 45 people were given 50,000 IU of vitamin D2 every two weeks. The researchers found that their levels also went up, but not quite as much.

“Vitamin D2 is effective in raising [vitamin D] levels when given in physiologic and pharmacologic doses and is a simple method to treat and prevent vitamin D deficiency,” Holick said. “While treating and preventing vitamin D deficiency, these large doses of vitamin D2 do not lead to vitamin D toxicity.”

The U.S. National Institutes of Health Office of Dietary Supplements recommends that you always talk to your health care provider before taking any supplements.

Many middle-aged adults may be walking around with a dangerous health problem and not even know it.

The condition called peripheral artery disease, or PAD, occurs when arteries in the legs become narrowed or clogged with fatty deposits, reducing blood flow to the legs. PAD affects about 8 million Americans.

PAD is as serious as heart disease, Dr. Ross Tsuyuki of the University of Alberta in Edmonton noted in a telephone interview with Reuters Health, “but, in general, it is under-recognized by the public and by our health care system.”

In 10 pharmacies in Central and Northern Alberta, Tsuyuki and colleagues had five pharmacy students screen 362 adults over age 50 for PAD. The screening procedure, which is fairly simple, compares the blood pressure in the leg to that of the arm.

Seventeen people who were screened — about 5 percent — had PAD. And, importantly, Tsuyuki said, 80 percent of the people found to have PAD were previously unaware they had the dangerous condition.

“PAD is a very strong risk factor for poor outcome, including heart disease, stroke and lower limb amputation,” Tsuyuki said.

“We informed them of what we found and followed up with them and most of them had gone to see their family physician for treatment,” Tsuyuki said, which may include aspirin or other anti-blooding clotting therapies and aggressive cholesterol-lowering treatments.

While the US Preventive Services Task Force currently does not recommend routine screening for PAD, Tsuyuki thinks it is worthwhile to screen people at high risk for PAD. “That would include people who already have heart disease and people who’ve suffered a stroke. They would be the highest priority,” he told Reuters Health.

“The second highest priority,” he added, “would be people middle-aged and beyond who are at high risk for heart disease and stroke, such as people with high blood pressure, diabetes and high cholesterol.”

The researcher reported his team’s findings over the weekend at the 2009 Canadian Cardiovascular Congress, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.

In a statement from the meeting, Heart and Stroke Foundation spokesperson Dr. Beth Abramson said: “People don’t recognize that leg cramps while walking may be due to circulation problems that put them at risk for heart disease and stroke.”

While PAD may have no symptoms, there often are some warning signs, such as leg pain during exercise, open leg sores that don’t heal, feeling of coldness or numbness in one or both legs, pain in the toes at night.

Current or ex-smokers are at increased risk for PAD as are people with diabetes, high blood pressure, high cholesterol and heart disease.

Jet lag is the term for disrupted sleep when you travel between time zones, and your body doesn’t adjust to sleeping on a new schedule.

The U.S. National Library of Medicine offers these suggestions to minimize jet lag:
Stick to a good bed time and sleep schedule before departing. Don’t miss out on sleep in an attempt to beat jet lag.
Adjust your bed time by a few hours before you leave, depending on which time zone to which you’ll be traveling.
If you’re only traveling for a few days, don’t worry about adjusting to a new time zone.
Don’t sleep on the flight, unless the flight includes your usual bed time.
Don’t consume alcohol or caffeine, but do drink plenty of fluids.
Keep up with your exercise routine, just not too close to bed time.

Surgery is slightly better than non-surgical treatment for patients with carpal tunnel syndrome who don’t have severe nerve damage (denervation), new research has found.

The study included 44 patients who had surgery and 52 patients who had non-surgical treatment, such as hand therapy and ultrasound. A year after treatment, the patients’ hand function was measured using the Carpal Tunnel Syndrome Assessment Questionnaire (CTSAQ).

The patients who had surgery showed an advantage in both function and symptoms — calculated by proportions of patients having at least 30 percent improvement in CTSAQ scores for these indicators, and having minimal interference in daily work or household activities. The study found that 46 percent of surgery patients and 27 percent of non-surgery patients met all three criteria.

“Overall, these data indicate that, in patients with carpal tunnel syndrome without denervation, surgery modestly improves hand function and symptoms by three months compared with a multimodality non-surgical treatment regimen, and this benefit is sustained through one year,” wrote Dr. Jeffrey Jarvik, of Harborview Medical Center at the University of Washington in Seattle, and colleagues.

“However,” they continued, “some patients allocated to surgery reported persistent symptoms, and 61 percent of patients allocated to non-surgical treatment avoided surgery altogether. Our study, together with previous evidence, indicates that surgery is useful for patients with carpal tunnel syndrome.”

The study appears online Sept. 24 in a special surgery issue of The Lancet.

Patient treatment preference is an important factor, two Swedish doctors noted in an accompanying editorial. When patients are “faced with the need to wear a splint each night and during daytime for some weeks, some might prefer early surgery while others may prefer partial recovery to potential surgical risk,” wrote Dr. Isam Atroshi and Christina Gummesson, both of Lund University.

“Nevertheless, patients with carpal tunnel syndrome who do not have satisfactory improvement with non-surgical treatment should be offered surgery,” the editorialists concluded.

Another study in the special surgery issue of The Lancet found that placing a drain in the skull after surgery reduces the risk of death and recurrence among patients with chronic subdural hematoma, in which blood collects under the dura, the outer protective membrane that covers the brain.

After surgery to drain the blood, between 5 percent and 30 percent of patients have recurrence of chronic subdural hematoma and require redrainage, Peter Hutchinson of Addenbrooke’s Hospital in Cambridge, U.K., and colleagues noted.

In the study, the researchers assessed 215 patients, aged 18 years and older, with a chronic subdural hematoma who were treated using the burr-hole surgery technique. Of those patients, 108 had a plastic drain inserted a few centimeters into the subdural space after surgery. The drain was left in for a few days.

Subdural hematoma recurred in 10 of 108 people (9.3 percent) with the drain and in 26 of 107 (24 percent) of patients without the drain. After six months, 8.6 percent of patients in the drain group and 18.1 of those in the non-drain group had died, the researchers reported.

A common, nonmalignant tumor of the breast called ductal carcinoma in-situ or DCIS may need a name change because the word “carcinoma” scares so many women, a U.S. panel of experts said on Thursday.

They said the term carcinoma creates a lot of worry in women who fear they will develop cancer, even though long-term survival rates for DCIS are excellent, approaching 100 percent. “We’ve had long discussions about this,” Dr. Susan Reed of the University of Washington School of Medicine told a briefing.

She was one of several independent panelists asked by the National Institutes of Health to look into whether too many women are being treated too aggressively for a condition that is poorly understood.

“If you use a word that evokes fear, as the word carcinoma may, I think we need to consider is that appropriate,” said Reed, who favors changing the name to something less scary.

DCIS is a condition in which abnormal cells accumulate in the breast duct, but have not spread to other tissues in the breast.

Since the start of widespread mammography screening in the 1980s, rates of DCIS diagnoses have increased sevenfold. By 2020, an estimated 1 million U.S. women will be living with a DCIS diagnosis.

And because most women diagnosed with DCIS get treated for it — with surgery to remove the cells and sometimes radiation — little is known about how much of a risk it presents, or whether some women might do well with less or no treatment.

“Despite having had a century of knowledge of the disease, we do not understand the natural history of DCIS, and probably never will,” Dr. Carmen Allegra of the University of Florida, who chaired the panel, told the briefing.

After two days of scientific presentations and many discussions, the panel is urging scientists to come up with better ways to determine which women with DCIS might develop invasive breast cancer.

“Given that this diagnosis has significant emotional impact for the women diagnosed with it, we felt it was critical to develop methods that would allow a very precise determination of exactly which patients would ultimately be at risk for developing invasive disease,” Allegra said.

And he said the medical community needs to at least consider whether the name of the condition, which raises the specter of cancer, may need to be changed.

Not all panel members think that is a good idea.

Dr. Arnold Schwartz, a surgical pathologist at George Washington University Hospital, said the cells that eventually replace the duct are identical to the cells in invasive cancer, suggesting that DCIS is a precursor to cancer.

“We have many other cancers in the body and precursor cancers that are also called carcinoma in-situ. Cancers of the skin, head and neck, esophagus and bladder also have the term carcinoma without any emotional impact,” he said.

More than 400,000 women in the world die from breast cancer each year.