At the end of 20 1 1, the Ministry of Health proposed in a document that the use of PET-CT should be standardized to protect the legitimate rights and interests of patients, and the positive rate should be no less than 70%. This statement means that PET-CT must be used according to symptoms in the future. In practice, the proportion of cancer detected by PET-CT in all medical institutions is less than 2%. What prompted 98% healthy people to spend nearly 10,000 yuan to take unnecessary risks?
PET-CT is used for the profiteering business of physical examination, and PET-CT is used for the physical examination of healthy people. There are always different opinions. Real experts never support healthy people to do it, and doctors who do PET-CT will not do it themselves or let their families do it.
"The main reason is the low detection rate of tumors." Tian Jiahe, chairman of the Nuclear Medicine Branch of the Chinese Medical Association and professor of nuclear medicine at the 30/KLOC-0 Hospital of the People's Liberation Army, said that the relevant statistics at home and abroad are 1%-2%. In recent years, 20% of the people who underwent PET-CT in 30 1 hospital were for physical examination, of which 1.3% was diagnosed as malignant tumor and 20% was detected.
Let healthy people use PET-
On CT physical examination, Tian Jiahe's attitude is "neither advocating nor opposing". However, Tian Jiahe found that some colleagues prefer to make the most direct evaluation of health economics-making money with PET-CT.
In China, the cost of PET-CT examination varies. Take a general checkup as an example. The unified price in Shanghai is 7,500 yuan, in Guangzhou it is 8,000-1 10,000 yuan, and "the most expensive in Beijing" is110,000-10.5 million yuan. The intermediary website said that "group buying with more than 5 people can help apply for a 10% discount".
The person in charge of the nuclear medicine department of a well-known hospital in Beijing told Southern Weekend reporter that the operating cost of PET-CT is quite high, with the import price of more than 20 million RMB, and the cost is about 30 million RMB with the personnel and maintenance fees. However, due to the sufficient source of the disease, a PET-CT has reached an income of 45 million yuan in only 20 1 1 year, and the cost has been recovered in one year.
Lin Hongwei, a tumor surgeon in the 306 Hospital of the People's Liberation Army, took the lead in publicly criticizing the abuse of PET-CT in Weibo. He appealed: "PET-CT is not used for physical examination!"
He asked many questions.
Doctor, "will you let your healthy family have a PET-CT physical examination?" The answer is usually "no".
You can ask around.
Doctor, will he check? Will his family check it out?
The risk of being hidden and ignored
In fact, when PET-CT is extremely popular, practitioners conceal the risks of PET-CT. The safety of PET-CT has been questioned. In April 2009, an article in the journal Radiology pointed out that radiation dose studies in Hong Kong and the United States showed that whole-body PET-CT scanning was accompanied by a large number of radiation doses and cancer risks.
In April 2009, the journal Radiomedicine of the Radiological Society of North America reported that whole-body PET-CT scanning was accompanied by a large amount of radiation dose and cancer risk.
Professor Pek-LanKhong, director of the Department of Radiological Diagnosis of the University of Hong Kong, and other researchers used three kinds of current mainstream PET-CT instruments. The results showed that the radiation dose was between 13-32 millisieverts. The incidence of cancer related to PET-CT is 0.2%-0.8%, and the younger the age, the greater the risk.
Therefore, the researchers suggest that PET-CT examination should be carried out after sufficient clinical reasons, and measures should be taken to reduce the dose.
Professor Robert E. Reiman, from the radiation safety department of Duke University Medical Center in the United Kingdom, said in an interview with Southern Weekend, "It is recognized by the scientific community that the damage caused by radiation will accumulate with the increase of exposure to radiation. Therefore, every PET-CT examination will increase the risk and eventually bring significant radiation dose after a period of time. " Robert e Lehman emphasized that children will face greater risks.
However, there are almost no active tips on the booking website, just doing it.
People who have finished PET-CT examination, as potential radioactive sources, should avoid too much contact with pregnant women and children in a short time.
Japan is the earliest and most widely used.
The countries where PET-CT is used for physical examination have given birth to the international "physical examination tourism" service. This service has also attracted a large number of people in China. However, even in Japan, the controversy of PET-CT physical examination is inevitable.
"What is the cost-effectiveness of using PET-CT for physical examination? The evidence in this regard is not sufficient. " Kouta, director of statistical analysis department of Japanese National Cancer Center, said, "At present, PET-CT physical examination is mainly driven by the interests of some medical institutions, and we are still waiting for more.
No amount of evidence will serve as a guide to promotion. "
A paper published in the Asia-Pacific Journal of Cancer Prevention in 2007 expressed a more negative view. It is found that the positive predictive value of PET-CT in the physical examination of healthy Japanese aged 50 -59 is only 3.3%. In other words, nearly 97% of abnormal tumor patients found in PET-CT physical examination are not really malignant tumor patients.
At the recent European Radiology Annual Conference held on 20th/20th/2nd, a multicenter study showed that PET-CT was not superior to CT or MRI in these two aspects.
The Canadian Medical Service Research Foundation, a non-profit organization funded by the Canadian government, also pointed out that PET-CT scanning can not only prevent cancer-related deaths, but also bring risks to patients. The foundation's report pointed out that a good inspection should be sensitive and specific, with a low error rate. It should be able to reduce the mortality rate of a certain disease and should not cause undue harm to people.
"There is no evidence that PET-CT scanning can prevent cancer.
Death related to disease. After combing many papers on the evaluation of the physical examination effect of PET-CT in recent years, the report said, "PET-CT scanning is neither sensitive nor specific, but it also brings many risks to patients, including unnecessary examination, excessive radiation exposure and high error rate. In addition, it also increases the chance of over-medical treatment. "
Doctor's view from the perspective of scientific ethics
A chief physician in the Department of Gastroenterology and Oncology, Beijing Cancer Hospital pointed out that PET-CT has a blind spot in finding lesions in hollow organs (stomach, intestine, etc.). ), so it can't replace routine examinations such as gastroscopy and colonoscopy.
Ouyang Xuenong, director of the Oncology Department of Fuzhou General Hospital of Nanjing Military Region, said: "Generally, physical examination is not recommended for healthy people. Because of the high cost and radiation of this kind of examination, there are still blind spots in the hollow organs (such as esophagus, stomach, intestine, etc.). ), can not replace gastroscope and colonoscopy. "
Doctors in the aforementioned 3A cancer hospital pointed out that PET-CT examination cannot replace CT and MRI examination. "Every kind of inspection has its advantages. Sometimes when doing PET-CT examination, we will ask patients to do further CT, MRI and even B-ultrasound examination. "
In fact, PET-CT can't detect all tumors. In the diagnosis of primary liver cancer, PET-CT is ineffective.
Some opinions even question the necessity of the whole health examination. "The regular physical examination of healthy people itself needs to be questioned." A radiologist at Peking Union Medical College Hospital told Caixin New Century, "PET-CT can find some small tumors, but sometimes even if it is found, it is meaningless. Because it is too small to be tested, such an examination can only cause patients' anxiety and lead to rounds of unnecessary examinations. "
In fact, despite the imaging examination and judgment
Whether it is a malignant tumor or not still only follows a "gold standard", that is, the pathological examination of the diseased tissue. "New inspection methods are emerging one after another, and the images are getting clearer and clearer, but must it be a good thing?"
Professor Qiao, an expert in tumor epidemiology from China Academy of Medical Sciences and Peking Union Medical College, also holds a negative attitude towards the use of PET-CT in physical examination of the general population. He pointed out that at present, many cancers have mature, simple and cheap detection methods, while PET-CT examination is too expensive and risky, and "does not have the value of popularizing to the whole people."
"It is definitely not a good medical behavior to let every healthy person receive PET-CT scanning." David W.Townsend, the world's first professor at the National University of Singapore who participated in PET-CT research, told Southern Weekend reporter.
When I visited the cancer testing center in Finland, I specifically asked about the scope of use of PET-CT. Professor Marku Marttila, the dean, told me that PET-CT would not be used casually for physical examination. "No matter how much money you have, it's useless. After you have to check with other instruments, the doctor thinks it is necessary. "
"This is not because of the price, but because of the risk." Cornelis A. Hoefnagel, a nuclear medicine expert at the Dutch Cancer Institute, said, "Only three people out of 1000 people may be detected in a PET-CT physical examination like Japan. It is not worthwhile for another 97 people to bear the radiation risk for three people. "
Radiation dose of PET-CT
The imaging agent used in PET-CT examination is generally fluorine-18( 18F-FDG) with radioactive isotope, and the injection measurement of 0. 1 mCi/ kg body weight is calculated. Generally, the measurement of radioactive developer injected by the examinee will not exceed 10mCi. That is to say, after 1 whole-body PET-CT examination, the radiation dose is about 10-32 millisieverts, and the natural radiation dose received by ordinary people every year is 1000-2000 microsieverts (note: 1000 microsieverts =/kloc-
The simplest metaphor: a whole-body examination of PET-CT is equivalent to a normal person's radiation for 30 years, and it is accepted in one hour. It is equivalent to standing on the second day after the Fukushima nuclear power plant leak in Japan.
Postscript: On the issue of PET-CT, many leaders and bosses asked me if I was good, because what they heard was advanced and good. Today, I finally wrote about the unknown radiation hidden in 1 PET-CT in the morning, which is a popular science.