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Dealing with the menace of incidentalomas .
Carmel Sparke “ YOU have got a community that
thinks modern medicine is amazing and it can tell them everything with certainty , and the reality is it cannot .” Associate Professor Tom Suth-
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‘ Should we do an MRI ? These are the little things causing a lot of anxiety .’
— Associate Professor Tom Sutherland .
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FAIRFAX |
benign will make you correct more than 99 % of the time , thus avoiding the snowball , he says .
But applying this label is obviously difficult for radiologists , who do not want to miss cancer .
Professor Sutherland acknowledges that his “ runs on the board ” make the harder calls easier for him compared with less experienced colleagues .
However , there are also the patients themselves — with literal
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erland describes a truth doctors are |
skin in this cost – benefit game — who |
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forced to acknowledge every day of |
understand what it means if they |
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their working lives . |
come out the loser . |
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As a radiologist over the past 20 |
Professor Sutherland talks of a |
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years , he has benefited from a revolu- |
woman recently referred to him for |
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tion : dramatic improvements in imag- |
a thyroid biopsy outside the clinical |
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ing technology . |
guidelines . |
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He said recently that a CT scan now |
“ I said , ‘ We do not need to do this ; |
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offers him 240 slices of brain in con- |
we should not do it . It is not the right |
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trast to the 24 when he first qualified . |
thing .’ |
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Also a director of imaging at Mel- |
“ It took 20 minutes of conversation |
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bourne ’ s St Vincent ’ s Hospital , he |
to get her to understand and accept |
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appreciates the wonders it has made |
that . |
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possible . |
patient ? These are the tiny little things |
a patient referred for an abdominal |
a breast nodule that gets an ultra- |
“ The reality is it would have been |
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But he says the incidental findings |
that are causing a lot of the anxiety ,” |
scan for suspected gallstones . |
sound , mammogram and a biopsy of a |
quicker for me to do the biopsy — and |
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that these machines pick up are creat- |
Professor Sutherland tells AusDoc . |
The scan detects an incidental liver |
fibroadenoma . |
more lucrative . |
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ing serious headaches given that their |
Various studies have estimated that |
lesion , so the radiologist suggests a |
“ All of a sudden , you have seen a |
“ I have had these conversations |
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unknown nature can trigger spiralling |
incidentalomas occur in about 15-30 % |
liver CT . |
GP with gallstones , and now you have |
before with other patients , and I |
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investigations , which usually — but |
of all diagnostic imaging tests , increas- |
The subsequent scan shows it is |
had $ 2000- $ 3000 of tests done and an |
have no doubt they have just gone to |
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not always , to make a critical point — |
ing to 20-40 % with CT and MRI scans . |
benign but finds a lung nodule . |
invasive procedure for no benefit .” |
another practice and had it done . |
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reveal nothing sinister at all . |
To highlight how big the snowball |
“ So the doctors then suggest a |
In a patient under 45 , calling the |
“ There I am thinking I have |
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“ Should we do an MRI in that |
rolls , Professor Sutherland talks about |
CT chest to investigate , and it shows |
original lesion on the ultrasound |
spent 20 minutes making |
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