Are you being over-radiated?

Item: On Saturday morning – a slow day in the news biz – I awoke to read a story on The Star-Telegram's website about Baylor Health Care System teaming with Texas Oncology, our state's largest cancer physicians group, to build a radiation treatment facility that uses proton therapy. The estimated cost: $50 million (Although CURE enjoys editorial independence, in the interest of full disclosure, I must report that Texas Oncology is an affiliate of U.S. Oncology, a division of McKesson Corporation, which owns CURE Media Group). Currently, there are nine proton facilities in operation nationwide and, since this would be the first in North Texas, organizers are hoping to locate the treatment center near D/FW International Airport, to accommodate patients traveling from throughout the region. In other words, why send patients to Oklahoma City's ProCure Proton Therapy Center or the M.D. Anderson Proton Therapy Center in Houston when they can spend their healthcare dollars closer to home?Item: On Saturday evening, the ABC Weekend World News led its broadcast with a story about recently released government data that indicate hospitals across the country needlessly exposed patients to radiation by scanning their chests twice on the same day. In 2008, the most recent year data were available, about 75,000 patients received double CT scans. A single CT scan is roughly equivalent to 350 standard chest X-rays. The problem, it seems, isn't so much with big-city hospitals but with smaller community hospitals. At major university teaching hospitals, a second CT scan is rarely, if ever, performed. But at smaller community hospitals with fewer resources, second scans are done more than 80 percent of the time. To make a quick and efficient diagnosis, the smaller hospitals will often perform one scan using iodine contrast to check blood flow, and one that does not. The annual cost to Medicare for this overexposure: $25 million.Item: In February, Laura Beil, a frequent contributor to CURE magazine, wrote in Men's Health about the business of proton therapy. Although proton therapy is clearly a superior treatment for certain childhood cancers, brain cancers and cancers in delicate places where surrounding tissue survival is crucial, it has not proven to be superior to conventional radiation treatment for prostate cancer. Yet in some proton therapy facilities, prostate cancer cases make up roughly half of patients treated annually. Why? Economics. "At the University of Pennsylvania's Roberts Proton Therapy Center, one of the world's largest, Medicare will reimburse $438 for a round of conventional radiation but will pay $1,282 for a proton blast. (Prostate-cancer treatment typically takes 44 sessions.)," Beil reported.There's a common theme that runs through these items: Sometimes, treatments are recommended that are not in the best interest of the patient but in the best interest of the hospital's bottom line. Here in North Texas, as Baylor battles UT Southwestern Medical Center for cancer-treatment supremacy (Baylor officials have admitted to me that it's their aim to become the M.D. Anderson of North Texas), it should come as no surprise that it would make such an investment for a technology that benefits relatively few patients – so few, in fact, that Baylor is compelled to locate its football-field-sized facility near the international airport for the "convenience" of patients traveling from throughout the region. Consider what James A. Brink, MD, chief of diagnostic radiology at Yale-New Haven Hospital, admitted to ABC News regarding radiation overtreatment: "There may be some financial motivation in certain instances."My best advice: Patient, beware! If you think you've received too much radiation exposure, either because your cancer meant an easier reimbursement or because your facility didn't have adequate staff to limit your exposure, let me know. Your exposure could simply be the price patients pay for proper treatment. Or it could be the personal cost of hospitals' doing business.