Should I get a CT (Computed Tomography) scan?

CT Scan Decision-Making: When Is It Appropriate?

A CT scan should only be performed when there is a clear clinical indication based on your symptoms, physical examination findings, and medical history, as the benefits must outweigh the potential risks of radiation exposure.

Appropriate Clinical Scenarios for CT Scanning

CT scans are valuable diagnostic tools in specific clinical situations:

Acute Abdominal Conditions

• For suspected acute intra-abdominal abscess: CT with IV contrast is the preferred initial diagnostic imaging modality in non-pregnant adults 1
• For suspected acute diverticulitis: Abdominal CT is suggested as the initial diagnostic modality 1
• For suspected acute cholecystitis/cholangitis: Ultrasound should be the initial imaging test, with CT as a subsequent imaging option if ultrasound is equivocal 1

Trauma Evaluation

• For major blunt trauma: CT with IV contrast is recommended, particularly for high-velocity accidents, falls from height >15 feet, or when there are concerning clinical findings 1
• For suspected internal bleeding: Contrast-enhanced CT is the key study for assessing bleeding sources 1

Inflammatory Bowel Disease Emergencies

• For acute IBD complications: IV contrast-enhanced CT is recommended to exclude intestinal perforation, stenosis, bleeding, and abscesses 1

Head and Neck Masses

• For evaluation of neck masses: CT provides detailed information about soft tissue and bones when a concerning mass is identified 1

Risks and Considerations

1. Radiation exposure: A CT scan uses radiation—about as much as 150 chest x-rays 1
2. Contrast reactions: Possible allergic reactions to contrast dye 1
3. Limited value in certain conditions: Some conditions are better evaluated with other imaging modalities like ultrasound or MRI

Special Populations

Pregnant Patients

• Ultrasound or MRI are preferred initial imaging modalities 1
• CT should be avoided unless absolutely necessary

Children

• Ultrasound is suggested as the initial diagnostic imaging modality for suspected intra-abdominal abscess 1
• The risk-to-benefit ratio of radiation exposure should be carefully considered 1

Alternative Imaging Options

1. Ultrasound: Preferred for initial evaluation of gallbladder disease, soft tissue masses, and in pregnant patients or children
2. MRI: Better for soft tissue evaluation, no radiation exposure, but may require longer scan times and has limitations with certain implants 1
3. Plain radiographs: May be sufficient for certain skeletal evaluations

Making Your Decision

When deciding whether to get a CT scan:

1. Discuss with your healthcare provider the specific clinical concern that warrants imaging
2. Ask about alternative imaging options that might provide the necessary information with less risk
3. Consider the urgency of your clinical situation—emergency conditions may warrant immediate CT
4. Understand the benefits of obtaining a definitive diagnosis through CT versus the potential risks

Remember that selective use of CT increases diagnostic accuracy and improves management of patients with acute conditions 2, but unnecessary scans should be avoided to minimize radiation exposure.