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CT vs Chest x-ray Need Opinion


lindseysmom

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Need your opinion. I asked my oncologist in April to do a CT scan, however he said it was not necessary. He said that a chest x-ray is all I needed, and that a CT is good for diagnosing but the x-ray is just as good to see if the disease is progressing. He told me he had written a paper on this. My thoughts are the x-ray may show if the tumor has changed, but may not show any new tumors. I have another appointment on July 19th and again he has only scheduled a x-ray. I would perfer a CT or does it seem that I am overreacting. I would love your thoughts on this.

Thanks so much.

Dee

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What's his name and where was this paper published? Was it peer reviewed? Anyone can write a paper. I can writer a paper, but I wouldn't recommend that you rely on it.

CT scans are more detailed studies. My first oncologist recommended a chest xray one year out from surgery as follow up. Had I followed his recommendation I would have found out in June of 2000 about the 4th tumor in the right lung upper lobe that was removed in April of 2000.

I would not accept an xray as followup for a diagnosis of lung cancer. Period.

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There is a machine called RapidScreen-2000 that will digitize an X-ray and make an X-ray about as sensitive as a CT scan

http://rsna2003.rsna.org/rsna2003/VBK/c ... id=3107535

http://www.ynhh.org/healthlink/cancer/cancer_2_01.html

J Thorac Cardiovasc Surg. 2003 Jun;125(6):1300-5. Related Articles, Links

Usefulness of low-dose spiral CT of the chest in regular follow-up of postoperative non-small cell lung cancer patients: Preliminary report.

Chiu CH, Chern MS, Wu MH, Hsu WH, Wu YC, Huang MH, Chang SC.

Chest Department, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.

OBJECTIVES: There is no consensus for the best postoperative follow-up in patients after complete resection of non-small cell lung cancer. Low-dose computed tomography of chest proves valuable in screening primary lung cancer and may be a useful tool in postoperative surveillance. METHODS: In part 1, 30 patients who underwent surgical resection of non-small cell lung cancer and were at the first (n = 14), second (n = 9), or fifth (n = 7) annual postoperative surveillance were selected chronologically and subjected to chest radiography, low-dose computed tomography, and standard-dose computed tomography to verify the diagnostic accuracy of low-dose computed tomography. In part 2, 43 patients were prospectively enrolled and followed up regularly after complete resection of non-small cell lung cancer. The follow-up protocol included physical examination, sputum cytology, serum carcinoembryonic antigen, chest radiography, and low-dose computed tomography every 3 months in the first 2 years postoperatively until tumor recurrence. RESULTS: In part 1, tumor recurrence was detected by standard-dose computed tomography in 7 cases. Low-dose computed tomography and chest radiography missed 1 and 5 of 7 cases, respectively. In part 2, tumor recurrence was found in 14 cases with 19 metastatic sites. Thirteen of the 14 (92.9%) cases were detected by scheduled visiting and 11 (78.6%) detected by low-dose computed tomography including the 7 without symptoms. Of the 19 recurrent sites found in 14 patients, 11 ones (57.9%) were detected by low-dose computed tomography. CONCLUSIONS: Low-dose computed tomography may be of considerable value in early detection of tumor recurrence in postoperative non-small cell lung cancer patients. Further large prospective studies are needed to verify this issue.

PMID: 12830048 [PubMed - indexed for MEDLINE]

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My doctors have always used CT chest/abdomen scans to montior me and I wouldn't be comfortable with just X-rays...especially since they are watching liver involvement. On top of which, what is the doctor's objection to using a CT scan? I would be frustrated with that and, when I get frustrated, I usually am looking for a different doctor. Good luck with this.

Margaret

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Guest bean_si (Not Active)

Please insist on a CT scan of the thorax. Insist on it. If he refuses, think about changing doctors. BS to his paper. From all I've learned, a CT is much more able to track any increase or decrease in tumor size.

Cat

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Looks like you are getting a concensus. I too think you should insist on a CT scan. ALOT of people on this website can tell you that their tumors were not picked up on an x-ray (including mine) My tumor is still not showing up on x-rays.

If your doctor still does not want to do a CT scan, switch doctors. He is not looking out for your best interest. Like Margaret said, the CT scan also picks up the upper abdomen which includes the liver. It is very important to be vigilant in keeping up with any new growths, don't let the cancer get the upper hand!

Good Luck,

TAnn

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I agree with everyone else. I would request a CT of the chest and abdomen because this disease can be pretty sneaky and there can be mets in other places while the chest can look OK. You have every right to get the very best care possible.

I wonder . . . if he was the one with lung cancer, would he think a chest x-ray was sufficient?

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My tumor DID show up on an x-ray - and was IIIa. The tumor was small, didn't show up on x-ray a mere eight months earlier when it was probably quite a bit smaller...

My oncologist follows me (currently) alternating x-rays with CT's every three months. I think you would be wise to get a CT and that your doctor should "humor" you. After all, if you are all clear, you'll sleep better, but if you AREN'T, you'll know sooner. X-rays aren't for soft tissue - remember that the first time you heard of someone having an x-ray was when a doctor thought a BONE might be broken...

Becky

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I agree with the others. My tumor was missed on a xray three years before it was picked up by a different radiologist. The standard practice in this area is follow up with ct if something suspicious is seen on xray. I had ct scan every three months for two years after surgery, then went to every four months and just graduated to every six months. If the doctor doesn't agree to a ct scan I'd change doctors mighty fast.

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I asked the same question months ago. My doctor does xrays every 6 months and alternated with CT scans every 6 months. This time I am scheduled for a MRI of the brain as well. I would insist on a CT...you have been nearly 6 months without one. If they see something on the CT they can then do a PET. Don't wait for symptoms.

Nina

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I don't know too much about this - it seems to me that it wouldn't be unreasonable for you to have a CT as it looks from your signature that you haven't had one since last year.

When considering what investigative tools to use, I think you also have to look at what difference it will make to treatment options. For example, mum had a PET and Bone scan in August last year, and we know that there was lymph node and rib involvement at that time. Mum started six months of chemo, which she completed last month. She didn't have another PET or Bone scan, because even if more bone mets had developed, the treatment protocol was not going to change. She did have a CT scan after completing 2 cycles and again at the end of the 6, essentially to monitor what effect the treatment was having on the primary tumour. She is currently stable, and due to see the Onc in 3 months, at which time I presume she will be having another scan.

Wishing you well.

Karen

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Hello Lindseysmom,

I had a 1.8 cm tumor in my lung and the chest x-ray tipped them off. They said they saw a spot on my lung so I was sent for a cat scan. So I guess the chest x-ray was of some benefit. I had the lobe removed and nearly four months after surgery, the chest x-ray showed no change. So I don't know if I should be too confident after reading all the answers to your post. Hope you are okay,

S haron

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