CT Cervical Spine

A computed tomography (CT) scan uses X-rays to create detailed, three-dimensional images of the spine and vertebrae in the neck (cervical spine). About half of diagnostic CT examinations in adults are scans of the body and about one third are scans of the head and neck. Current machines typically have multiple rows of detectors operating side by side, so that many slices (currently up to 64) can be imaged simultaneously, reducing the overall scanning time. All the data are processed by computer to produce a series of image slices representing a three-dimensional view of the target organ or body region. A CT study has an average of two to three CT scans. The advent of computed tomography has revolutionized diagnostic radiology. Since the inception of CT in the 1970s, its use has increased rapidly.

Reasons for a CT scan include suspicion of tumors, fractures, deformities, infection, spinal stenosis, herniated discs, or compression fractures secondary to osteoporosis. CT is commonly used to confirm or further explore problems identified on x-ray. In a study at the Grant Medical Center, nearly one fifth of trauma patients who had a CT scan of the cervical spine during an initial trauma evaluation had incidental findings, including fractures of the ribs and skull, as well as osteopenia, osteoporosis and emphysema, These findings highlight the sensitivity and utility of the CT scan as a diagnostic tool.

However, recent research, such as the findings published in the Archives of Internal Medicine, add to mounting evidence that Americans are overexposed to radiation from diagnostic tests, especially from computed tomography. This is because CT scans have much larger radiation doses than conventional X-rays. A study done by the National Cancer Institute estimated that radiation from more than 70 million CT scans performed in the United States in 2007 will ultimately cause about 29,000 cases of future cancer and a possible 15,000 deaths. Most experts feel that for any one person the risk of radiation-induced cancer is much smaller than the natural risk of cancer.

Thus, given the potential risk, over utilization of computerized tomography should be avoided. Providers should consider reducing radiation doses or using other options, such as ultrasonography and magnetic resonance imaging (MRI). Limiting the number of CT studies to only medically necessary situations and increasing communication among providers to avoid duplicate testing are imperative. The PRC for cervical CT provides the appropriate criteria for using this diagnostic tool.