is Associate Professor of Radiology and Obstetrics &
Gynecology and Director of Ultrasound at Dartmouth Medical
School and Dartmouth-Hitchcock Medical Center, Lebanon, NH. He
is also a member of the editorial advisory board of this
You certainly don't need me to trumpet all of the wondrous
advances in medicine these days. Some of these cutting-edge
developments also have their darker side, if you will. Our
department recently hosted Dr. Paul Chang, Director of Informatics
and PACS at the University of Pittsburgh as a visiting professor.
He related the story of how several entrepreneur radiologists on
the West Coast had started entire body CT scans on paying
"customers" to screen for potential disease. He called them "Yuppie
Scans," as they were seemingly designed for the self-absorbed,
immortality-seeking types that are prevalent amongst my generation.
Now, this wasn't news to most of the world (I understand there was
an article on this topic in Newsweek recently), but here in
Northern New England, home of the picturesque village green and
quaint country store, this was rather a hot item.
As an editorial aside, I choose to live here in a large part for
the quality of life. In fact, it is unofficial but common knowledge
to be one of the prime employment benefits (in lieu of the more
common hard currency) at our institution. My own family has also
elected to be one of the few homes in the entire civilized world
without cable or satellite television. We receive a total of three
channels, and that's with a big deer-rack antenna on our little
cape roof. On a really good Saturday night, a fourth station comes
in: I can envision little skating "ghosts" on Hockey Night in
Canada on a Montreal station (in French, sans doute!). This comes
in with the same spatial resolution as a mediocre gallium scan.
Forget about seeing the puck, one needs more than just a little
imagination. Enough digression.
With this background in mind, one could have knocked me over
with a maple leaf with this futuristic use of imaging on the Left
Coast. With the average lag time of several light years for
phenomena to journey from hip California to rural New Hampshire, I
could be six feet under by the time this trend reaches here.
Anecdotally, it seems like the radiologists involved with Yuppie
scans have indeed saved some lives from "incidental" pancreatic or
renal cancers being unearthed. Having seen several friends and
acquaintances (including radiologists) die from these insidious
diseases, this is undoubtedly wonderful news. But what of the other
ramifications? Who should go through with this testing? It is
offered to anyone who can pay for the CT screening, although you
had better bring your wallet (or valid credit card) to the
appointment. What about the further diagnostic testing, biopsies,
and even surgery, often for benign disease, engendered by this
indiscriminant screening? The added cost in physical terms and
psychic toll are difficult to ascertain, but are certainly
significant. There are no NIH or NCI guidelines, no clear mandates
other than a discretionary income. Dr. Chang predicted that in 2
years this will be a big subject in radiology and medicine,
engendering panel discussions at the RSNA, pro- and con- articles,
and editorials, etc.
In closing, you may have heard about the old New Englander who
was asked by a "flatlander" (from elsewhere) if he had lived in New
England all his life. The old man replied, "Not yet." If the yuppie
scan were offered to me, I would say "not yet." At least, not until
we know more about the advantages and drawbacks. So excuse me, it
is about time for the second period face-off of the hockey game.
Now where did I put my special nuclear medicine reading