You know the drill, resident experiences an unwitnessed fall, seems okay, maybe a little confused, call the physician, order to send to ER for evaluation. Three hours later, resident returns, no new orders, CT scan “negative”, done. Unfortunately, many CT scans are done too soon post fall/injury and bleeds aren’t always evident, resident returns to the ER 48 hours later and lo and behold, there is evidence of a bleed. Is the bleed related to the fall 72 hours earlier or was it a spontaneous bleed? Hard to tell however, the majority of diagnoses will reflect “related to previous fall” or “blunt force trauma,” rarely will there be a diagnosis of “spontaneous bleed.” Right, wrong, or indifferent, the resident has now had 2 CTs, the first likely unnecessary. No big deal, Medicare covers it, the family is happy because more testing is done and although there is a bleed, it may not need surgical intervention.

However, did you know that CT scans may be responsible for approximately 5% of cancers diagnosed each year? A recent study reported in MedPage Today projected that CT exams in 2023 alone could lead to over 100,000 future cancers across the lifetime of exposed patients. These risks of CT scans in older adults are worth paying attention to—especially when imaging is repeated within a short time frame.

Still no big deal? Well, as with all research there are differing opinions. The American College of Radiology (ACR) responded to this study by emphasizing that “there are no published studies directly linking CT scans (even multiple CT scans) to cancer.” They also remind us that “Americans should not forgo necessary, life-saving medical imaging and continue to discuss the benefits and risks of these exams with their healthcare providers.”

Agree—the conversation should be had. But maybe we shouldn’t wait until something happens. Maybe this type of transfer should be discussed upon admission. A thoughtful perspective on this balance is shared in a recent JAMA Internal Medicine article, which explores how providers can weigh the benefits of imaging against potential harm.

There is obviously no easy or correct answer—this is person-centered, individualized care. Be sure your residents and families are educated on the risk and benefit of all procedures ahead of time. Review advance directives at least quarterly, initiate advance care planning when appropriate, and remember what is in the best interest of the resident is your priority. With the risks of CT scans in older adults becoming more evident, informed decision-making is more important than ever.

Stay well and stay informed!