Case I read in the JAMA which I get because I signed up during covid.
Late 20's Hispanic lady shows up in the ER with what they think is probably food poisoning. But they do a CT. Which shows changes in her liver which probably is a fatty liver. But they do a biopsy just in case. Biopsy results in a bleed which requires a transfusion and 4 days in the hospital. Biopsy result, fatty liver.
There is also a nontrivial chance of every CT scan to cause fatal cancer. It's a ton of radiation[1], and ERs love pushing it indiscriminately on vulnerable people.
Surprisingly few ER docs anywhere in the world have even a rudimentary understanding of the risks of CT scanning patients. There's a lot of information around about this, but my own first hand (anecdotal) experience is that I've had ER docs try to convince me that it's basically the same as an X-Ray and act like I'm a crazy person when I explain that it's orders of magnitude higher and cumulative over a lifetime. On one hand, it's not their job to care about your long term health - they need to rule out an emergency and get you out the door as quickly as possible - but it's very concerning.
It's a bit like how general practitioners aren't taught about nutrition at all, so give out really poor advice for heart disease patients (the leading cause of mortality in Western economies).
Edit: For comparison, a chest X-ray is around 0.1mSv, a chest CT at 6.1mSv, so a factor of 61 between (https://www.radiologyinfo.org/en/info/safety-xray ). Compared to natural exposure (usually 1 to 3mSv/a) however, a chest CT isn't that bad at 2 to 3 years natural dose, 2 polar flights or 1 year of living at higher altitude or Ramsar (https://aerb.gov.in/images/PDF/image/34086353.pdf ). Acute one-time dose damage has been shown above 100mSv, below that there is no damage shown, only statistical extrapolations.
So I'd say that the risk of using a CT right away should be lower than the risk of overlooking a bleed or a clot in an emergency, where time is of the essence and the dance of "let's do an X-ray first..." might kill more patients than the cancers caused by those CTs.
> On one hand, it's not their job to care about your long term health - they need to rule out an emergency and get you out the door as quickly as possible - but it's very concerning.
Yeah, but what's the alternative when you have a stroke? They need to understand it's type and the mistake here is likely to be fatal since they require opposite treatments.
Late 20's Hispanic lady shows up in the ER with what they think is probably food poisoning. But they do a CT. Which shows changes in her liver which probably is a fatty liver. But they do a biopsy just in case. Biopsy results in a bleed which requires a transfusion and 4 days in the hospital. Biopsy result, fatty liver.