No CT bashing

But Dr. Origitano is quick to point out that the study is not an exercise in CT "bashing."

"It does not say CT scans aren't any good," he says. "It says, if you're going to get a scan, [see] if the patient has a new neurological deficit. And if you want to see consequences for surgery, wait at least till the next day. If you get a scan too early you'll miss a lot of changes ... to occur down the line."

CT scans after brain surgery are still often required to check if a device is properly positioned, he notes, and to see how much of a tumor was removed (though he suggests MR imaging could work better for the latter).

He also notes the limitations of the study. It was conducted at one institution, so more research is needed to say how well the results carry to other health care centers.

Best practice

Dr. Origitano says the real point of the study is to identify the best practice and account for variations in how medicine is performed.

"What we're trying to do is a classical event that happens in medicine," he says. "You find out there are a number of different practices, none of which are wrong. So do we have evidence which would direct us to best practice?"

In the study, for example, one of the three doctors ordered almost nine-tenths of his CT scans within the first seven hours following surgery. The reason? That's how he learned to do it.

"In medicine, there are a lot of cultural, institutional practices which we carry forward because that's basically how we're taught," Dr. Origitano says. "A lot of what we do is not bad medicine, but it's medicine derived out of culture, habit, different schools of thinking. And as medical resources become more expensive--and any test we do including a CT scan has some risk to it--we need to be thoughtful about when we're going to apply these studies," he says.



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