An increasing number of patients are missing out on full medical treatment because of their being obese, a new study has revealed. These people are either unable to fit into the scanners, or the X-rays or ultrasound waves are not able to penetrate their body fat.
Dr. Raul N. Uppot, who led the study, is an assistant radiologist at Massachusetts General Hospital and also an instructor in radiology at Harvard Medical School, both in Boston. He, along with his colleagues reviewed all radiology records from tests performed at Massachusetts General Hospital between 1989 and 2003 to look for those which were hindered due to patient size. These reports included scans used to look for tumors, blood clots, broken limbs, injuries and diseased organs, such as standard X-rays, CT scans, MRI scans and PET scans.
When radiologists are unable to evaluate an image clearly, they mark it as “limited due to body habitus". Dr Raul Uppot and his team looked for the occurrence of this phrase in all the reports from year 1989 to year 2003.
"Obesity is affecting the ability to image these people. We're having trouble finding out what's wrong," Dr. Uppot elucidated. "When they come to the hospital, people are so concerned about the disease they have that they don't realize that being obese could hinder the ability to deliver health care". "We looked at people who were able to fit on the imaging equipment and get the scan". "When radiologists read the film, they had trouble interpreting the film because the quality of the image was not very good because of the patient's size."
Study results
The researchers found that in spite of advances in medical technology, the percentage of habitus limited reports had almost doubled. In 1989 the percent of inconclusive exams due to patient size was 0.10 percent, while in 2003 this figure had mounted to 0.19 percent.
Though the number itself was small what was more alarming was the increase in numbers said Uppot.
Many cases showed the patients too large to fit into scanners or so fat, that X-rays proved useless. This could be remedied by increasing the power on X-ray and CT machines in an effort to get a better image but would lead to an undesirable increase in radiation dose.
The different types of imaging also showed varying difficulties, with abdominal ultrasounds leading the list of the most difficult in giving proper diagnosis, with 1.9 percent followed by chest X-rays (0.18 percent), abdominal computed tomography (CT), abdominal X-rays, chest CT and magnetic resonance imaging (MRI).
The ultrasounds were the most affected according to Uppot.
"In an obese person because the ultrasound beam does not get to the organs or get to them adequately enough we cannot get a picture. It looks like a snowstorm -- I don't know if you have seen those televisions where it is just whiteout? It looks like that;" he said.
Ultrasound waves which work by sending high-frequency sound waves through the patient, where they bounce off internal organs and come back, were less able to penetrate thick fat. The situation with X-rays was also similar said the researchers. The problem was different with CT scans and MRI where weight limitations of the table and size of opening on the imager created problems for overweight people.
Uppot said that many manufacturers had started to address the issue with the weight limit for CT scans in the US having been increased from 450 pounds (204 kilograms) to 550 pounds (250 kilograms), and for MRI from 350 (159 kilograms) to 550 pounds (250 kilograms).
Conclusions
"In the past 10 years or so, medicine has become so dependent on imaging," Uppot said. "Instead of doing very meticulous clinical examinations, a lot of doctors now rely on CT scans, ultrasounds, etcetera, to tell them what's happening inside the body. What happens when you're too big to fit on a table? Or you can fit on a table but the image is poor quality?"
Patients would have to settle for substandard care because radiologists would not be able to get the images needed to diagnose potentially serious problems particularly in surgery where without the necessary abdominal scans it would be hard to tell if a bypass operation was healing properly.
"Americans need to know that obesity can hinder their medical care when they enter a hospital," Uppot said in a news release.
Along with patients, the hospital staff who moved the obese patients on and off the imaging tables also suffered with roughly 83 percent of technologists having reported some pain while moving obese patients reported Uppot and colleagues.
An estimated 64 percent of the U.S. population is either overweight or obese which has its effect on the health care system, with obese people having more chances of developing illnesses like cancer, diabetes and heart disease.
The study appears in the August issue of the journal Radiology.
