Dear Doctor: I'm a 42-year-old guy who doesn't work out. I have a few pounds to lose but I don't smoke and I only have a beer on weekends. Should I have a total-body scan? R.T.W., Forest Hills

The News:
The latest instantaneous computerized axial tomography (CAT) technology can scan your entire body painlessly in just fifteen minutes. You've heard total body scans advertised on radio and TV, but you haven't heard your doctor recommend it. Here's why:

Good News:
Quick and painless, a scan can demonstrate unrecognized problems in the heart, lungs, abdomen and pelvis.

• In the heart: calcium deposits in coronary arteries can suggest coronary arteriosclerosis (blood vessel narrowing that could lead to blockage).
• In the lung: early, potentially malignant, nodules.
• In the abdomen: aortic aneurysm, large masses, enlarged spleen, fatty liver, and some liver masses.
• In the pelvis: kidney stones and some enlarged lymph nodes.

The scan also gives a good approximation of bone density.

Bad news: Cost:
Between $800-1000 not covered by insurance.

False Positives:
The scans demonstrate many "abnormalities" that are completely irrelevant. But more tests - - involving time, greater risk and money - - are often required to prove that the findings are not clinically important. For example, calcium in coronary arteries often does not indicate coronary artery disease. But proving that the positive CAT scan findings do not represent a clinical problem may require a half-day thallium stress test involving radioactive tracers as well as more radiation, at a cost of twice the original scan.

False Negatives:
The total body scan can miss serious problems. Continuing with the example of heart disease, modern research suggests that the cause of many, if not most, heart attacks is due to blockage of a coronary artery not by calcium but by a soft cholesterol plaque that the scan does not detect.

Bottom Line:
We don't know yet whether total body scans will save lives nor do we know how often they will miss important problems and diagnoses. They will be useful in screening or monitoring some patients based on risk factors or presence of disease. Ask your doctor whether a scan might be worth your time and money.

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