By Ansley Franco
The headlines were designed to alarm: CT scans may account for five percent of all future cancer diagnoses in the U.S. annually. After the release of a JAMA-published study and its circulation by PBS and other outlets this spring, patients started quoting those numbers back to their physicians in exam rooms across the country.
But according to Birmingham neurosurgeon Phillip Cem Cezayirli, MD of Haynes Neurosurgical Group, the conversation around imaging, especially head, brain and spine scans, needs a re-set.
“I’ve had people quote that paper, and they’re not quoting the actual paper, they’re quoting the headline,” Cezayirli said. “The study was all theoretical. They just looked at a few years of images and then postulated based on that.”
The national study fueling the panic noted that 93 million CT scans were performed in 2023. Abdominal and pelvic CT scans contributed to the largest share of projected cancers with nearly 40 percent.
But missing from the broader coverage, Cezayirli says, is critical context: for neurological conditions, imaging often leads to earlier diagnosis, faster treatment and better outcomes even when the symptoms are as commonplace as a headache.
Cezayirli’s approach to imaging in neurosurgery follows a clear principle: If there are any red flags, you get imaging. Whether it’s a new onset headache, unexplained neurological symptoms, or persistent spine pain, imaging isn’t just a diagnostic tool, it’s a form of reassurance and risk reduction.
“The best way to look at it for me is: are you going to regret not getting the imaging more than regret getting the imaging?” Cezayirli said. “If you have no symptoms, you don’t need to get images. I think if someone has symptoms or signs of disease, better to get imaging and know that it’s nothing that needs any type of treatment than to continue to wonder.”
That perspective stems in part from his commitment to value-based care. While imaging may seem like an unnecessary cost to some, it often prevents far more expensive, or irreversible, complications later.
Not all imaging is equal. “CT is typically the first line for neurological issues due to its speed, availability and affordability,” Cezayirli said. “The entire process of conducting a CT scan takes less than five minutes to complete, with the actual imaging taking less than a minute. And at an independent facility, it’s about $100.”
An MRI, on the other hand, is more sensitive and detailed, but significantly more expensive, often costing several thousand dollars, and takes up to 30 minutes per scan. While it’s the preferred modality for evaluating soft tissue or chronic neurological conditions, it’s not always practical as a first step.
For patients who are pregnant or of childbearing age, CT is used more cautiously due to the radiation exposure. In these cases, MRI or alternative strategies may be employed, in line with the “As Low As Reasonably Achievable” (ALARA) principle established by the American College of Radiology more than a decade ago.
Cezayirli is the first to acknowledge that radiation exposure is a real consideration. But the risks are routinely overstated, he says, particularly when they’re presented without clinical nuance.
“I am annoyed that JAMA would publish a paper like that. PBS probably should’ve been more responsible in knowing that a headline like that is completely misleading,” Cezayirli said. “
He emphasizes that patients should advocate for themselves and ask informed questions, but not let headlines dictate their care. Rather than discouraging imaging, Cezayirli believes the conversation should shift toward responsible use and better education.
