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Why SPECT brain scanning is not the answer for all psychiatry
SPECT imaging was developed in the 1960s and gained popularity in the 1990s. It shows
blood flow and activity in the brain after a patient has been injected with a radioisotope that
allows the machine to see blood flow and activity. It is a tool that can assess several organs of the
body, but is particularly useful when assessing the brain where it can specifically show areas of
the brain that work well and areas that are not functioning at normal levels (too much or too little
blood flow). This can be extremely valuable in complex psychiatric cases when traditional
evaluation has not helped. However, many claim that using SPECT imaging is necessary in order
to make all correct diagnoses. Some have suggested that SPECT imaging should be required
before making all mental health decisions for patients. Although often helpful, SPECT imaging
is expensive, not always accurate, and is potentially dangerous to patients. It is unrealistic to
require all psychiatrists to use or have access to SPECT imaging when making a diagnosis.
Due to the rapidly rising costs of medical care, doctors, hospitals, patients, and insurance
companies are always looking for ways to cut costs. Although SPECT is not among the most
expensive imaging machines, it is still very expensive. Requiring SPECT imaging would be
especially expensive for hospitals. Acquiring the appropriate equipment to administer SPECT
scans costs anywhere between $400,000-$1,000,000 (Fornell). Often SPECT scans reveal what
the doctors already suspected or correctly diagnosed. With the variety of life-saving equipment
that hospitals must have on hand, SPECT equipment could easily been seen as an overly
expensive tool to confirm what the doctors already know.
Required SPECT imaging would also put a burden on patients. Costs for current mental
health services are often not covered by insurance or require large out of pocket payments from
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patients. These high cost frequently deter people from seeking needed help and sticking to
treatment programs. The cost of administering a SPECT brain scan costs roughly $1,000-$4,000
and is rarely covered by insurance. Requiring patients to be scanned before receiving treatment
is likely to increase the number of people who delay or avoid treatment due to cost.
Some argue that SPECT imaging costs about the same as MRI or CT scans. However,
MRI and CT scans produce higher quality images and are more widely used in the medical
community (Glover). As a result, MRI and CT scans are often covered by insurance and the out
of pocket expenses for these scans in less than would be required for a SPECT scan. As far as
insurance companies are concerned, using SPECT in psychiatric practice is experimental and
they are unlikely to cover this expensive test in the near future.
2.
Another reason it would be unwise to require SPECT scans is that the images produced
are not always accurate. In order for SPECT scans to work, a radioactive isotope “has to have
adequate uptake into the brain as well as long enough retention period for imaging”
(Moster). Many things have to go exactly right for the image to be a true representation of what
is going on in the patient’s brain.
In spite of the shortcomings of SPECT scans, Daniel Amen- the world leader in SPECT
in psychiatry -believes so much in them that he has suggested, “It will soon be malpractice to
not use imaging in complicated cases,” (Amen, Stop Flying Blind). The two problematic words
in this statement are “soon” and “malpractice”. Because of costs, inaccuracies and insufficient
technology saying “soon” is in no way accurate. Furthermore, to declare this “malpractice” is to
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assume that SPECT would be available to nearly all psychiatrists, in the year 2014 it unrealistic
to claim such
As most psychiatrists will tell you, the brain is extremely complex. Every brain is
different and every patient is different. For example, having low blood activity in the frontal lobe
is often an indicator of depression, but not always (Carlat). The idea of having all psychiatrist use
SPECT is to assume that there is an exact definition of what each disorder looks like in the brain.
However, it is not that simple. Depression is usually associated with lower activity, but there is
not necessarily a “textbook” depressed brain (Carlat).
Unfortunately, some individuals with mental health challenges see SPECT as a cure-all
machine due to misleading advertising or personal beliefs. This is often gives false hope and
convinces people to spend large amounts of money for something they do not totally understand.
On the Amen Clinics website it claims, “SPECT can specifically help people with ADHD
[attention deficit hyperactivity disorder]. ... SPECT can specifically help people with anxiety and
depression. ... SPECT can specifically help people overcome marital conflict. ... SPECT can
specifically help people age better. ... SPECT can specifically help people with weight issues. ...”
(Amen Clinics). These claims apply to the majority of the population, much more than
complicated psychiatric casess SPECT is meant for.
Because mental illness can be so devastating and often difficult to treat, those with it can
become desperate and are willing to try anything to become better. M. Elizabeth Oates,
Commission on Nuclear Medicine, Board of Chancellors at the American College of Radiology,
and chair of the department of radiology at the University of Kentucky, points out “I think you
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have a vulnerable patient population that doesn’t know any better “ (Tucker) These people
unfortunately would be the ones paying the price for these common inaccuracies.
3.
Finally using SPECT in all of psychiatry would be potentially dangerous to patients. Each
SPECT scan requires a radioactive fluid to be injected into the bloodstream. It is commonly
accurately pointed out that SPECT uses the same amount or less radiation than MRI or CT,
however MRI or CT radiation is not directly injected into the bloodstream like SPECT
procedures (Types of brain imaging). To safely perform this radioactive procedure would require
extensive training to untrained psychiatrist and/or have to be performed by a nuclear medicine
technologist (Mayfield clinic).
Another possible harm would come by way of overconfident, undertrained, or mislead
psychiatrist. Correctly reading these scans can be extremely difficult, and in order for a
psychiatrist to know what each scan means in the first place would require some sort of “normal
brain image database” to compare each scan to (Smith). This could leave psychiatrists to draw
their own conclusions and assume that they have hard evidence behind those conclusions.
Doctors would prescribe medications with false confidence, such confidence would cause many
physiatrist to be less willing or slower in changing medicines when necessary. Currently
psychiatrists are trained to be extremely sensitive with medications and to closely monitor
patient’s reactions to each treatment; having scans could decrease this sensitivity. These changes
in procedure would cause more problems than they would solve.
Conclusion
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Due to the evidence stated above, SPECT is not meant for all psychiatric cases and it
would be unrealistic to expect everyone to use it. It is ultimately too expensive, not reliable
enough, and too potentially harmful to be widely required. Although widespread use is not yet
appropriate, it can be a valuable tool in complex psychiatric cases. Just like any new medical
procedure needs sufficient time, testing, and research to become common practice, SPECT brain
imaging has the potential to transform mental health after sufficient time, testing and
improvements in technology.
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Work Cited
Mercola, Dr “SPECT Imaging: An Invaluable New Tool for Psychiatry.” Mercola.com. N.p., n.d.
Web. 12 Nov. 2014.
Demitri, Michael “Types of Brain Imaging Techniques.” Psych Central.com. N.p., n.d. Web. 12 Nov.
2014.
Carlat, Daniel. “Brain Scans as Mind Readers? Don’t Believe the Hype.” WIRED. N.p., n.d. Web. 10
Dec. 2014.
Glover, Lacy “Why Your MRI or CT Scan Costs An Arm and a Leg.” The Fiscal Times. N.p., n.d.
Web. 10 Dec. 2014.
Cheryl Stewart “SPECT Scan | Single Photon Emission Computed Tomography.” Mayfield Clinic
N.p., n.d. Web. 10 Dec. 2014.
Moster, Mark L. “SPECT Scanning in Neurology and Neuro-Ophthalmology :: EHSL - NANOS
Annual Meeting Collection.” N.p., n.d. Web. 10 Dec. 2014.
Fornell, Dave. “SPECT vs. PET, Which Is Best?” DI Cardiology. N.p., n.d. Web. 10 Dec. 2014.
Amen, Daniel G. “It’s Time to Stop Flying Blind: How Not Looking at the Brain Leads to Missed
Diagnoses, Failed Treatments, and Dangerous Behaviors.” Alternative Therapies in Health &
Medicine 19.2 (2013): 10–14. Print.
Tucker, Neely. “Daniel Amen Is the Most Popular Psychiatrist in America. To Most Researchers and
Scientists, That’s a Very Bad Thing.” The Washington Post 7 Aug. 2012. washingtonpost.com.
Web. 10 Dec. 2014.
“Amen Clinics - Home.” Amen Clinics. N.p., n.d. Web. 15 Dec. 2014.
Smith, N. D. et al. “Towards Adapting a Normal Patient Database for SPECT Brain Perfusion
Imaging.” Inverse Problems 28.6 (2012): 065001. Institute of Physics. Web. 10 Dec. 2014.