Executive Physical

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Last week I got a reminder from my doctor that it was time for my annual physical. It will probably be the routine drill. He will listen to my lungs, flash his light in my eyes and ask me to cough a couple of times as he examines for a possible hernia. He might run an EKG to test my heart or order an mri if he sees something suspicious. But that's it. And that's sufficient as far as I'm concerned. I've always left my physicals with a clean bill of health, confident that nothing terrible was brewing inside.

But there are a growing number of people with a taste for advanced medical technology--and money to burn--who are possibly being misguided by the hype of an alternative to the traditional annual exam. I call it the executive physical: a battery of noninvasive tests using the newest, most powerful and most expensive imaging systems out there--machines that can scan, at incredibly high resolutions, every twist and turn of your body. Here are some of the most popular.

FULL-BODY SCAN This is the Cadillac of high-tech testing. Using a technology known as electron-beam computed tomography, radiologists take detailed internal pictures from the shoulders to the pelvis. The whole thing takes 10 minutes and provides such information as how much unwanted calcium has collected in your coronary arteries, whether there is an abnormal growth in your liver or colon or whether your bones are showing early signs of osteoporosis. Cost: $500 to $725, little of which your insurer is likely to reimburse.

PET SCAN A lot of patients are taking it upon themselves to order their own positron emission tomography scan. This extremely powerful test screens your body's function rather than its structure; by visualizing cellular activity, it shows abnormal processes, such as those associated with cancers and metabolic dysfunction. The PET can spot tumors and other problems that may not be detectable with traditional MRI or CT scans. It also gives information about heart disease and many neurological disorders like Alzheimer's. Cost: $2,000 to $3,000.

LOW-DOSE CAT SCAN The most promising of the new tests may be the low-dose CAT scan. It is especially popular with smokers and former smokers who want to know how much of a toll their habit has taken on their lungs. Studies have shown that the low-dose scan is superior to the traditional chest X ray both in speed and detection rate. Less than one minute of your time on the table produces detailed images of the lungs in tiny slices, increasing chances of detecting abnormalities that could be early signs of cancer or emphysema. Cost: $200 to $300.

Are these tests worth the cost? They have not been rigorously tested, and there is no strong scientific evidence that they are beneficial, although some people will be lucky: a serious disease, lung cancer, for example--may be detected in its earliest stages, when it is most treatable.

For most people, these scans may turn up more questions than answers. Because their resolution is so high, the machines pick up the tiniest abnormalities and don't always distinguish between the benign and the life threatening. Faced with ambiguous results, patients often undergo a series of follow-up, sometimes invasive tests--that turn up nothing more than harmless scar tissue.

Dr. Ian is a correspondent for nbc's Today Show. E-mail: ianmedical@aol.com.