The high cost of precision

So far, the government's most significant response to the scanning boom has been to reduce the reimbursements for a variety of medical scans, including CTs.

Undeterred, doctors simply ordered more scans.

The momentum to scan keeps building, and even patients clamor for the procedure regardless of whether they have to pay themselves.

Madyoon figured that out of the 6,000 heart scans his practice has conducted, about a quarter have been on middle-aged patients with no symptoms of heart trouble -- a situation not covered by Medicare or private insurers.

The American College of Cardiology and the Society of Cardiovascular Computed Tomography do not recommend scans for people who show no symptoms of heart disease.

In those patients, there is little evidence that a scan leads to any better care than a physical exam, cholesterol test, a walk on a treadmill and a few questions about family history, diet and tobacco use.

But Madyoon believes scientific data will eventually show that screening saves lives. He called the radiation risk a "nonissue" because patients tend to be in their 50s and older, and the scans don't have to be repeated for several years.

"This test is powerful," he said. "We're diagnosing hidden disease."

Patients haven't complained, he said.

Ali Nader, a 46-year-old attorney in Beverly Hills, didn't have any symptoms of heart trouble, but at a funeral for yet another relative who died of a heart attack, a cousin told him about a new type of scanner that could see into his coronary arteries.

He and his brother decided to visit Madyoon in June for scans. The total bill was $3,000 -- a $500 discount. Their arteries were fine.

"I have more peace of mind than before," Nader said.

He plans to repeat the scan once a year just to make sure.

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alan.zarembo@latimes.com