According to a U.S. Government Accountability Office (GAO) report released recently, doctors and other health care providers with a financial interest in medical imaging, such as CT and MRI scans, made 400,000 more referrals in 2010 than those who did not. Overutilization is only one concern shared by nine medical specialty societies earlier this year, who, in conjunction with the ABIM Foundation’s “Choosing Wisely” campaign, released a list of 45 tests and procedures doctors and patients should question.
The American College of Radiology (ACR), one of the participant medical societies, initially solicited expert opinion from physician leaders with its Board of Chancellors. A working group was then formed to further identify common clinical scenarios in which medical imaging may be misused and should be reconsidered.
Here’s a summary of their findings:*
- Don’t do imaging for uncomplicated headaches. Absent specific risk factors, medical imaging is unlikely to change or improve the outcome.
- Don’t image for suspected pulmonary embolism (PE) without moderate or high pre-test probability. While PE is common, they are rare in the absence of specific risk factors. Imaging is only helpful to confirm or exclude PE for patients demonstrating such risk factors.
- Avoid admission or preoperative chest x-rays for ambulatory patients with unremarkable history and physical exam. Only two percent of such images lead to change in care management.
- Don’t do computed topography (CT) for the evaluation of suspected appendicitis in children until after ultrasound has been considered as an option. This caution speaks to radiation risk. An ultrasound is “nearly as good” as CT in the accurate evaluation of suspected appendicitis in experienced hands. Reducing radiation exposure is especially important in the pediatric population.
- Don’t recommend follow-up imaging for clinically inconsequential cysts. Simple small cysts in women of reproductive age as well as postmenopausal women are common. Follow-up imaging after a quality ultrasound is unnecessary and only increases risk related to radiation exposure.
What’s at Stake?
Recognizing that patients sometimes ask for tests and treatments that are not necessarily in their best interest, and that physicians often struggle with decisions about prescribing tests and procedures as a way of covering all possible bases, the purpose of developing evidence-based tests and procedures is for patients and doctors to think and talk about overuse of health care resources in the U.S.
How does your organization ensure medical imaging is not overused? I encourage you to share your thoughts via a comment below.
*The ACR provides these factors for information purposes only and is not intended as a substitute for consultation with a medical professional.