Monday, March 15, 2010

Health care imaging that’s costly, risky, and overused

The FDA has recently gone on the offensive against the overuse of health care imaging scanners such as CTs and MRIs, which can lead to unnecessarily high doses of radiation. While emphasis was placed on the responsibilities of device manufacturers to ensure safe usage of their products, and calling on the patients not to insist on imaging over their doctor’s protests, little emphasis was placed on perhaps the most important performer in the medical choreography that results in an imaging test: the physician. Doctors are, after all, the ones who order such procedures.

Now a new publication is calling for more rational use of imaging technology, and using the compelling example of pelvic and lower abdominal pain in women to make the case. Even though the standard means of visually evaluating female pelvic conditions is the ultrasound, CT scanners are increasingly being used. In addition to providing a massive dose of potentially cancer-causing radiation, CTs are vastly more expensive than ultrasound, which carries no cancer risk since it uses sound waves to create images. A further irony is that CTs frequently need to be followed up with ultrasound to confirm a potential diagnosis.

Harvard doctor Beryl Benacerraf, who wrote the commentary, calls on his fellow clinicians for a more rational use of imaging. Why, after all, choose the most expensive, less accurate option that carries health risks, when a cheaper, more reliable, and risk free alternative is available?

On a policy level, this is the type of physician behavior contributing to the paradigm that has emerged over 3 decades of health services research showing that regions of the United States that treat patients with more imaging, more procedures, and longer hospital stays, actually have worse outcomes, even when you control for the health of their populations. And they also spend significantly more. On an individual level, it’s compelling evidence for patients not to insist on imaging or testing when your doctor recommends against it.

Photo credit: The author

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