CT & Responsibility

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 - Mary C. Tierney
Mary C. Tierney

In the early days of the Clinton Whitehouse, MRI became the whipping boy for “excesses” in medical imaging; today it seems CT is being pushed into the spotlight, both for too many exams being ordered as well as excess radiation dose. That spotlight is likely to get more intense, too, as the government is challenged to slash Medicare costs.

A recent New York Times article quotes more than 95 million as the number of CT, MRI and PET scans done each year in the U.S., representing $100-billion-a-year industry. Medicare pays the bill for $14 billion of that, a number that represents a doubling from 2000 to 2006. The article also says 20 percent to 50 percent of the procedures were useless as the results did not help diagnose ailments or treat patients. Another growing problem? Bad scans due to older scanners in use, poor quality studies, no standard to adhere to and variances in the experience of radiologist reads. For sure, this is nothing we as an industry are proud of.

We all know of imaging done that wasn’t necessary. A friend recently visited the ER with a terribly sore and swollen foot he thought could be broken. After an ultrasound exam and an x-ray, the ER physician said all was well. He was sent home to take anti-inflammatories, ice it and let it heal. Three days later, after yet another four views via x-ray, his orthopedist casted the broken foot. 

The links between excess radiation and cancer are clear. Study after study reveals x-ray-based radiation dose is far higher than it should be, and growing all the time. With imaging studies—many radiation-based—a key tool of physicians to diagnose disease today, an increase is natural. But responsibility and appropriateness need to reign supreme with consideration given to the risks and benefits of each test ordered. The latest findings from the National Council on Radiation Protection and Measurement estimate Americans are exposed to seven times more radiation from diagnostic scans than in 1980. Why? Doctors are overusing tests for profit, often self-referring patients to imaging exams at facilities they own, and thus increasing health and possibly cancer risks to patients.

As Hippocrates wrote: “Declare the past, diagnose the present, foretell the future; practice these acts. As to diseases, make a habit of two things—to help, or at least to do no harm.” When imaging exams are used properly, the patient will get the best in care and treatment and costs will decrease.