Medical Imaging Overutilization Needs to Stop, Say Radiologists

A new report is calling for radiologists to lead a collaborative effort to control overutilization of medical imaging services, a practice that exposes patients to unnecessary radiation and adds to healthcare costs.

“In most cases, an imaging procedure enhances the accuracy of a diagnosis or guides a medical treatment and is fully justified, because it benefits the patient,” said William R. Hendee, Ph.D., of the Medical College of Wisconsin in Milwaukee, author of the report that will appear in the October issue of Radiology. “But some imaging procedures are not justified, because they are unnecessary for the patient’s care. These are the uses of imaging that we, as medical physicists, radiologists, radiation oncologists and educators, are trying to identify and eliminate.”

Although the growth in medical imaging over the past two decades has yielded important benefits to patients, allowing millions of patients to avoid more invasive diagnostic and treatment procedures, overutilization of imaging services can be detrimental to patients by exposing them to unnecessary radiation. Between 1980 and 2006, the annual US population radiation dose from medical procedures increased seven-fold, according to the National Council on Radiation Protection and Measurements.

In August 2009, the American Board of Radiology Foundation hosted a two-day summit with more than 60 participating organizations to examine the causes and effects of imaging overutilization. The summit, entitled “Medical Imaging: Addressing Overutilization in the Era of Healthcare Reform,” identified several key forces influencing overutilization, including payment mechanisms and financial incentives in the US healthcare system, the practice behavior of referring physicians, self-referral, defensive medicine, patient expectations, and duplicate imaging exams.

“There are many causes of overutilization of imaging in medicine,” said Dr. Hendee in a statement. “Some of these causes, such as self-referral to physician-owned imaging facilities and defensive medicine to shield against potential lawsuits, are beyond radiology’s influence to correct and must be dealt with more globally within medicine. However, some of the causes do occur within radiology, and the profession is hard at work to address them.”

Summit participants offered several suggestions to reduce overutilization, such as a national collaborative effort to develop evidence-based appropriateness criteria for imaging, greater use of practice guidelines in requesting and conducting imaging exams, decision support at the point-of-care, education of referring physicians and the public, accreditation of imaging facilities, management of self-referral and defensive medicine, and payment reform.

A second meeting, "Improving Patient Care through Effective Communicating in Imaging," was held in Washington, D.C., Aug. 5-6.

For more:

• Read the R&D report, “Radiologists call for national strategy to address medical imaging overuse”
• Download presentations from the American Board of Radiology Foundation’s 2010 National Healthcare Summit
• For patient-friendly information on radiation dose and safety, visit RadiologyInfo.org