Radiologists: Doctors Overuse Imaging Scans

CHICAGO – Doctors are ordering too many unnecessary imaging tests, raising the cost of healthcare and exposing patients to excess amounts of radiation, imaging experts said on Tuesday.

They said many doctors order tests that will not find the cause of their patients' complaints. But better communication among doctors and providing physicians decision-making technology could cut down on unnecessary tests.

"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," William R. Hendee of the Medical College of Wisconsin in Milwaukee, whose study appears in the journal Radiology, said in a statement."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."

The paper represents the best ideas from a two-day summit representing more than 60 organizations involved in medical imaging.

Overuse of the costly scans has been a concern of policymakers for the past few years, prompting cuts in Medicare reimbursement. Recent studies on radiation risks from computed tomography, or CT scans, and several cases of accidental radiation overdoses have drawn new focus on medical imaging.

A report last year by the National Council on Radiation Protection and Measurement found that Americans receive seven times more radiation from diagnostic scans than in 1980.

Hendee said there are several reasons for overuse of medical imaging, which includes magnetic resonance imaging, or MRIs, and positron emission tomography, or PET, scans that doctors use to help diagnose disease and chart the progress of cancer treatment.

Two reasons for overuse — doctors who refer patients for scans at their own imaging facilities and doctors who order tests to protect against potential lawsuits — require broad solutions, Hendee said.

But, he said, radiologists can play a big role in educating ordering physicians about what scans are appropriate and when.

"Often they do not know the right criteria for requesting a study," Hendee said. He said the American College of Radiology has developed appropriateness guidelines, but many doctors don't know about them.

He said many large hospitals, like Massachusetts General in Boston, have developed decision support software that helps doctors ordering scans decide which tests would be best for their patients' complaint.

Hendee said programs like this need to be made available to more doctors to eliminate unnecessary tests.

And he said doctors need to find a better way to communicate with radiologists to see if the test they want to order is a good fit. Hendee said text messaging may help.

Hendee said patients often request specific imaging tests and he said doctors need to take the time to explain why ordering them is a waste of money and resources.