Radiologists must lead efforts to curb overtesting

An op-ed piece in the New York Times published Jan. 30 has the radiology community readdressing the issue of radiation dose.

In the piece, provocatively titled "We Are Giving Ourselves Cancer," cardiologist Rita F. Redberg and radiologist Rebecca Smith-Bindman--both from the University of California, San Francisco Medical Center--point out that cancer may soon pass heart disease as the leading cause of death in the U.S., and wonder whether patients are "silently radiating" themselves to death.

In particular, they address the fact that the use of medical imaging procedures with high doses of radiation--such as CT--have "soared" over the past 20 years and that CT scans, while once rare, now are given routinely. And, they say, while studies suggesting that use of medical imaging has slowed have been published, "we still have a long way to go."

For example, they say, emergency room physicians still "routinely order multiple CT scans even before meeting a patient." This may have been a little bit of an overreach on their part--a look at the more than 200 comments on the article shows that more than one ED physician believes that charge is an exaggeration.

Still, it is clear that excessive imaging is a problem in emergency rooms. For example, a study out of Johns Hopkins University School of Medicine published last summer found that $500 million annually could be saved if emergency room physicians stopped the routine and excessive use of head CT scans to search for stroke in patients who present with dizziness, when a routine bedside physical exam would be sufficient to identify the small group of patients who really need imaging.

Other studies suggest that more dose reduction strategies are needed, as well. In the August 2013 issue of JAMA Pediatrics, researchers reported that the increased use of CT in pediatrics, along with the wide variability in radiation doses, has resulted in more children receiving high-dose exams, and that "strategies targeted to the highest quartile of doses could dramatically reduce the number of radiation-induced cancers."

Redberg and Smith-Bindman are right. More needs to be done. They suggest that professional societies and regulatory bodies should be doing more to provide standards and guidelines related to radiation dose, and say that patients also should do their part by taking advantage of initiatives like the Image Wisely campaign.

But isn't this really an issue radiology should be taking the lead on? The American College of Radiology has been trying to do its part by, for example, issuing appropriateness criteria to provide guidance to physicians on the benefits and risk of tests before they are ordered. One radiologist, Robert M. Milman, M.D., as described in this article in Diagnostic Imaging, has particularly taken the imaging appropriateness issue to heart and spends much of his time making presentations to referring physicians on appropriate image ordering.

There's no reason why other radiologists can't be as proactive as Milman in addressing this issue. After all, if radiologists won't tackle issues related to radiation dose and appropriate imaging, who will? - Mike (@FierceHealthIT)