RSNA 2014: Levin urges radiologists to 'champion' Choosing Wisely

Radiologists must champion the use of Choosing Wisely lists, particularly since so many recommendations on the lists pertain to medical imaging, said David Levin, professor and chairman emeritus of the radiology department at Thomas Jefferson University Hospital in Philadelphia, during a session this week at the annual meeting of the Radiological Society of North America in Chicago.

The Choosing Wisely initiative was launched by the American Board of Internal Medicine Foundation with the goal of enlisting medical specialty professional organizations to make five recommendations for preventing overuse of certain treatments in their fields. The American College of Radiology was among the first nine organizations to participate in the initiative when it began in 2012.

Reducing unnecessary imaging should be "our responsibility" as radiologists, Levin said. "We talk about adding value--one of the ways we can add value is by eliminating unnecessary imaging. These are clear cut examples of a bunch of imaging tests that have been identified by a host of reputable medical societies and I think we have to respond to that."

Levin has been continually analyzing Choosing Wisely lists to see how many of them relate to medical imaging. According to Levin, when the first nine organizations to participate in the Choosing Wisely campaign issued their lists, 16 of the 45 recommendations listed by those organizations related to imaging (after taking into account the fact that some of the organizations listed the same tests).

As of this past October, Levin said, the number of organizations participating in Choosing Wisely had increased to 62. Of the 320 unnecessary and overuse tests listed by those organizations, 72 are related to radiology, which suggests, Levin said, "that a huge number of tests that we do are probably not really necessary."

Levin said he would like to see the radiology profession do more to encourage the use of Choosing Wisely recommendations. One of the problems, he said, is that Choosing Wisely has become somewhat of an "unwieldy" information source, considering that the lists are coming from 62 separate sources and contain recommendations that are duplicative. It would be more useful, he said, if the lists could be updated in way that would specifically list tests pertaining to imaging.

Looking forward, an initiative like Choosing Wisely will be increasingly important for radiologists who become involved in ACOs (affordable care organizations) or bundled payment and capitation plans, Levin said. "Because that's where you will really need to get rid of unnecessary imaging."