Unnecessary imaging for cancer patients persists

The threat of legal liability is a likely contributor to continued orders for unnecessary imaging tests, according to researchers from Brigham and Women's Hospital Department of Radiology who presented their findings this week at the American Roentgen Ray Society's (ARRS) Annual Meeting in Vancouver, Canada.

Out of 250 cancer patients who underwent PET/CT scans, the researchers--examining reports attached to those scans--determined that 84 reports recommended additional imaging tests. Of those additional tests, 43 were deemed unnecessary.

"Some of the factors prompting unnecessary recommendations include reluctance of physicians to accept uncertainty regarding diagnosis, partly driven by legal liability concerns, combined with a failure to fully consider the patients' clinical circumstances and the likely cost-effectiveness of additional imaging tests," Atul Shinagare, M.D., a co-author of the study, said in the announcement.

However, the researchers also found that referring physicians failed to follow through on 70 percent of those additional imaging recommendations.

"Our research indicates that imaging specialists can substantially reduce the frequency of recommendations for additional imaging tests in oncologic PET/CT reports without adversely impacting patient outcomes," Shinagare said.

In a second study also presented at the meeting this week, researchers at Yale New Haven Hospital in Connecticut determined that short-term follow-up MRIs for patients who underwent benign MRI-guided breast biopsies likely were unnecessary. For that research, doctors found no malignancies on follow-up MRIs for 144 patients with 176 lesions conducted between three and 36 months after the initial testing.

Unnecessary imaging was at the heart of a recent heated debate between National Coordinator for Health IT Farzad Mostashari and Harvard Medical School Assistant Professor Danny McCormick, M.D., the author of a controversial study published in the March edition of Health Affairs that found that doctors with electronic access to test results were more likely to order increased imaging exams.

A study published last fall in the Archives of Internal Medicine found that physicians ordered at least $6.8 billion worth of unnecessary tests for their patients each year.

To learn more:
- read this Brigham and Women's announcement
- here's an announcement from the ARRS

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