As federal lawmakers discuss ways to trim healthcare costs, they will want to consider this statistic released last week: the rate of MRIs, PET and CT scans in the U.S. tripled between 1996 and 2007.
Explosion in scan rates
Use of radiology screenings triples between 1996 and 2007
Included in the Centers for Disease Control and Prevention's 33rd annual report on the health of the nation, the finding came as no surprise to the medical community, especially radiologists who caution against overutilization of these highly expensive exams that could expose patients unnecessarily to radiation. According to the CDC's Health, United States, 2009 report, “the use of advanced imaging during emergency-department visits increased fivefold among adults under 65 years of age and quadrupled among adults 65 years old and older.” And in 2008, the Medicare program paid $546 million to hospitals and physicians for mammography, $169.6 million for colonoscopy and $63.3 million for prostate cancer screenings (Feb. 1, p. 6). Furthermore, CT scans are part of a federal examination of safety issues regarding medical radiation (Feb. 15, p. 12).
Stephen Amis, professor and chairman of radiology at the Albert Einstein College of Medicine, said a CT scan is the quickest and most definitive way to determine “if something is going on.” And, he said, the number of these scans has increased dramatically from 3 million in 1980 to 70 million in 2008.
“There is no good study which shows which scans shouldn't have been ordered,” Amis said. Even so, he said physicians today use CT scans for several conditions that did not require these tests before, such as appendicitis; bowel, gallbladder and pancreas disease; and kidney stones. This is why Amis is part of a working group that seeks to develop tight guidelines for imaging. He said the idea developed from a National Council on Radiation Protection and Measurements meeting last year.
“They convened a meeting between radiology and emergency medicine last fall and the goal was to look at this issue, particularly in the emergency setting.”
Amis cited a few reasons why emergency physicians rely on these tests. First, hospital emergency departments are often crowded, and imaging tests provide physicians with answers in a shorter amount of time than it would take to conduct long patient histories. Then there are the legal concerns stemming from the Emergency Medical Treatment and Active Labor Act, which requires most hospitals to provide examination and stabilizing treatment regardless of insurance coverage and ability to pay.
But there are also economic incentives to physicians who own their own imaging equipment, according to Paul Ellenbogen, who practices at 679-bed Texas Health Presbyterian Hospital Dallas. “What we know is that physicians who own equipment use it much more than those who don't,” said Ellenbogen, who is the secretary-treasurer of the American College of Radiology, or ACR.
Both Ellenbogen and Amis said the ACR and the Radiological Society of North America are preparing to launch the Image Wisely campaign, which is similar to Image Gently, an initiative by the Alliance for Radiation Safety in Pediatric Imaging to raise awareness about the opportunities to lower radiation doses in the imaging of children.
“The position of ACR is that we don't want people to stop using imaging because they are afraid of radiation or lack of access or cost,” Ellenbogen said. “We want imaging to be available and affordable to do the right test at the right time for the right reasons.”
Georges Benjamin, executive director of the American Public Health Association, said such tests are valuable, but also that physicians should ask themselves if the tests are truly necessary. “I can tell you that most good doctors use the test to confirm what they can find out by history and physical exam,” Benjamin said. “Tests are wonderful, but you always have to ask yourself: Is its value of such a degree that I absolutely need to do it?” he added. “In most cases, quite frankly, they are often confirmatory.”
While the CDC's 574-page report included an entire special section on medical technology, its purpose was to give a broad—and also comprehensive—view of the nation's health to the president and Congress. In it, the CDC reported that overall life expectancy in 2007 was 77.9 years, and that life expectancy at birth increased more for the black than the white population between 1990 and 2007, which narrowed the gap between the two racial groups.
“The good news is that we continue to show health improvements throughout the various populations in America,” said APHA's Benjamin of the report. “I think there's a couple of disturbing trends which continue,” namely “spending too much on healthcare, and the number of uninsured continue to plague our system.”
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.