COMMENTARY

Rita Redberg on Excess Use of Radiation Imaging Tests

Rita F. Redberg, MD

Disclosures

February 20, 2014

In This Article

Guidelines Should Favor Nonradiation Tests

However, we also need some changes to our guidelines so that when there are equivalent tests, those without radiation can be favored by making them a higher class of recommendation, assuming that the medical gain is equal for both tests. There are, of course, a lot of differences across specialties -- but for example, in cardiology stress imaging, there's echo or there's nuclear testing. Obviously, nuclear testing has radiation and stress echo does not, but the choice really has to be according to what the person ordering is comfortable using and what is available in your area.

However, having said that, I think it's certainly incumbent on all of us to be comfortable with both a non-ionizing radiation as well as an ionizing radiation technique, and honestly think about which is best for our individual patient, because there certainly are opportunities to choose a non-ionizing radiation technique.

Don't Forget Treadmill Tests

There has also been a huge increase in the amount of stress imaging we're doing as opposed to baseline treadmill tests, and we could go back to our guidelines, which really do urge treadmill tests alone for a lot of uncomplicated patients with normal EKGs. We can become familiar with what's available locally and be sure that we're comfortable referring, reading, and using non-ionizing radiation tests, such as ultrasonography and MRI, as well as the CT scans and nuclear cardiology tests that do use radiation.

I think that lower-dose radiation scans can easily be done and still produce a high-quality image. There are a lot of reasons why our use of CT scans in particular and medical imaging in general has increased, and part of it is that the picture quality is so good and there is a lot of appeal to having a good picture. I think the main reason we tend to send the pictures with a lot of reports is because it so attractive.

But what we really have to think about before ordering an imaging test (as we would for any test) is, have we already gotten all of the information we need from a thorough history as well as a physical examination? Will this test that I'm ordering, be it an imaging test or any kind of test, give me additional information that I didn't or couldn't have already gotten from a history and physical? Could I get to that same answer or treatment path without this test? And will this test actually lead to a change in management that will lead to better outcomes for the patient?

I think going through that algorithm mentally for most things we order -- and in particular, tests with ionizing radiation that carry cumulative radiation exposure risks, which increase cancer risks over a lifetime -- is really important for our patients. We need to be sure that we are making the right decision and balancing risks and benefits for every one of the tests we order.

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