Imaging overuse

A consortium of professional medical societies, including the American Society of Radiology, is fighting the overuse of imaging. Examples include scans for uncomplicated headaches, routine chest X-rays, and nonspecific back pain. Between 2000 and 2007, the use of imaging studies grew faster than that of any other physician service in the Medicare population. One study determined that 20 to 50 percent of imaging provides no useful information. The problem with too much imaging (besides unnecessary costs) is that it can expose you to excessive radiation and can lead to over-diagnosis followed by unnecessary interventions that do more harm than good.

Here’s a rundown of various types of imaging tests:

• X-ray: quick and cheap; low radiation; usually the best way to assess injuries to arms and legs. Radiation exposure is the same as three hours of environmental radiation to which we’re all continuously exposed.
• CAT scan, or CT: a computerized composite of hundreds of X-rays; provides more detail than an X-ray. For example, it can detect an intercranial hemorrhage. The radiation dose is about the same as eight months of background radiation.
  
• MRI: provides excellent detail and doesn’t involve radiation; uses a magnetic field and radio waves. Good for assessing soft tissues of joints and detecting subtle brain abnormalities, but not good for visualizing air-filled structures, such as the lungs. (It’s best for chronic headaches, but the CT scan is best of sudden and/or severe headaches.) The tube-like MRI and CAT scan devices look similar.
• Ultrasound: does not entail radiation; uses high frequency sound waves; scanner is hand-held “wand;” used for imaging pregnancies and fluid-filled organs such as the heart and gall bladder.

I have started to decline x-rays on my teeth, mostly because they strike me as an unnecessary expense. Of course, this decision does not go unchallenged. But I’m sticking to my guns.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.