June 12, 2012
News Office: Jason Bardi (415) 502-6397
Rebecca Smith-Bindman, MD
Dr. Rebecca Smith-Bindman, a UCSF radiologist and professor of radiology and biomedical imaging, answered these questions in light of a new study showing that medical imaging is increasing even in health maintenance organization systems (HMOs), which don't have a financial incentive to conduct them.
Q: What is the new study and what did it find?
A: Our study just published in the medical journal JAMA (2012;307(22):2400-2409) highlights how frequently we use imaging and raises questions as to whether some of it can be reduced.
Study Paper: Use of Diagnostic Imaging Studies and Associated Radiation Exposure for Patients Enrolled in Large Integrated Health Care Systems, 1996-2010, The Journal of the American Medical Association
Study Paper: Environmental Causes of Breast Cancer and Radiation From Medical Imaging: Findings From the Institute of Medicine Report, Archives of Internal Medicine
We looked at large numbers of patients enrolled within six integrated health care systems. We studied 1 to 2 million patients each year, for 15 years. We found that:
Q: What are the implications for patients?
A: Patients need to be engaged in understanding the risks as well as the benefits of imaging, so that they can have more realistic expectations and make informed choices.
Most imaging is valuable, and necessary imaging has far more benefit than harm. However, there are definite harms from imaging, including high-dose radiation exposure as we highlighted in our study; false positive examinations that lead to further testing, diagnosis and treatment; and the over-diagnosis of disease that leads to completely unnecessary treatment and labeling of patients with disease.
Patients should make more informed choices regarding when and how to image. That may lead them to request fewer tests, to defer some tests, and possibly to decide that they are willing to accept uncertainty and opt out of a particular test.
Q: Should patients opt out of medical imaging altogether?
A: No. Patients should not be fearful of getting necessary testing, including CT, which can save lives. It is a remarkable technology that helps with many diagnoses, and when necessary can profoundly improve care. Rather, patients should discuss the tests with their doctors and should be vigilant in ensuring that their imaging is truly necessary.
The two ways to reduce your exposure to radiation from medical imaging are to eliminate unnecessary exams, and to receive more standardized and lower doses in necessary exams.
Q: How can patients eliminate unnecessary medical imaging exams?
A: First, whenever an advanced imaging test is ordered for you or your loved one, you can and should ask if the test is really necessary, how will it help your care, and if you can wait and have it later. Some specific questions:
Q: Any other questions to ask?
A: If the test is a CT or a PET CT, ask about the dose and the steps taken to ensure that the dose is as low as possible, and ask if there is another study that can be ordered that does not deliver radiation. Also ask how you can be sure the test will be done in the safest way possible.
About UCSF Medical Center
UCSF Medical Center consistently ranks as one of the top 10 hospitals in the United States. Recognized for innovative treatments, advanced technology, collaboration among health care professionals and scientists, and a highly compassionate patient care team, UCSF Medical Center serves as the academic medical center of the University of California, San Francisco. The medical center's nationally preeminent programs include children's health, the brain and nervous system, organ transplantation, women's health and cancer. It operates as a self-supporting enterprise within UCSF and generates its own revenues to cover the operating costs of providing patient care.
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