Radiologist, Find Your Voice

In a major front-page story, "The High Cost of Precision," in its Sunday, September 7, 2008 edition, the Los Angeles Times once again focused on the negative side of CT technology. Its opening statement positioned its argument by saying, "CT scans produce detailed views of internal organs, but they expose patients to significant radiation." The tone of the piece was made even clearer with two subsequent headlines: "Revolutionary scans come with a risk," and the real kicker, "CT scans can be good for doctors." Hint: Doctors make a ton of money from these scans, most of which are unnecessary. There is, of course, nothing new about the fact that the media love to write stories about how doctors are making money with sophisticated imaging technologies. Both the New York Times and, now, the Los Angeles Times have focused in the past year on articles that underscore the outliers in the profession who are greedy and unscrupulous. As in any profession, these types of people are unfortunately part of the fabric, and it has been this way since the beginning of time. Examples are easily found, and they make for good newspaper copy. In this particular case, the author of the article focuses on one aspect and byproduct of one of the most remarkable technologies ever invented. Without comparing the obvious risks associated, say, with surgeries that have been replaced by CT, the author outlines in great detail the number of CTs performed in a year; the fact that at 81 CT scanners per million people, the United States has almost three times the average for the rest of the industrialized world; and the cumulative radiation dose of these scans (frightening levels of millisieverts). Most of the radiologists interviewed are from academic medical centers, one is with a radiology benefit management firm, and the physician cited as the one doing the most scans is a Beverly Hills cardiologist. Not exactly the most representative sample that could be found. It isn't until the last part of a very long piece that one finds a really positive quote. "As long as a scan is medically necessary, the benefit in practically all cases outweighs the small risk in the future," according to John D. Boice Jr, ScD, a radiation expert who is the scientific director of the International Epidemiology Institute in Rockville, Md. We move through the maze of negative issues with CT: the radiation exposure, the cost to the health care system, the unnecessary scans, the profits that doctors make from the scans, the defensive medicine that drives a significant number of scans, the supposedly controversial application in cardiac imaging, and our general abundance of scanners in this country. There were no quotes from the ACR to add any perspective at all, and there were no quotes from any private-practice radiologists. Where is the silver lining? I think that there is an opportunity in all of this for radiologists to find their voices, especially for those who practice outside the academic environment. In many ways, private practice is under assault, and the media are giving only one side of a very complicated story. They love the sensational, and this is clearly in that realm. It is really not even news, since the past year has seen a variety of articles in the national press focusing on the same theme. Radiology needs to get a voice and begin to tell the rest of the story. When you find your voice and set out to inform the media about the benefits of CT and other technologies, about the great lifesaving work that private-practice radiologists do every day, and about the significant health care costs that are offset through diagnostic imaging technologies, what will you say? How will you frame the issue? In what way will you persuade them that there is more—much more—to the story? Here's one idea. I recently had the privilege of listening to Paul Berger, MD, CEO, NightHawk Radiology Services, Coeur d'Alene, Idaho, speak about his views on key issues facing radiology today. Among these views was that radiologists can and should recapture the high ground in the debate over radiation dose and safety. He says that radiologist are uniquely trained and positioned to be the educators, arbiters, and controllers of the issue of radiation safety in all settings. He says that this has not been given enough attention as an important role by most radiologists. I believe that Berger is right, and that the debate about dose will be increasingly complex; it will need to be led by those who know more about it than anyone else in medicine: radiologists. There is no doubt that radiologists understand best when a CT should be ordered, as well as when an ultrasound or MRI would be a better alternative. There is no doubt that there is real danger and risk associated with radiation exposure, just as there is real risk each and every time a patient is anesthetized or pharmaceuticals are administered. Minimizing these risks, while curing or managing the disease, is what physicians are trained to do. Journalists often overlook this basic premise of medicine. This article, and others like it, should be a wake-up call for the profession. The issue is important, it is not going away, and the patient is going to be informed, one way or another. Wouldn't it be better if the profession organized itself in a way that could influence these messages in a positive way? This is an issue that affects the business side of imaging. It is an issue where radiology can lead the way toward clarity. It is an issue that should not be relegated to the bottom of the list. Speak up for your profession.