Increase in Imaging Concerns Researchers

Questions about the necessity of imaging tests continued to dominate headlines this week, as a new study published in JAMA claims that HMOs are seeing an increase in imaging despite the lack of their financial incentive to conduct them. Amid concerted efforts to lower, manage, and optimize imaging doses, “the latest study showed a dramatic increase in imaging rates and a doubling in the proportion of patients who incurred high and very high radiation exposures from 1996 to 2010, paralleling the rise in the fee-for-service world,” according to a UCSF press release. “The number of ultrasound examinations doubled, the number of CTs tripled, and the number of MRIs quadrupled,” according to the statement. “The analysis also showed enormous variation from system to system, with some types of imaging being done 5 to 10 times more often in one system compared to the others.” According to the study, this information demonstrates that imaging drivers are independent of lowered rates, reimbursement caps, and changed fee structures. The threat, researchers say, is that all this increased demand will lead to greater radiation exposure, and therefore, greater incidents of cancer. “It’s not just that we’re doing more advanced imaging tests, but we are also doing these tests in such a way that the tests deliver higher — and more variable — doses of radiation,” said lead researcher Rebecca Smith-Bindman. She advocates that patients “insist on the necessity and safety of all radiological scans they undergo.”ACR challenged these findings, citing reports that imaging is a “slow-growing” field associated with “greater life expectancy,” “declines in mortality rates,” and fewer invasive surgical procedures. Paul Ellenbogen, chair of the ACR Board of Chancellors, said that the data set was old, and that the uptick in imaging use has since “tightened in recent years as providers have become more educated about when and which scans should be ordered and radiation education efforts more widespread.”