Too much medical imaging, too little time to fix what’s broken?

In the U.K., demand for medical imaging has been growing so steadily in recent years that many radiologists are, frankly, overwhelmed.

A radiologist there gives his view on how this challenging scenario snowballed into being and what can be done to make the problem more manageable.

Much of what he lays out will resonate with his peers and colleagues in the U.S.

“We radiologists must accept some responsibility for this [situation] ourselves,” writes Dr. Giles Maskell in brief commentary published Nov. 2 in The BMJ. “[A]s technological advances result in ever more detailed images, we identify more and more findings of uncertain significance and we frequently choose to resolve this uncertainty by proposing further imaging” [1].  

Many if not most of these findings will turn out to be clinically inconsequential, adds Maskell, a consulting physician in southwest England and past president of the Royal College of Radiologists.

 

Beware ‘Increasing Enthusiasm for Imaging-Based Screening’

After accounting for the self-inflicted pain of overloaded worklists, radiologists should recognize that the broader source of demand for ever more imaging lies with forces outside of radiologists’ bailiwick, Maskell argues.

These include such specific clinical scenarios as

  • referrers’ reliance on imaging to rule out possible diagnoses rather than detect suspected pathologies,
  • longer disease survival periods calling for serial imaging-based monitoring and
  • “increasing enthusiasm for imaging-based screening, for example to detect cancers of the breast, lung and prostate.”

Meanwhile, Maskell points out, certain systemic factors are in play as well.

There’s the widespread expectation of imaging in emergency settings, the use of ER imaging as a triage tool and, within and beyond the ED, the use of imaging as a “form of replacement for clinical examination—an approach which has its own consequences.”

 

Remedy: ‘Something Much More Radical Than a New Set of Guidelines’

More from Maskell:

Perhaps even more significant overall is the societal trend towards reduced tolerance of uncertainty which in the context of healthcare is sometimes characterized as ‘defensive medicine.’ This often manifests as rigid adherence to guidelines and protocols. In imaging, as elsewhere, these are generally drawn up with the objective of ensuring that any patient who might benefit from a particular test gets that opportunity. A by-product of this approach is that some patients who may not benefit will still get the test.”

As these rushing streams continue feeding the U.K.’s raging river of imaging demand, any effort to stem the flow, Maskell maintains, must include “something much more radical than a new set of guidelines.”

Turning the problem around, he adds, “will need to take into account the views of patients as well as healthcare professionals.”

Full commentary with links to related content here.

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