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Subscribe to RSSThe latest medical images can provide spectacular pictures, giving doctors and patients enormous amounts of information about a wide range of medical conditions. But doctors may have gotten overly enthusiastic about using them.
A study out Tuesday in the Journal of the American Medical Association found that the number of MRIs quadrupled, CT scans tripled and PET scans went up 57 percent between 1996 and 2010. The researchers tracked up to 2 million members of six large health systems in the U.S.
There is no question that before performing a surgery, for example, a doctor wants to see as much as possible. Magnetic Resonance Imaging (MRI) uses magnets and radio frequency fields to scan the body and help doctors make diagnoses of tumors, torn ligaments or strokes without surgery. A PET, or positron emission tomography, scan can be conducted alone or combined with MRI with radioactive isotopes to show metabolic activity in the body such as cancer.
The images help; the question is just how much.
“The increase in use of advanced diagnostic images has almost certainly contributed to both improved patient care procedures and outcomes, but there are remarkably few data to quantify the benefits of imaging,” radiology professor and lead author Dr. Rebecca Smith-Bindman from the University of California, San Francisco, and her colleagues write.
Why does it matter? The biggest reason is cost. Americans now spend an estimated $100 billion a year on medical imaging. For each patient, each procedure can cost between a few hundred and several thousand dollars. Usually doctors order them for the best of reasons, but sometimes it is defensive medicine based on the fear of lawsuits or, even worse, the need to amortize the huge cost of a piece of equipment the practice has purchased.
Another major downside of increased imaging is the “false positive,” which is the discovery of a growth or other apparent problem that presents no danger but needs to be removed -- with additional cost and anxiety.
The biggest danger with scanning comes from CT, or computed tomography. A CT scan exposes the patient to huge amounts of X-rays. One CT scan of the chest, for example, zaps a patient with the same amount of radiation as 150 old-fashioned X-rays. In their survey of medical records, the authors of the latest study found that 3.9 percent of patients were receiving an exposure or more than 50 millisieverts every year. In comparison, that is about the equivalent of the one-time amount that the Japanese government estimates that the nearby residents of the Fukushima power plant got in the hours before they evacuated.
A recent Institute of Medicine report on risk factors for breast cancer listed chest CT scans high on the list. Last week, an international study found that children who get CT scans have a slightly higher risk of later developing leukemia and brain cancer. While the absolute risk of cancer is still small, the British researchers suggested minimizing radiation exposure as much as possible.
In a separate report released by the UCSF researchers Monday, Smith-Bindman said a woman should ask her doctor these questions before getting a CT scan:
- Is this scan absolutely necessary?
- Is it necessary to do it now?
- Are there alternative tests?
- How can I be sure the test will be done in the safest way possible?
- Will having the scan information change the management of my disease?
For the sake of our pocketbooks and peace of mind, we all might be well advised to ask our doctors the same questions about any medical scan we receive.
Robert Bazell is NBC's chief science and medical correspondent. Follow him on Facebook and on Twitter @RobertBazellNBC
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10/4 they do help, maybe it is the insurance company behind this articale? It is all about saving money not, saving us.
Starting out in medicine in 1977, I still feel the same way. Radiologists have a license to steal. Just think about it. There is no competition, and they all graduate knowing the same thing - 'We're going to make a pile of money just sitting around and looking at pictures all day'. And yeah, yeah, yeah, don't give me the crap about "Gee, if I miss a tumor. . ."
if you were in medicine then you would know radiologists do not order any initial exams therefore no license to steal doctors order radiologic exams, i would love to see you tell this to a group of breast cancer survivors that they dont need mammos you heartless fool
If you think they are stealing from you, don't have any imaging done.Or if you have a CT and they recommend an MRI, DON'T DO IT. That way they won't steal anymore of your money.
Howard, you really don't know anything of the real radiology world. We do not refer to ourselves, and rely on referrals from other docs. Other docs who have begun to read their own and displace radiologists - particularly cardiologists. Oh, and these cardiologists are self referring, so there is no competition to keep them honest. "just look at pictures all day" Right. Just like a surgeon simply whittles all day.
Next time you have an MR, PET, CT, US, read or require an interventional neuroradiologist to stop the stroke you are having, just do it yourself
Enough, you aren't worth the time to write this
These imaging techniques should be used more and more. Why not? The problem is our crappy system of healthcare in which we pin procedure costs to medicare rates kills market forces and prevents the costs from going down even when demand goes up.
They should not be used more and more, they are not harmless. If you are going to get a MRI, refuse the contrast dye that they may want to give you. It will do you more harm than good.
pj,
interesting point. Where did you get your MD again?
eric, I do not need a medical degree to do research. I also research what is wrong with my car before I take it in. I have never been wrong with my diagnosis, yet I am not a mechanic.
It sounds crazy, but some day I hope we begin to practice prevented medicine. Instead of I wished we had known medicine. Which means more scans.
" the need to amortize the huge cost of a piece of equipment the practice has purchased." And thereby subjecting the patient to unnecessary radiation.
clearly malpractice
medical profession needs to police itself better
these machines are cash cows.... if we didnt subsidize health care and set rates costs would go down and docs would not push them for profit....
everything in this country is a cash cow do you complain when you pay 5000 for a flat screen tv or 40000 for a new car? then why do you complain when you have to pay for something that may save your meaningless life. People complain at my clinic when they wait 15minutes but they will go home and sit on the couch and watch tv for 4 hours a night. we have it sooo good that we complain about the things keeping us alive. I want you to complain next time you pay 10 dollars for a burger because that was an unessarry meal they only want your money and they dont care if you are full or not
you sound like someone that is way overpaid
unnessary radiation? then dont stand in the sun, dont fly on planes, dont smoke, dont sit too close to a tube tv, dont stand next to your circuit breaker box in your own house, dont play by those green boxes in the backyard, keep away from the really big power lines, dont use a radio, dont use cell phones, dont use a microwave, dont use wireless internet, dont be by any electrical devices where transformers are used, dont hang out next to a power plant. dont use anything that involve atoms cause they all decay. If you could see radiation then you would see nothing else. IDIOT who knows nothing keep commenting.
Phil, what is your problem? People have concerns, and they are legitimate concerns and you think that you are so superior that you have the right and privilege to call them idiots. Honey, look in the mirror. Do you see that finger pointing at and accusing other people? Look at who the other fingers are pointing at.
hey head injury woman who thinks they know anything would you be saying that if the Computed Tomography CT your child had saved its life? No you wouldn't next time your child falls and hits its head dont bring it to an ER in america then! Geeez people if you dont want these life saving tests then go live in pakistan and turkey where they practice medicine the old fasionded way with no radiology and they kill to have their med students come here to learn. america is overcrouded please leave and i will scan those who are apriciative of my skills and train those who want to learn.
you can lie to these idiots but not me f you
Another piece of journalistic crap to keep us from the best diagnostic tools available. I know. It took me 9 months and thousands of misspent dollars to find the cause of my debilitating leg pain. Doctors refused to give me an MRI for fear of being accused of over using technology. I was nearly unable to walk for the better part of 9 months all because the current regime and their "death panelists" decided I'm no longer "cost efficient" for the health system. I, no one else, pay a substantial amount for my own health insurance and I not only expect but DEMAND the best health care technology has to offer!
get a new doc you idiot 2nd opion anyone geexz
Thanks; smart ass. I did.
It is impossible to look inside the body without one of these machines. So either get a scan or get cut open. Please give me the non-invasive scan.
thank you
There is a reason the term "exploratory surgery" is never used anymore. It is because it has been made unnecessary by imaging
Surgery or CT scan??
there is no proof that these machines have caused one cancer the only link between radiation and cancer is the atomic bombings and japan that is the only data to posturize differently is fear mongering
Please read the Lancet paper that this article was based on. Oh...keeping current with the literature isn't necessary once you're practicing. This is part of the problem.
If we ever want to have a rational medical care system, we need to get the lawyers out of it.
ever wonder why in health care the more the volume the higher the price gets,where everthing else the more the volume the lower the cost,well except maybe goverment.
Government should be able to push the prices down to rational levels considering the demand growth and reduce reimbursement rates accordingly but every side has the lobby.
and gambling
even devorces get cheaper in the long run as you get poorer
Doctors aren't perfect, and don't always have all the answers. But often times they do act as if you are questioning their abilities if you question the use of these tests. Regardless of how they act, just because they say so isn't always a legitimate reason for the test. Any patient should be able to trust their doctor to do what's right, but we need to face reality, many doctors have a case load that's larger than they can handle. Sometimes they call for these tests to cover their asses. If you aren't comfortable with their actions, and they won't listen to your concerns, get another doctor. My parents are in their 80's, and their GP wouldn't know their names if she didn't have her laptop with her. Look out for your self, because you may be the only one who is.
Hospitals, both public and private, are in competition with each other. Therefore, each wants to show how it has the latest tools, be it a PET, MRI, CT, or da Vinci surgery robotic tool. As a result, most communities have more than is needed for the population served. Because, these machines cost big bucks, they have to be used more than what is truly needed to recoup the cost. I expect that some MDs order these test for CYA.
I think one thing that should be thought about is the frequency and the expense. By and large we operate on a fee for service schedule that for radiology has been rather generous; justifiable considering the investment in technical equipment. What bothers me is, similar to big pharma, radiology companies are making money hand over fist because of this spike. I have no problem using these diagnostic tools, but I think looking at the method or the rate of reimbursement should be reviewed considering the investment is ultimately paid for rather quickly with the frequency of testing. Hmm. Market controls...
lawyers,it's way to late to ever do anything about them,like a cancer they have infiltrated washingtion,our only hope is a natural disaster like yosemite erupting,to wipe out this life on earth and start over again where only the rats and cockroches have survived,how ironic
What the article fails to address are the advances in technology that have occurred alongside the increase in referrals. I am a Nuclear Medicine Technologist, and when I graduated in 96 we were taught PET but were also told that tracer manufacturing and distribution was so problematic that it might never be feasible for standard clinical practice. As availability of the short lived radiopharmaceuticals has increased so have the number of referrals. I can't imagine being a cancer patient and having to make a decision about surgery or therapy without the all possible information available to myself and my physician.
if i were to become a doctor it would be a gp,very hard to get sued when you claim to be a practionor
I'm more than sick and tired of negative articles about how doctors overuse medical imaging for profit,etc. Those statements, which are incorrect, except in rare instances, somehow imply that the practice of medicine is better served by Insurance companies, Government, and the Lay Press, than Doctors that are very well educated and dedicated to the care of their patients.
There is no doubt that some screening tests may overall have a relatively low yield, but if they expose treatable, lifethreatening illnesses a fraction of the time, that is a large number of patients nonetheless who will live longer and better lives. Think about it, if that is you are your family memebers.
Doctors are primarily interested in helping their patients live better quality and longer lives. Most of us are not policy makers. It is the policy maker who is making these decisions based on what else, the bottom line? But when you scratch under the surface, one finds few committing fraud, and most practicing good medicine.
People are living longer due to technologies, and not necessarily due to good health habits. If people took better care of themselves, perhaps there would be less need for mical imaging and the Health Care Dollar. Concentrate on that instead of complaining when someone wants to tax or takeaway your triple cheeseburger!
I do agree with you that most physicians want to help their patients and that they aren't policy makers. But I'd also point out that this article is based upon your colleagues findings not the lay literature.
MS Pearce et al. Radiation exposure from CT Scans in Childhood and Subsequent Risk of Leukemia and Brain Tumours: a retrospective cohort study. The Lancet. On-line publication 7-June 2012.
I guess all that I can say is Google (or lit search it for the fulltext).
It is a reasonable concern of patients and something to be considered.
kirsty,
I severly doubt you teach med students on anything but a cursory level.
Its really difficult to prove anything, especially causation, conclusively with retrospective studies.
Any 1st year med student knows this
If you practice medicine without retrospective studies, you'd have little to rely on beyond a hunch. Most of the recommendations about a healthy lifestyle come from retrospective studies (e.g., Framingham Heart Study). I guess that you'd like to toss that too.
Can you prove it? No, but if your a physician, you'd hopefully have some concept of stats, and with that I'd take a decent p value as some assurance. I'll point out that right now you sould like the cigarette industry dening the risk of smoking. That being said, I'm certainly not claiming that physicians are anything like cigarette companies.
It is funny that physicians move mountains to ban dropped sided cribs because 32 babies died between 2001-2010 in them. In contrast, I'll bet you many, many more children will die from unnecessary (as determined by the literature) head/abdominal CTs; however, I keep seeing individuals claiming to be physicians justifying it.
I'd like to stick with the summary from the Lancet study, "Although clinical benefits should outweigh the small absolute risks, radiation doses from CT scans ought to be kept as low as possible and alternative procedures, which do not involve ionising radiation, should be considered if appropriate." Can't we at least agree with that?
Advance imaging needs to be restricted to high party officials, ruling elite, and party donors. We have limited resources and they must reserved for those worthy of leading us.
Doctors must order the newest, and likely most expensive tests, so that abnormalities are not missed. Failure to order these tests would absolutely result in a malpractice lawsuit if an early abnormality is not caught. The doctor who refers a patient to the radiology department of a hospital doesn't earn one cent from the referral. If society wants to decrease the costs brought on by medical imaging, it must change the tort laws, so that physicians won't get sued if they don't order the technologically newest tests.
ER docs don't make the money themselves, but they certainly understand the cash flow in the hospital.
Cost is an issue, but it should be considered by the person receiving the service in consultation with their doctor. This will only happen if the patient has to pay something for services that he/she receives. Letting someone else decide if you should or should not have a test based on cost is never going to work to everyone's satisfaction, and will do little to improve the value patients receive for their healthcare dollar.
When I ask my doctor what a test that he prescribes is going to cost, he just laughs because he has no idea. You can't have an efficient market when price is obscured from buyers and sellers.
What a stupid article. This makes about as much sense as saying vaccinations spiked in the mid eighteenth century. Of course medical imaging spiked in the past sixteen years. The number of imaging devices in use also spiked during that period. The number of maladies being detected by imaging spiked. And as the article pointed out, a lot of the scans ordered by physicians were in response to the malpractice lawsuit industry. Is MSNBC suggesting that these machines sit idle in order to hold down medical costs?
MSNBC always tries to present rag journalism in it's best light. Welcome to the new FAUX news!!!!!BWAHHAHHA.