Radiologists must be cognizant of patient safety at all times, as overexposure to radiation from imaging equipment can cause cancer. However, numerous organizations and national campaigns have sought to educate health care providers, patients and families on the importance of making optimal clinical decisions.
As an initiative of the American Board of Internal Medicine, Choosing Wisely has been the subject of multiple studies. In the April issue of the Journal of the American Medical Association, researchers led by Catherine Gliwa and Steven Pearson, M.D., of the National Institutes of Health, examined the role that evidence pertaining to the benefits, risks and costs of medical imaging procedures plays in selecting services.
“Aiming to reduce wasteful medical care, the ABIM’s Choosing Wisely initiative asks leading physician specialty societies to create a ‘Top 5’ list of medical services that provide no overall benefit to patients in most situations,” wrote the authors.
By selecting the least beneficial exams, physicians can help weed out the procedures that suggest no additional health benefits while also being of higher risk, cost, or both, compared to other modalities. As Choosing Wisely grows, evidence-based clarity on tests provided by radiologists can improve the credibility of the campaign’s efforts.
Twenty-five different practices participated in the study, producing one or more Top 5 lists, which included 135 services. Of those, 36 percent were for diagnoses or monitoring health; 34 percent for treatments; and 30 percent for screening populations. Afterward, the authors assessed the various reasons for choosing these low-benefit services. Forty-nine percent pertained to greater risks for patients, 24 percent related to increased costs, and 16 percent were a mix of both rationales.
Reducing high cost procedures
According to Diagnostic Imaging, a recent article in JAMA Internal Medicine from Jeremiah Schuur, M.D., M.H.S., and his colleagues at Brigham and Women’s Hospital detailed five low value services used in the emergency department.
While there was no direct advice or language to wholly eliminate specific exams, their research indicated that following guidelines and digital imaging protocols are necessary for mitigating high costs. Recently, the federal government passed the Protecting Access to Medicare Act of 2014 that included language pertaining to meeting CT radiation dose standards, otherwise known as XR-29.
Although federal laws can help determine the ordering of procedures, the choice ultimately falls on radiologists and referring physicians to collaborate on clinical decision making.
Eliminating waste
As health care shifts toward quality over quantity for medical services, decreasing wasteful expenses becomes the main target of providers. By taking the time to wisely decide on the proper procedure, radiologists can improve health outcomes while also protecting patients and themselves.
It takes the courage of physicians to make the right choice, and Choosing Wisely is only a small part of the process. With providers and patients being held accountable for decisions, they must work together to achieve optimal solutions.
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Ronny Bachrach
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