Huge Rise in CT, MRI, Ultrasound Scan Use: Study

TUESDAY, June 12 (HealthDay News) — The number of advanced
diagnostic scans, such as CTs and MRIs, has zoomed upward since 1996,
greatly boosting the amount of estimated radiation that patients receive,
according to a new analysis of the medical records of millions of
Americans in HMO health plans.

It’s not clear what extra risk the radiation poses, nor is it known how
much difference the scans have made in terms of diagnosing and treating
illness. Still, the existing research raises questions about overuse of
the scans, said study lead author Dr. Rebecca Smith-Bindman, a professor
at the University of California, San Francisco.

“We spend in the ballpark of $100 billion a year on medical imaging,
and we need to invest some research dollars to figure out how best to
spend these dollars and when to image more and when to image less,” she
said. “The impact on health outcomes should be the driver of these
decisions, rather than the fact that a new test has simply become
available and we are enamored with the images.”

The researchers studied millions of patients from six large HMO (health
maintenance organization) health care systems over the period from 1996 to
2010. They followed 1 million to 2 million patients each year.

According to the findings, published in the June 13 issue of the
Journal of the American Medical Association, patients underwent an
average of just over one imaging examination — such as an X-ray — per
year. A little over one-third were advanced diagnostic imaging tests, such
as CT (computed tomography), MRI (magnetic resonance imaging), nuclear
medicine, a subset of nuclear medicine called PET (positron emission
tomography), and ultrasound scans.

The researchers found that CT scans grew by nearly 8 percent a year,
MRIs by 10 percent a year, and ultrasounds by nearly 4 percent a year.
Nuclear medicine scans, which are fairly uncommon, dipped by 3 percent a
year, however PET scans grew rapidly from 2004 to 2010 — by 57 percent
annually.

The researchers calculated that the percentage of patients who received
high or very high levels of radiation through scans also rose over the 15
years. Of those who received scans in 2010, nearly 7 percent received high
annual radiation exposure and nearly 4 percent received very high annual
exposure.

Smith-Bindman said the scan rates in the HMOs in the study were a bit
lower than in traditional fee-for-service systems, but the growth rates
were the same. “While the financial incentives are very different in the
[HMO] setting, the other factors that have led to the dramatic rise in
imaging are all the same — physician and patient demand, improvement in
the technologies that allow it to answer a broad range of questions, fear
of medical malpractice suits, and uncertainty due to the lack of clinical
guidelines on when to use imaging,” she said.

CT scans are often unnecessary, Smith-Bindman added, and she believes
that there aren’t enough good guidelines regarding the use of scans in
general.

Scanning technology has become much more accurate and useful over time,
said Dr. Hiroto Hatabu, an associate professor of radiology at Brigham and
Women’s Hospital in Boston, who co-wrote a commentary accompanying the
study.

For example, Hatabu said, scans make it much less difficult to diagnose
bleeding in the brain.

But he acknowledged that high-tech scans can be overused. “I think we
can use information technology and try to control it in the future. And
there are ongoing efforts to decrease the radiation doses and get the same
information.”

The Medical Imaging Technology Alliance, a trade organization for
the medical imaging industry, announced last week that it has launched new
projects to protect patients from being exposed to unnecessary levels of
radiation.

More information

For more about CT
scans
, visit the U.S. National Library of Medicine.

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