Think Twice Before Ordering These Imaging Tests

Do patients need an imaging test for an uncomplicated headache? What about a chest X-ray before outpatient surgery?

These common imaging scans were among a list of five tests or procedures identified today by the American College of Radiology as possibly unnecessary or overused tests. ACR was one of nine physician organizations that each identified five common tests that should be discussed before being ordered. The initiative is part of the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely campaign to provide evidence-based recommendations for physicians with the goal of reducing healthcare costs and improving patient care.

“Although imaging use is down significantly in recent years and Medicare spending on imaging is at 2003 levels, opportunities remain to ensure appropriate ordering of scans,” John A. Patti, MD, FACR, chair of the ACR Board of Chancellors, said in a statement.

As part of the campaign, Consumer Reports is working with the ACR and other groups to distribute patient-friendly resources to help with conversations about these imaging exams.

The ACR recommendations address:

• Imaging for uncomplicated headache absent specific risk factors for structural disease or injury
• Imaging for suspected pulmonary embolism (PE) without moderate or high pre-test probability of PE
• Pre-operative chest X-rays without specific reasons due to patient history or physical exam
• CT to evaluate suspected appendicitis in children until ultrasound is considered an option
• Follow-up imaging for adnexal (reproductive tract) cysts 5 mm or less in diameter in reproductive-age women

Recommendations from other physician organizations also address medical imaging. For example, the American College of Physicians noted that patients likely don’t need brain imaging scans like a CT or MRI after fainting. The American Academy of Allergy, Asthma and Immunology advised that uncomplicated acute rhinosinusitis is generally diagnosed clinically and does not require a sinus CT scan or other imaging. The American Academy of Family Physicians said that women under 65 and men under 70 with no risk factors shouldn’t be screened for osteoporosis with dual energy X-ray.

“Today these societies have shown tremendous leadership in starting a long overdue and important conversation between physicians and patients about what care is really needed,” Christine K. Cassel, MD, president and CEO of the ABIM Foundation, said in a statement. “Physicians, working together with patients, can help ensure the right care is delivered at the right time for the right patient. We hope the lists released today kick off important conversations between patients and their physicians to help them choose wisely about their health care.”

ABIM Foundation also announced eight new participating societies today, including the Society of Nuclear Medicine, which will release their lists this fall.

The complete lists from the specialty societies, including evidence and guidelines, is available at www.ChoosingWisely.org.