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BMJ 2010; 340 doi: (Published 30 June 2010) Cite this as: BMJ 2010;340:c3429

Overuse of imaging puts patients and health budgets at risk

Twin commentaries last week called for an overhaul of diagnostic imaging in the US. One said much of it is unnecessary and expensive, and the other warned that overuse of computed tomography (CT) is potentially unsafe. Both want doctors to think more carefully before ordering high technology imaging and suggest legal, regulatory, and educational reforms to control overuse and protect patients. The Food and Drug Administration should take the lead in establishing standards of practice and regulating compliance, write the authors. Current systems of oversight are absent or fragmentary.

Each year, around 10% of the US population has a CT scan and use continues to grow thanks to inbuilt perverse incentives that allow office based doctors to buy their own machines and refer their own patients. Both commentaries say this must stop. Uncritical use of any imaging technique leads to a cascade of overdiagnosis, further tests, and even invasive unnecessary treatments. CT scans are associated with a measurable risk of radiation induced cancer. A proportion of all imaging tests are no use to doctors or patients. This proportion is unknown but thought to be substantial.

Reformers should start with the medical curriculum, which ignores the appropriate use of imaging, then tackle the tort laws that drive so much defensive imaging, says one commentary. Regulators need to get a grip on CT imaging in particular, says the other. Radiation doses could be halved without loss of diagnostic accuracy.

Viruses mutated from vaccines hamper global eradication of polio

Efforts to eradicate polio suffered a serious setback 10 years ago when health authorities first discovered pathological strains of the virus that had mutated from commonly used live vaccines. One or two outbreaks of vaccine derived polio have occurred every year since then, writes one commentator from the Lebanon.

One of the biggest outbreaks of vaccine derived polio began in Nigeria …

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