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Gerard Amirtham. Chief Radiographer. South Eastern Radiology,
Victoria, Australia.
Re: US report calls for national strategy to reduce overuse of
medical imaging.
Susan Mayor. BMJ 2010; 341:c4658 (Published 25 August 2010)
I would like to reflect on my personal experience in regards to the
overuse of CT scan in Australia. I manage a private medical imaging centre
located in a suburb where there are a larger number of non English
speaking migrants.
The overuse of CT scan not only reflects upon patient safety (in
terms of radiation safety [1] and potential reaction to IV contrast [2])
but also the quality of care provided by doctors to these patients.
Demand for services of General Practitioners (GPs) has increased over
the years due to large intake of migrants as well as the increase in aging
population. With more patients there has been a general increase in the
number of medical imaging request by GPs, however there are concerns that
unnecessary CT scan request are also being made [3]. This could partially
be attributed to patient demands and the practice of defensive medicine.
Language and cultural barrier between health provider and patient coupled
with inaccessibility of previous medical records may have contributed to
the overuse of medical imaging. Due to lack of information or
misinformation, medical practitioners may have inadvertently requested
more medical test resulting in the overuse of medical imaging. The
challenge here is to have a delicate balance that does not compromise
patient safety and quality of care. CT scan request must be made on the
basis of clinical justification and taking into consideration the effects
of radiation especially on women and children [4].
Private run imaging centres depend on Medicare [5] billing to support
their business structure. Recently there was a sudden reduction in CT scan
request from GPs after an article was published in the newspaper in
regards to possible risk of cancer due to overuse of CT scan [6]. It
affected our practice for a few months as there were less patients being
referred for CT scan. This only goes to show that there is a great
potential for GPs to reduce the number of request for CT scan if they
choose to do so without compromising quality. Due to the cancer scare some
patients even refused to undergo CT scan even though clinically indicated
[7]. Situation was back to as it was when a more balanced view of the risk
of CT scan was published in the newspaper [8].
Medical practitioners should empower themselves to be "effective",
providing services on scientific knowledge to all who could benefit and
refrain from providing services to those not likely to benefit [9].
Radiologist and radiographers should be more proactive when dealing with
medical imaging request forms that have insufficient clinical information
to warrant such examination. It is a challenge to be proactive in a
private setting as it can have financial implication to the practice.
However having constant communication between clinicians and imaging
professionals there can be more effective, safe and quality services
provided to patients.
References:
[1] Diagnostic CT Scans: Assessment of Patient, Physician, and
Radiologist Awareness of Radiation Dose and Possible Risks. Lee CI May
2004 Radiology, 231, 393-398.
[2] Trends in Adverse Events after IV Administration of Contrast
Media. Sachiko T. AJR 2001; 176:1385-1388
[3] Towards the appropriate use of diagnostic imaging. Richard M
Mendelson and Conor P J Murray. MJA 2007; 187 (1): 5-6.
[4] Radiation exposure and the justification of computed tomography
scanning in an Australian hospital emergency department. M. Street.
Internal Medicine Journal 39 (2009) 713-719.
[9] Crossing the Quality Chasm: A new health system for the 21st
century. Institute of Medicine. March 2001.
[10] US report calls for national strategy to reduce overuse of
medical imaging Susan Mayor. BMJ 2010; 341:c4658 doi: 10.1136/bmj.c4658
(Published 25 August 2010).
Over use of medical imaging in Australia.
Gerard Amirtham. Chief Radiographer. South Eastern Radiology,
Victoria, Australia.
Re: US report calls for national strategy to reduce overuse of
medical imaging.
Susan Mayor. BMJ 2010; 341:c4658 (Published 25 August 2010)
I would like to reflect on my personal experience in regards to the
overuse of CT scan in Australia. I manage a private medical imaging centre
located in a suburb where there are a larger number of non English
speaking migrants.
The overuse of CT scan not only reflects upon patient safety (in
terms of radiation safety [1] and potential reaction to IV contrast [2])
but also the quality of care provided by doctors to these patients.
Demand for services of General Practitioners (GPs) has increased over
the years due to large intake of migrants as well as the increase in aging
population. With more patients there has been a general increase in the
number of medical imaging request by GPs, however there are concerns that
unnecessary CT scan request are also being made [3]. This could partially
be attributed to patient demands and the practice of defensive medicine.
Language and cultural barrier between health provider and patient coupled
with inaccessibility of previous medical records may have contributed to
the overuse of medical imaging. Due to lack of information or
misinformation, medical practitioners may have inadvertently requested
more medical test resulting in the overuse of medical imaging. The
challenge here is to have a delicate balance that does not compromise
patient safety and quality of care. CT scan request must be made on the
basis of clinical justification and taking into consideration the effects
of radiation especially on women and children [4].
Private run imaging centres depend on Medicare [5] billing to support
their business structure. Recently there was a sudden reduction in CT scan
request from GPs after an article was published in the newspaper in
regards to possible risk of cancer due to overuse of CT scan [6]. It
affected our practice for a few months as there were less patients being
referred for CT scan. This only goes to show that there is a great
potential for GPs to reduce the number of request for CT scan if they
choose to do so without compromising quality. Due to the cancer scare some
patients even refused to undergo CT scan even though clinically indicated
[7]. Situation was back to as it was when a more balanced view of the risk
of CT scan was published in the newspaper [8].
Medical practitioners should empower themselves to be "effective",
providing services on scientific knowledge to all who could benefit and
refrain from providing services to those not likely to benefit [9].
Radiologist and radiographers should be more proactive when dealing with
medical imaging request forms that have insufficient clinical information
to warrant such examination. It is a challenge to be proactive in a
private setting as it can have financial implication to the practice.
However having constant communication between clinicians and imaging
professionals there can be more effective, safe and quality services
provided to patients.
References:
[1] Diagnostic CT Scans: Assessment of Patient, Physician, and
Radiologist Awareness of Radiation Dose and Possible Risks. Lee CI May
2004 Radiology, 231, 393-398.
[2] Trends in Adverse Events after IV Administration of Contrast
Media. Sachiko T. AJR 2001; 176:1385-1388
[3] Towards the appropriate use of diagnostic imaging. Richard M
Mendelson and Conor P J Murray. MJA 2007; 187 (1): 5-6.
[4] Radiation exposure and the justification of computed tomography
scanning in an Australian hospital emergency department. M. Street.
Internal Medicine Journal 39 (2009) 713-719.
[5] http://www.medicareaustralia.gov.au/
[6] Doctors Ignoring CT scan Cancer Risk. Author: MARK METHERELL
HEALTH CORRESPONDENT
The Age. Date: 15/03/2010
http://newsstore.theage.com.au/apps/viewDocument.ac?multiview=true&sy=ag...
[7] Patients at risk from CT scan scare.
The Australian. Date: 12/04/2010.
http://www.theaustralian.com.au/news/patients-at-risk-from-ct-scan-
scare/story-e6frg6n6-1225852468761
[8]To CT scan or not to CT scan: a guide. Lawrence Lau
The Australian. Date: 05/06/2010
http://www.theaustralian.com.au/news/health-science/to-ct-scan-or-not-to-
ct-scan-a-guide/story-e6frg8y6-1225875602846
[9] Crossing the Quality Chasm: A new health system for the 21st
century. Institute of Medicine. March 2001.
[10] US report calls for national strategy to reduce overuse of
medical imaging Susan Mayor. BMJ 2010; 341:c4658 doi: 10.1136/bmj.c4658
(Published 25 August 2010).
Competing interests: No competing interests