Greg Freiherr, Industry Consultant
Greg Freiherr, Industry Consultant

Greg Freiherr has reported on developments in radiology since 1983. He runs the consulting service, The Freiherr Group.

Blog | Greg Freiherr, Industry Consultant | April 20, 2012

'Choosing Wisely' Campaign Validates Use of Imaging Tests

Over the past several years, the radiology community has taken it on the chin with reimbursement cuts to reports of radiation overexposure. Earlier this month, it looked like radiology would be hit again, this time by nine physician societies whose leaders compiled a list of “five things physicians and patients should question” – part of a concerted “Choosing Wisely” campaign launched by organized medicine.

At first glance, it looked gloomy. Of the 45 “things” listed, 26 had to do with imaging. But after examining each group’s recommendations, imaging came out looking pretty good. Rather than attacking radiology, the recommendations were really a vindication that the vast majority of imaging tests are reasonable and justified.

Two groups – the American Society of Nephrology and American Academy of Allergy, Asthma & Immunology – nearly skipped over imaging entirely. Nephrologists named mammography as one of several diagnostic tests (i.e., colonoscopy, prostate-specific antigen and Pap smears) that shouldn’t be performed routinely on dialysis patients with limited life expectancies. Specialists of allergy, asthma and immunology questioned sinus computed tomography (CT) in the same breath as they cautioned against indiscriminately prescribing antibiotics for uncomplicated acute rhinosinusitis.

The American College of Radiology had little choice but to recommend against imaging studies, as these are the only “things” the College addresses. But its choices were in line with long-standing policy, for example, recommending against imaging for uncomplicated headache and against CT for suspected appendicitis, “until ultrasound has been considered”.

Ditto for the American Society of Nuclear Cardiology, whose sole purview is, well…nuclear cardiology. The Society cautioned against the use of imaging for low-risk and asymptomatic patients, as well as for a preoperative assessment of patients facing low- and intermediate-risk noncardiac surgery. Additionally, the Society advised physicians to use methods that reduce radiation exposure or forego tests altogether, “when limited benefits are likely.”

Clinical oncologists advised against performing positron emission tomography (PET), CT and radionuclide bone scans to stage early prostate and breast cancers at low risk for metastasis, just as they cautioned against using these modalities for asymptomatic patients “treated for breast cancer with curative intent.”  

The American Academy of Family Physicians urged caution when imaging for low back pain and against using X-ray absorptiometry to screen for osteoporosis in women under 65 and men under 70 who have no risk factors.

The American College of Physicians mirrored the recommendation of its family practitioner colleagues regarding low back pain, adding three more caveats: recommending against imaging studies as the initial diagnostic test for venous thromboembolism; the use of CT or magnetic resonance imaging (MRI) to evaluate simple syncope (with a normal neurological exam), and preoperative chest X-rays when intrathoracic pathology is not suspected.

Three of the four cautions raised by cardiologists against imaging questioned stress cardiac imaging and advanced noninvasive imaging for asymptomatic patients or those scheduled to undergo low-risk noncardiac surgery. These were accompanied by advice not to routinely perform echocardiography when following up adults for mild, asymptomatic native valve disease.

Later this year, more specialty groups are expected to issue similar lists. Judging from the nine lists already released, imaging will have reason to be happy.

Related Content

FDA Clears Mobilett Elara Max Mobile X-ray from Siemens Healthineers
Technology | Digital Radiography (DR) | March 20, 2019
The U.S. Food and Drug Administration (FDA) has cleared the Mobilett Elara Max mobile X-ray system from Siemens...
Older Biologic Age Linked to Elevated Breast Cancer Risk
News | Women's Health | March 19, 2019
Biologic age, a DNA-based estimate of a person’s age, is associated with future development of breast cancer, according...
HeartFlow Analysis Successfully Stratifies Heart Disease Patients at One Year
News | CT Angiography (CTA) | March 19, 2019
Late-breaking results confirm the HeartFlow FFRct (fractional flow reserve computed tomography) Analysis enables...
PET Scans Show Biomarkers Could Spare Some Breast Cancer Patients from Chemotherapy
News | PET Imaging | March 18, 2019
A new study positron emission tomography (PET) scans has identified a biomarker that may accurately predict which...
SyncVision iFR Co-registration from Philips Healthcare maps iFR pressure readings onto angiogram.

SyncVision iFR Co-registration from Philips Healthcare maps iFR pressure readings onto angiogram. Results from an international study presented at #ACC19 show that pressure readings in coronary arteries may identify locations of stenoses remaining after cardiac cath interventions.

Feature | Cardiac Imaging | March 18, 2019 | By Greg Freiherr
As many as one in four patients who undergo cath lab interventions can benefit from a technology that identifies the
Non-Contrast MRI Effective in Monitoring MS Patients
News | Neuro Imaging | March 18, 2019
Brain magnetic resonance imaging (MRI) without contrast agent is just as effective as the contrast-enhanced approach...
Jennifer N. A. Silva, M.D., a pediatric cardiologist at Washington University School of Medicine in Saint Louis, Mo., describes “mixed reality” at ACC19 Future Hub.

Jennifer N. A. Silva, M.D., a pediatric cardiologist at Washington University School of Medicine in Saint Louis, Mo., describes “mixed reality” at ACC19 Future Hub.

Feature | Cardiac Imaging | March 17, 2019 | By Greg Freiherr
Virtual reality (VR) and its less immersive kin, augmented reality (AR), are gaining traction in some medical applica
WVU cardiology chief Partho Sengupta, M.D., describes at ACC 2019 how artificial intelligence already helps cardiologists in echocardiography.

WVU cardiology chief Partho Sengupta, M.D., describes at ACC 2019 how artificial intelligence already helps cardiologists in echocardiography. Photo by Greg Freiherr

Feature | Cardiac Imaging | March 16, 2019 | By Greg Freiherr
Machine learning is already having an enormous impact on cardiology, automatically calculating measurements in echoca
New MRI Sensor Can Image Activity Deep Within the Brain
News | Magnetic Resonance Imaging (MRI) | March 15, 2019
Calcium is a critical signaling molecule for most cells, and it is especially important in neurons. Imaging calcium in...
Fujifilm Launches Three New Software Tools for Aspire Cristalle Digital Mammography System
Technology | Mammography | March 15, 2019
Fujifilm Medical Systems USA announced it has fulfilled all U.S. Food and Drug Administration (FDA) regulatory...