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

Table 1. Compared to 2-D mammography, which yields four images per patient, digital breast tomosynthesis (DBT), or 3-D mammography, produces hundreds of images per patient. While this provides more information for clinicians, the exponential increase in data can result in reader fatigue and burnout, which may ultimately affect patient care.

Table 1. Compared to 2-D mammography, which yields four images per patient, digital breast tomosynthesis (DBT), or 3-D mammography, produces hundreds of images per patient. While this provides more information for clinicians, the exponential increase in data can result in reader fatigue and burnout, which may ultimately affect patient care.

Sponsored Content | Case Study | Artificial Intelligence | April 09, 2020
As the largest independent imaging group in Michigan with 10 locations across the state,...
Figure 1. R MLO view from four different years. The skin mole is marked with a circular skin marker (TomoSPOT REF# 782, Beekley Medical) on the far-left image. These images demonstrate the potential for significant variability in location of the skin lesion due to movability of the skin during positioning.

Figure 1. R MLO view from four different years. The skin mole is marked with a circular skin marker (TomoSPOT REF# 782, Beekley Medical) on the far-left image. These images demonstrate the potential for significant variability in location of the skin lesion due to movability of the skin during positioning. 

Sponsored Content | Case Study | Breast Imaging | April 09, 2020
Christina Jacobs, M.D., Director of Breast Imaging (...
#COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2 United Imaging has installed its first transportable CT Scanner at Maimonides Medical Center in New York City to help expand its capacity for imaging during the fight against coronavirus in the U.S. As the hospital scales its operations to meet the needs of an expected influx of coronavirus patients, doubling its capacity to 1,400 beds, United Imaging’s scanner will help expand its capacity for imaging studies to support diagnosis and treatment.

United Imaging has installed its first transportable CT Scanner at Maimonides Medical Center in New York City to help expand its capacity for imaging during the fight against coronavirus in the U.S. As the hospital scales its operations to meet the needs of an expected influx of coronavirus patients, doubling its capacity to 1,400 beds, United Imaging’s scanner will help expand its capacity for imaging studies to support diagnosis and treatment.

News | Coronavirus (COVID-19) | April 09, 2020
April 9, 2020 — United Imaging, a global leader in adva
The interior of the German air force Airbus A-310 Medivac in Cologne, Germany, before its departure to Bergamo, Italy, March 28 to being ferrying COVID-19 patients to Germany for treatment to aid the Italians, whose healthcare system has been overwhelmed by the rapid spread of the coronavirus pandemic. Bundeswehr Photo by Kevin Schrief.

The interior of the German air force Airbus A-310 Medivac in Cologne, Germany, before its departure to Bergamo, Italy, March 28 to being ferrying COVID-19 patients to Germany for treatment to aid the Italians, whose healthcare system has been overwhelmed by the rapid spread of the coronavirus pandemic. Bundeswehr Photo by Kevin Schrief. Find more images from the COVID-19 pandemic.

 

Feature | Coronavirus (COVID-19) | April 08, 2020 | By Melinda Taschetta-Millane and Dave Fornell
In an effort to keep the imaging field updated on the latest information being released on coronavirus (COVID-19), th
#COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2  The first of three clinical scenarios presented to the panel with final recommendations. Mild features refer to absence of significant pulmonary dysfunction or damage. Pre-test probability is based upon background prevalence of disease and may be further modified by individual’s exposure risk. The absence of resource constraints corresponds to sufficient availability of personnel, personal protective equipment, COVID-19 testing, hospital beds, and/or ve

 The first of three clinical scenarios presented to the panel with final recommendations. Mild features refer to absence of significant pulmonary dysfunction or damage. Pre-test probability is based upon background prevalence of disease and may be further modified by individual’s exposure risk. The absence of resource constraints corresponds to sufficient availability of personnel, personal protective equipment, COVID-19 testing, hospital beds, and/or ventilators with the need to rapidly triage patients. Contextual detail and considerations for imaging with CXR (chest radiography) versus CT (computed tomography) are presented in the text. (Pos=positive, Neg=negative, Mod=moderate). [Although not covered by this scenario and not shown in the figure, in the presence of significant resources constraints, there is no role for imaging of patients with mild features of COVID-19.] Image courtesy of the journal Radiology

News | Coronavirus (COVID-19) | April 07, 2020
April 7, 2020 — A multinational consens...
#COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2 Chest CT findings of pediatric patients with COVID-19 on transaxial images. (a) Male, 2 months old, 2 days after symptom onset. Patchy ground-glass opacities GGO in the right lower lobe

Chest CT findings of pediatric patients with COVID-19 on transaxial images. Male, 2 months old, 2 days after symptom onset. Patchy ground-glass opacities GGO in the right lower lobe. Image courtesy of Radiology: Cardiothoracic Imaging

News | Coronavirus (COVID-19) | April 06, 2020
April 6, 2020 — Children and teenagers with COVID-19...
A recent study earlier this year in the journal Nature, which included researchers from Google Health London, demonstrated that artificial intelligence (AI) technology outperformed radiologists in diagnosing breast cancer on mammograms
Feature | Breast Imaging | April 06, 2020 | By Samir Parikh
A recent study earlier this year in the journal Nature,