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More Imaging-Related Studies

By May 7, 2010Commentary

Imaging is currently one of the most prominent villains in the excess cost and utilization story.  Three recent studies indicate both that there probably has been real abuse and that more imaging may also have significant clinical benefits.  First, the positive news.  There are circumstances, many probably, in which use of imaging accelerates accurate diagnosis and treatment and prevents unnecessary use of other health services.  An article in the Annals of Internal Medicine recounts one such situation.  (Annals Article) The authors used MRI to identify brain impacts from infective endocarditis.  The MRI identified more medical issues than did other diagnostic methods and led the authors to modify treatment plans for the affected patients.

Now the not so good.  The same issue of the Annals reports on research regarding lung-cancer screening using low-dose CT.  (Annals Article) In this randomized trial, CT screening was compared to normal chest x-rays for detection of lung cancer and for rates of false positives.  CT screening generated more false positives, which were more often followed by additional diagnostic tests and even invasive procedures or surgery.  The risks and costs of this additional unnecessary care is obvious.  As is often the case, large scale population screening carries very large costs in relation to its benefits, and has more risks to patients than are initially apparent.  A better strategy is needed for routine detection of disease.

Finally, a study published in the Journal of the American Medical Association examines use of diagnostic imaging for Medicare beneficiaries with cancer.  (JAMA Article) Cancer treatment is a very expensive category of care for Medicare and other payers and the cost has been skyrocketing, particularly because of the costs of new biotech drugs.  The researchers found that rates of imaging had escalated dramatically for Medicare beneficiaries with cancer, along with costs.  It is unclear that all this additional imaging has improved outcomes for the patients.  Ironically, excess imaging of some types increases cancer risk.

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