05 Sep Medical Imaging Continues to Rise in US Hospitals
MedicalResearch.com Interview with:
Rebecca Smith-Bindman, MD
Professor, Department of Radiology and Biomedical Imaging,
Epidemiology and Biostatistics
Philip R. Lee Institute for Health Policy Studies
University of California, San Francisco
MedicalResearch.com: What is the background for this study?
Response: Medical imaging increased rapidly from 2000 to 2006. The rise in imaging can be attributed to improvements in technical aspects of imaging, strong physician and patient demand, and strong financial incentives. While imaging contributes to accurate disease diagnosis and improved treatment, imaging can also increase costs and patient harms, such as incidental findings, overdiagnosis, anxiety, and radiation exposure associated with increased risk of cancer. Potential overuse of diagnostic testing has been addressed by the American Board of Internal Medicine Foundation’s Choosing Wisely Campaign and initiatives by payers to reduce imaging through payment reductions, but there remains uncertainty in the impact of these initiatives on imaging rates.The objective of our study was to evaluate recent trends in medical imaging.
Our study assessed imaging from 2000 through 2016 among individuals enrolled in diverse U.S. integrated healthcare systems and among individuals residing in Ontario, Canada and assessed changes in medical imaging utilization over time by country, health system, and patient demographic factors.
MedicalResearch.com: What are the main findings?
Response: We found that Imaging with CT, MRI, and ultrasound in 7 U.S. integrated healthcare systems and in Ontario, Canada have continued to increase in recent years. While annual growth in CT, MRI, and ultrasound were highest in the early years (i.e., between 2000 and 2006), utilization in imaging continued to rise between 2012 and 2016 (1-5% annually) for most age groups in both the U.S. sites and Ontario, Canada.
The notable exception is for pediatric CT (<18 years old) which has declined since 2006. In contrast, nuclear medicine demonstrated a consistent decline in every age category and healthcare system.
MedicalResearch.com: What should readers take away from your report?
Response: Imaging rates continue to rise despite both educational efforts and financial disincentives.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: I think to impact rates of advanced imaging, greater education of patients and physicians is required. Further, there is a need for well conducted research studies to help guide imaging followed by well conducted studies to understand the best approaches for changing practice. While most decisions regarding medical treatments and medications are supported by randomized trials, these types of studies are rare with respect to imaging. There has been the feeling that imaging is purely beneficial, without potential harms, and this is obviously not true, but drives its ongoing growth. Well conducted studies are essential to help guide patients and providers to the appropriate use of medical imaging’
Smith-Bindman R, Kwan ML, Marlow EC, et al. Trends in Use of Medical Imaging in US Health Care Systems and in Ontario, Canada, 2000-2016. JAMA. 2019;322(9):843–856. doi:10.1001/jama.2019.11456
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