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Choosing Wisely Nixes Radiology Treatments

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Imaging for low back pain and some dual-energy X-ray absorptiometry (DEXA) screening for osteoporosis have become the latest radiology procedures drawing frowns from the Choosing Wisely campaign.

They were on the list of “15 things physicians and patients should question” released today by the American Academy of Family Physicians. The academy recommended against imaging for low back pain within the first six weeks of symptom onset unless red flags, such as certain neurological deficits, are present. And the academy said not to use DEXA osteoporosis screening for women younger than 65 or men younger than 70 if they have no risk factors. The academy explained:

DEXA is not cost effective in younger, low-risk patients, but is cost effective in older patients.

Choosing Wisely is a campaign by the ABIM Foundation, which was established in 1999 by the American Board of Internal Medicine to further medical professionalism. As part of the campaign, various medical societies are releasing lists of procedures that, according to Choosing Wisely’s Web site, “may be unnecessary, and in some instances can cause harm.”

Here are the other radiological and radiation oncology procedures that the Choosing Wisely lists released so far this month have included (with the American Academy of Clinical Toxicology/American College of Medical Toxicology list due on Thursday):

  • American College of Surgeons: Routine whole-body diagnostic CT in patients with minor or single-system trauma; admission or preoperative chest X-rays for ambulatory patients with unremarkable history and physical exam; CT for evaluation of suspected appendicitis in children without considering ultrasound first.
  • American Academy of Orthopaedic Surgeons: Routine postoperative deep vein thrombosis ultrasound screening after elective knee or hip arthroplasty.
  • American Society for Radiation Oncology (ASTRO): Whole-breast radiotherapy as part of breast conservation therapy for women 50 or older for early-stage invasive breast cancer without considering shorter treatment schedules; proton beam therapy for prostate cancer outside a clinical trial or registry; routine intensity-modulated radiation therapy for whole-breast radiotherapy as part of breast conservation therapy.

In addition, the Commission on Cancer suggested considering radiation therapy instead of surgery for certain cancers.

Considering the proton-therapy boom and recent evidence that it may offer some clinical benefits, the recommendation against its use for prostate cancer came as a surprise. Michael Steinberg, MD, chairman of ASTRO’s Board of Directors, told DOTmed News:

I was expecting a fair amount of push-back. But when I announced it, the director of a newly opened proton therapy got up and said he supported the proton suggestion because he’s of the belief that the way to use protons in prostate is in the context of a clinical trial or registry.

Related CME seminar (up to 35.25 AMA PRA Category 1 credits™): UW Radiology Review Course “Not Just for Residents”

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