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Physicians Alliance’s Lists Say: Image Less

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The National Physicians Alliance (NPA) seems to think there’s entirely too much imaging going on. On Monday, it released three “top five” lists that collectively contain seven recommendations against certain imaging practices.

The lists “reflect common clinical activities in primary care where the quality of care could be improved,” according to an NPA news release.

This project started in 2009 with a grant. The NPA was instructed to use the grant to develop lists of evidence-based activities that could improve health care quality and reduce costs. It convened working groups of NPA members in the areas of family medicine, internal medicine, and pediatrics.

The fruits of their labor were published Monday in the online version of Archives of Internal Medicine. Each working group came up with a “top five” to-do list—or, actually, more of a don’t-do list.

The family medicine and internal medicine lists shared three imaging-related recommendations:

  • Don’t do imaging for lower-back pain within the first six weeks of the onset of symptoms unless there are specific red flags, such as progressive neurological deficits.
  • Don’t perform annual ECGs or other annual cardiac screens for healthy, low-risk patients with no symptoms.
  • Don’t do DEXA bone scans for osteoporosis in women younger than 65 or men younger than 70.

The pediatric “top five” included one imaging-related recommendation: don’t order diagnostic imaging for minor head injuries unless the child has lost consciousness, is younger than 2, or exhibits other risk factors such as dizziness, neurological deficits, or pooling of blood around the eyes (“raccoon eyes”).

All of these procedures, the NPA says, increase costs without improving patient outcomes. In some cases, the net benefit to patients actually may be negative because of radiation exposure or false positives that trigger unnecessary tests and treatments. As Stephen R. Smith, MD, the NPA’s project leader, put it:

Unfortunately, some elements of the health care system include expensive practices that do not improve health and in some cases cause harm. Practicing responsible medicine means always doing what is best for the patient while being mindful that resources are finite and that doing more does not always mean better care.

None of these recommendations is likely to startle anyone. In fact, we’ve discussed most of them in this forum over the past few months. Still, though the NPA may come off as a bit self-congratulatory, it never hurts to be reminded of best practices. And if the medical community doesn’t address the pressures to rein in costs and reduce radiation exposure, the political community is likely to take on the job. We’ve all seen how messy that can be.

Related seminar: Cardiac Imaging

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