New Guidelines: Costly CAT Scans, MRIs, Often Unnecessary

Editor's Choice
Main Category: Back Pain
Article Date: 01 Feb 2011 - 11:00 PDT


Commonly directed CAT scans and MRIs, which are rather costly, may be completely unnecessary and a waste of time according to newly released guidelines. These CAT scans can cost patients and insurers up to $1,500 and an MRI, sometimes up to $3,000 while not proving to be at all beneficial and simply routine.

Amir Qaseem, MD, PhD, MHA, FACP, director of clinical policy for The American College of Physicians (ACP) states:

"Low back pain is one of the most common reasons for a patient to see a physician and many patients with low back pain receive routine imaging that is not beneficial and may even be harmful. Unnecessary imaging can lead to a series of unnecessary additional tests, interventions, follow ups, and referrals that do not improve patient outcomes."

The ACP's recommendations are based on a systematic review conducted for the Diagnosis and Treatment of Low Back Pain joint clinical practice guideline from ACP and the American Pain Society, and a subsequent meta-analysis.

Decisions for repeat imaging should be based on the development of new symptoms or changes in current symptoms. To be most effective, efforts to reduce routine imaging should take into account clinician behaviors, patient expectations, and financial incentives.

Patient education strategies should be utilized to inform patients about current and effective standards of care and help them understand the benefits and harms of the radiological testing.

An MRI machine uses a powerful magnetic field to align the magnetization of some atoms in the body, and radio frequency fields to systematically alter the alignment of this magnetization. This causes the nuclei to produce a rotating magnetic field detectable by the scanner, and this information is recorded to construct an image of the scanned area of the body. Strong magnetic field gradients cause nuclei at different locations to rotate at different speeds. 3-D spatial information can be obtained by providing gradients in each direction.

X-ray computed tomography (CT or CAT) is a medical imaging method employing tomography created by computer processing. Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of two-dimensional X-ray images taken around a single axis of rotation.

Paul Shekelle, MD, PhD, FACP, chair of ACP's Clinical Guidelines Committee continues:

"Efforts to control expenditures should not focus solely on the costs, but rather on the value of health-care interventions. The best way to maintain effective and efficient care is to identify and eliminate wasteful practices, and to demonstrate which interventions provide high-value, which means their benefit is sufficient to justify their harms and costs."

The ACP continues that for doctors, it is essential to assess the benefits, harms, and costs of an intervention to understand whether it provides good value. It is important to reduce the use of interventions that provide no benefit. Assessment of the cost of an intervention should include not only the cost of the intervention itself, but also any downstream costs that occur because the intervention was performed.

For interventions that provide additional benefit at additional cost, ACP recommends assessing their value to patients and society with cost-effectiveness analysis.

Source: American College of Physicians

Written By Sy Kraft, B.A.
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

• Additional
• References
• Citations