From the October 2018 issue of HealthCare Business News magazine


“Maybe a physician thinks that performing a CT is appropriate but then the order goes to the diagnostic imaging group that says, ‘This really would be better if it were an MR,’” said Merrill. “They’ll call the physician who may usually agree and send a different script. Or he or she might say, ‘No, my patient has a pacemaker so you need to give them a CT.’”

Image Wisely, Image Gently and RadiologyInfo.org have made information on imaging exams that do not utilize ionizing radiation more accessible. The ACR’s Appropriateness Criteria, which offers guidance on the most appropriate tests for specific clinical conditions, is another powerful tool for choosing the right exam for the right patient.


It’s important that providers understand such tools are merely guides and not tell-all instructions. “The Appropriateness Criteria isn’t meant to be a cookbook of medicine but to help the ordering physician have the most current information and promote those conversations addressing what the experts have said about this condition,” said David Kurth, senior director of the ACR Practice Parameters and Appropriateness Criteria.

In addition to clinicians, the responsibility of knowing the risks of CT use falls on patients themselves and is on the rise as more engage in consultations and shared decision-making with their physicians on which exam is the right choice based on their condition and individual needs.

But while the drop in CT exams among Medicare beneficiaries may appear positive due to the decrease in ionizing radiation exposure, statistics on total utilization are limited due to a lack of any reliable source of information on non-Medicare patients. At the same time, the extent to which each factor has contributed to this decline is uncertain.

“With CMS mandating the use of appropriate use criteria in 2020, it should become less of an issue,” Jason H. Launders, director of operations for Health Devices Group at the ECRI Institute, said. “However, it isn’t clear how much of that is being driven by financial concerns or dose concerns.”

Technique and technology
The actions of the patient before and during the exam make all the difference. For example, movement during a CT scan can lead to repeats of procedures, exposing patients to more ionizing radiation.

“Patients, especially children, can be somewhat anxious about the scan or outwardly frightened,” said Duke’s Frush. “To have parents in the room, some preparatory information available, child specialists or anticipatory training for patients and parents, can allow the scan to happen more efficiently, with less chance for movement-affected scan quality.”

October 2018 Magazine

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