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Entries in X-Rays (3)

Thursday
Apr052012

Doctors: Extra Tests Not Key to Best Patient Care

Comstock/Thinkstock(NEW YORK) -- In an effort to end medical over-testing, nine major medical professional organizations have banded together to try to change the way doctors use tests and procedures once considered fairly routine.

The campaign, Choosing Wisely, a joint effort led by the American Board of Internal Medicine Foundation and Consumer Reports, released a list of 45 common tests and procedures it hopes will be more carefully prescribed and performed.

The campaign is a frank attempt by a wide consortium of medical groups to address what many characterize as rampant, wasteful procedures and spending in the U.S. health care system.

"The distinction to be drawn is between 'care' and 'tests,'" said Dr. Thoralf Sundt, chief of cardiac surgery at Massachusetts General Hospital.  "Doing tests is not the same as providing care in all instances."

Several of the over-used tests called out by the specialty organizations are procedures that have long been considered routine or harmless by many.  Staples such as cardiac stress tests or chest x-rays before minor surgery got the thumbs down from several of the groups.

Some of the recommendations are not radically different from what other groups have been saying for years.  Several guidelines, such as those recommending against Pap tests for women under age 21 or bone density scans for women before age 65, have recently been publicized by the U.S. Preventive Services Task Force, the government body charged with reviewing and recommending health care processes.

But many doctors say that the endorsement of less testing by the heavyweight medical specialty groups may just resonate with more physicians and could alter what has been routine practice.

"It is important because it signals from physician leadership that there is waste in the system that should and could be reduced," said Dr. Harlan Krumholz, professor of investigative medicine and public health at Yale University School of Medicine.  "And it should be just the beginning of a movement."

Many doctors do such screenings and procedures for a variety of reasons other than patient care, doctors say.  Often the reason is simple: a given test or procedure is what the doctor has always done.

Others feel that ordering a barrage of tests will yield the source of a patient's problem, or will reveal an unknown danger.  Other doctors use tests defensively, out of fear that not ordering a test could look like negligence and prompt a lawsuit.

"After a while, getting a CT for a headache or fainting spell even without any neurologic deficits or a stress test for asymptomatic patients becomes the de facto 'standard of care' and physicians are afraid to miss something lest they be sued," said Dr. John Messmer, associate professor of family and community medicine at Penn State College of Medicine.

But experts say it's time to drop this just-in-case mindset.

Reframing conventional medical thinking about testing would likely be a money-saver for the U.S. healthcare system. Some research groups estimate that excessive, unnecessary testing and procedures account for as much as one-third of U.S. medical spending, which totaled more than $2 trillion in 2009 alone.

Copyright 2012 ABC News Radio

Wednesday
Apr042012

Five Medical Tests You May Not Need

Keith Brofsky/Thinkstock(NEW YORK) -- A routine visit to the doctor's office can bring up a laundry list of medical tests, all designed to screen for one serious disease or another.  But according to a new report from leading physician groups, a large number of medical tests and procedures billed as routine are largely unnecessary.

For many patients and doctors, it's easy to adopt the notion that if a little screening is good, more of it is better, "just to be sure" nothing is wrong.  But that approach is costly, both in terms of health care dollars spent and the potential risks of the screenings.

"There's no medical treatment or test that is 100 percent without risk," said Dr. Christine Cassel, president and chief executive officer of the American Board of Internal Medicine Foundation.  "Things that you might think are routine actually should not be done because they expose patients to risk."

To help patients parse through the barrage of medical procedures, the ABIM Foundation and Consumer Reports have created the Choosing Wisely project, a campaign that asked nine physician groups to identify five tests or procedures in their fields that are over used or unnecessary.

Cassel said the project is designed to give patients as much information as doctors have about screening, as well as to rein in health care costs.

The full list was published on Wednesday, but here's a look at five common tests you may not need:

Cardiac Stress Test


Cardiac stress tests were once considered a staple of routine check-ups.  Also called the treadmill test or an exercise EKG, doctors often use it to determine if a patient has blocked arteries.  The U.S. Preventive Services Task Force has long recommended that people at low risk for cardiovascular disease and with no symptoms of heart trouble don't need an annual stress test.  But a 2010 Consumer Reports survey of 8,000 people ages 40 to 60 found that 44 percent of low-risk people with no symptoms had been screened.

According to the American College of Cardiology, stress tests should only be performed on patients who have peripheral artery disease, diabetics over age 40 and people who have an increased risk of coronary artery disease.

Chest X-rays Before Minor Surgery

For many years, chest x-rays were another nuts-and-bolts part of hospital care.  But the test is going by the wayside.  The American College of Radiology said for most patients undergoing outpatient procedures, the tests are unnecessary. 

Some people should get a chest x-ray before going under the knife, such as those with a history of heart problems, lung disease or cancer.  For others with a normal physical exam, the ACR said the test leads to a change in patient care in only two percent of cases.

Imaging Tests for Lower Back Pain

According to the American Academy of Family Physicians, lower back pain is the fifth most common reason for all visits to the doctor's office.  But unless a patient has certain red flags of a deeper physical problem, such as spinal abnormalities or neurological problems, the AAFP and the American College of Physicians say doctors shouldn't use MRIs, CT scans or other imaging to investigate lower back pain.

Frequent Colon Cancer Screenings

Colonoscopies, perhaps the most unloved cancer screening, are a necessary aspect of health care after age 50.  A recent study found that having precancerous growths spotted on colonoscopies removed cut the death rate from colon cancer by 53 percent. 

Most major medical groups recommend that people over 50 get a colonoscopy every 10 years.  However, the key is moderation.  According to the American Gastroenterological Association, most adults who are at an average risk of colon cancer and who get a clean bill of health from a colonoscopy don't need another one for the next decade -- good news for health care pocketbooks, since the test costs an average of $1,050.

Bone Density Scans

Osteoporosis becomes a real risk for people, particularly women, with increasing age.  The National Institutes of Health estimates that one in five women over age 50 has osteoporosis.  But patients may want to ask their doctors how often they need a bone density scan to screen for signs of the disease.

The American Academy of Family Physicians echoes the U.S. Preventive Services Task Force in recommending that only women over age 65 get a bone mineral density test, called dual-energy x-ray absorptiometry, or a DEXA scan.  The AAFP also recommends the test for men age 70 and older, although the USPSTF said there is insufficient evidence to balance the risks and benefits of screening men for osteoporosis. 

The test costs more than $100, and unless a woman under age 65 has additional risk factors, such as smoking, an eating disorder or previous broken bones, doctors say the scan is unnecessary.

Copyright 2012 ABC News Radio

Wednesday
Oct262011

Routine Chest X-Rays Don’t Cut Lung Cancer Death, Study Finds

Stockbyte/Thinkstock(HONOLULU, Hawaii) -- Annual chest X-rays may not prevent lung cancer deaths, according to new findings published in JAMA and presented Wednesday at the annual meeting of the American College of Chest Physicians.

The study was part of the larger Prostate, Lung and Colorectal Cancer Screening Trial, which included more than 150,000 participants ages 55 to 74.  Researchers found that smokers and non-smokers who were given annual chest X-rays for as long as four years were just as likely to die from lung cancer as those who were not screened.

During the 13-year period of the study, 1,696 patients who underwent annual chest X-rays developed lung cancer, compared to 1,620 patients who developed lung cancer but did not get chest X-rays.

An estimated 220,000 people nationwide have lung cancer, and more than half that number will die from the disease, according to the American Cancer Society. It is considered the leading cause of cancer death in the U.S.  

A chest X-ray is one of a few screening options for lung cancer and, for years, many medical experts recommended X-ray screenings for both smokers and non-smokers.

In 2004, the U.S. Preventive Services Task Force concluded that there was no evidence to support any type of routine lung cancer screening in people without symptoms of the disease.

The latest findings come on the heels of another large trial, called the National Lung Screening Trial, which showed the computed tomography (CT) scans were slightly better at preventing lung cancer death compared to X-rays.

“All prior studies assessing chest X-rays as a screening maneuver for lung cancer were negative, but some folks had remained unconvinced,” said Dr. Robert Mayer, vice chairman for academic affairs at the Dana-Farber Cancer Institute. “Hopefully, this study will end the discussion.”

This study begs research into whether routine CT scans, another screening method, can prevent death in those who may show symptoms, compared to not getting screened, Dr. Harold Sox, a professor in the department of medicine at the Dartmouth Institute, wrote in an accompanying editorial.

Copyright 2011 ABC News Radio







ABC News Radio