Quick, what do these have in common: a PET-CT scan to screen for cancer in a healthy adult; a CT scan for a child with a minor head injury but no clinical problems; and a cesarean section on a woman with a normal pregnancy before the 39th week?

They're all potentially unnecessary tests or procedures included on a new round of lists for the Choosing Wisely campaign, which aims to advise doctors and patients about potentially harmful or wasteful medicine. The lists, prepared by 17 leading medical societies, will be announced Thursday at a press conference in Washington, D.C.

The 90 procedures form the second phase of the campaign, and stack onto the 45 other questionable therapies and exams released when Choosing Wisely kicked off last April.

"We were trying to spark conversations about what care is really needed and we think we've exceeded our goal," Daniel Wolfson, COO of the ABIM Foundation, which started the campaign, told DOTmed News.

Previous estimates have suggested up to one-third of medical care in the United States, or some $200 billion worth, is wasteful or unnecessary, Wolfson said.

The group will also announce Thursday a $2.5 million grant from the Robert Wood Johnson Foundation. Wolfson said they will use the money to fund efforts by regional groups or medical societies to raise awareness about unnecessary care.

He said they expect to finance 20 projects, possibly including pilot studies on how to use decision support systems, computer programs that use appropriateness criteria to guide doctors when ordering tests or therapies.

Grant recipients will likely be announced in late March or early April, he said.

How the lists are made

The societies participating in the second round, which include the American Academy of Pediatrics, the American Academy of Family Physicians and the Society of Thoracic Surgeons, typically made their lists of about five procedures by consulting their quality and safety committees or board members, Wolfson said.

The Society of Nuclear Medicine and Molecular Imaging said it compiled a list of eight or nine suggestions after meeting with different subcommittees, a list it then whittled down to the final five.

The procedures included on the lists aren't necessarily performed that often. Dr. Gary Dillehay, SNMMI's president-elect and the chair of the groups' Choosing Wisely task force, said the tests they recommended caution about weren't known to be particularly abused or overused. "Times have changed on some of these things, and they (just) don't apply anymore," he told DOTmed News.

For instance, performing a PET/CT screening on symptom-free, healthy adults to check for cancer has a malignancy yield of only around 1 percent, the society said in the document released by Choosing Wisely. But the scans carry the risk of false positives that can trigger riskier biopsies or unnecessary treatments.

"It's just the yield is so low, when you rank the cost and the radiation exposure you get from it, it's not worth it," Dillehay said.

Also included on SNMMI's list is PET scans, including beta-amyloid scans, for dementia in patients who haven't previously been evaluated by a specialist, such as a neurologist or psychiatrist. "Without objective evidence of dementia, the potential benefit of PET is unlikely to justify the cost or radiation risk," the society said. Dillehay said SNMMI recommends for those who do order beta-amyloid tests to also follow the appropriateness criteria released earlier this year by the society and the Alzheimer's Association.

Reaching consumers

Part of the challenge with the campaign is reaching consumers. One of Choosing Wisely's backers, Consumer Reports, will help convey the medical societies' recommendations to the public in lay language, Wolfson said. The magazine will also likely receive some of the campaign's grant to expand its work.

Fifteen consumer groups, including AARP, the Leapfrog Group and even Wikipedia, also are participating in the campaign.

In fact, since the program kicked off last year, Consumer Reports has funded a fellow to monitor and edit entries on Wikipedia to make sure they're accurate and can help consumers, Wolfson said. For instance, the fellow might include a reminder in an entry on antibiotics that they're only good for bacterial, not viral infections. In the lists released Thursday, the American Academy of Pediatrics cautioned against prescribing antibiotics for seemingly viral respiratory illnesses.

The campaign still has a ways to go. In September or October, Choosing Wisely will announce its third phase and another 15 lists, Wolfson said. Groups participating in the fall campaign include the American Academy of Dermatology and the American Society for Radiation Oncology.

"We think the impact has been far and beginning to be deep, so we're elated about the results so far," Wolfson said.

The societies in this go-around are the American Academy of Family Physicians, the American Academy of Hospice and Palliative Medicine, the American Academy of Neurology, the American Academy of Ophthalmology, the American Academy of Otolaryngology-Head and Neck Surgery, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Rheumatology, the American Geriatrics Society, the American Society for Clinical Pathology, the American Society of Echocardiography, the American Urological Association, the Society for Vascular Medicine, the Society of Cardiovascular Computed Tomography, the Society of Hospital Medicine, the Society of Nuclear Medicine and Molecular Imaging and the Society of Thoracic Surgeons.