"Perspective"

More serious and ill-advised claims are made in "Elements of Danger - The Case of Medical Imaging," an accompanying "perspective" which states, among other things, that "with few exceptions - such as mammography - most radiologic imaging tests offer net negative results. There is no evidence to support this claim which is refuted by a recent paper from the National Bureau of Economic Research which directly associates advanced medical imaging with increased life expectancy.5


With regard to utilization patterns, the perspective states "Physicians can easily defend their practices because their specialty societies argue that the procedures are 'appropriate' The issue of radiation exposure is unlikely to come up." This is patently false. ACR Appropriateness Criteria® (www.acr.org/ac), created more than a decade ago and available to all providers, help physicians prescribe the most appropriate imaging exam for more than 210 clinical conditions and do factor radiation dose into the decision making process. ACR Appropriateness Criteria are used by many private insurers in their coverage process as well as point of entry decision making software in use at Massachusetts General Hospital and elsewhere to help determine the most appropriate exams for patients.

The perspective also negatively categorizes scans by stating that patients "incurred costs for procedures of uncertain value..." Negative exams are of value. They preclude further costly and invasive exploratory techniques, rule out disease, provide a baseline to monitor patient health, and provide the patient with peace of mind.

Efforts to Reduce Radiation Dose:

The radiology community has embraced the 'ALARA' or 'as low as reasonably achievable' concept, espousing that providers use only the amount of radiation necessary to obtain optimal images. Radiologists are working to lower dose and to educate elected officials, government agency staff, and referring physicians about the need for further steps toward this goal. The ACR, in an effort to stem the unnecessary growth in radiation dose that Americans receive from imaging, has worked with other radiology organizations to educate all stakeholders in the principles of radiation safety and appropriate utilization of imaging.

For years, the ACR has promoted radiation safety among radiologists, non-radiologists, and the public through the ACR Practice Guidelines and Technical Standards, facility accreditation programs, government relations efforts, ACR Appropriateness Criteria® to educate referring physicians on the most appropriate imaging exams for given indications, continuing medical education offerings, and the ACR patient education Web site, www.radiologyinfo.org, a cooperative effort with the Radiological Society of North America.

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