Medical societies target overused imaging exams

Nine physician specialty societies have identified commonly used tests or procedures in their respective fields that are not always necessary and are releasing the lists as part of the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely campaign, aimed at helping physicians make better use of finite health resources.

"Physicians, working together with patients, can help ensure the right care is delivered at the right time for the right patient. We hope the lists released today kick off important conversations between patients and their physicians to help them choose wisely about their healthcare," said Christine K. Cassel, MD, president and CEO of the ABIM Foundation.

The American College of Radiology (ACR), one of the nine specialty societies offering recommendations, identified five imaging procedures whose necessity should be discussed before being ordered:

• Imaging for uncomplicated headache absent specific risk factors for structural disease or injury;
• Imaging for suspected pulmonary embolism (PE) without moderate or high pre-test probability of PE;
• Pre-operative chest x-rays without specific reasons due to patient history or physical exam;
• CT to evaluate suspected appendicitis in children until ultrasound is considered an option; and
• Follow-up imaging for adnexal (reproductive tract) cysts 5 mm or less in diameter in reproductive-age women.

The American College of Cardiology (ACC), another of the nine societies, identified the following five recommendations:

• Cardiac imaging tests (particularly stress tests or advanced non-invasive imaging) should not be given if there are no symptoms of heart disease or high-risk factors like diabetes or peripheral arterial disease are not present.
• Cardiac imaging tests (particularly, stress tests or advanced non-invasive imaging) should not be given as part of a routine annual follow up in patients who have had no change in signs or symptoms.
• Cardiac imaging tests (particularly stress tests or advanced non-invasive imaging) should not be given prior to performing low-risk surgery that is not related to heart disease.
• Echocardiography should not be used as routine follow-up care in adults with mild heart valve disease who have had no change in signs or symptoms.
• Patients experiencing a heart attack and undergoing a PCI should not have stents placed in an artery or arteries beyond those responsible for the heart attack.

In addition to the ACR and the ACC, the other seven organizations releasing lists as part of the campaign include: the American Academy of Allergy, Asthma & Immunology, the American Academy of Family Physicians, the American College of Physicians, the American Gastroenterological Association, the American Society of Clinical Oncology, the American Society of Nephrology and the American Society of Nuclear Cardiology.

The complete lists from the specialty societies, including additional detail and evidentiary information communicating when a particular test or treatment may be appropriate based on clinical evidence and guidelines, are available at www.ChoosingWisely.org.