2 years ago, Jaime Olmos and I published a paper arguing that diagnostic medical radiation was over
utilized and more harmful than clinicians considered. We documented that the literature backed us
up, but that no method had been utilized to end this overexposure. We proposed developing a
Radiation Vital sign and including clinical pathways in the EHR
Method – partial literature review
Results: Hong et al published in JAMA an association of increased incidence of cancer in children
exposed to diagnostic low-dose ionizing radiation. They concluded that “Medical professional should
weigh the benefits of diagnostic low-dose ionizing radiation with the associated risks to justify each
decision.” (But that has been an ineffective stagey for 20 years.)
Meulepas published in the Journal of the NCI ‘CT Imaging in Kids Raises Cancer Risk
A Dutch study reported increases in multiple types of tumors’.
Adam et al in NEJM catalyst published an article on Stemming Low-Value Prescribing. “…make it
easier for clinicians to access useful information” (they sent out letters). There are many
opportunities in government to randomize policy interventions as they are rolled out, with minimal
extra effort.” But much data also shows these strategies to be ineffective long term. (When will we
Ashley et al wrote in JAMA “The Path to Diagnostic Excellence Includes Feedback to Calibrate How
Clinicians Think” announcing “The Moore Foundation’s recently announced $85 million, 6-year
initiative on improving diagnostic excellence could be particularly transformative because it “aims to
reduce harm from erroneous or delayed diagnoses” but also “goes beyond avoiding errors and
includes consideration of cost, timeliness and patient convenience.””
I hope they include appropriate diagnostic testing.
Daniel Morgan wrote “Basic misunderstandings about how tests work and how accurate they are
contribute to a bigger problem. Although precise numbers are hard to come by, every year, many
thousands of patients are diagnosed with diseases that they don’t have. They receive treatments
they don’t need, treatments that may have harmful side effects.” They later add over-ordering CT
scans. But they only conclude that clinicians and patients should be educated to prevent this.
This July Kwan et al wrote a paper in JAMA “Trends in Medical Imaging During Pregnancy in the
United States and Ontario, Canada, 1996 to 2016” concluding that “The use of CT during pregnancy
substantially increased in the United States and Ontario over the past 2 decades. Imaging rates
during pregnancy should be monitored to avoid unnecessary exposure of women and fetuses to
Kwan et al wrote a paper in JAMA “Trends in Medical Imaging During Pregnancy in the United States
and Ontario, Canada, 1996 to 2016” concluding that “The use of CT during pregnancy substantially
increased in the United States and Ontario over the past 2 decades. Imaging rates during pregnancy
should be monitored to avoid unnecessary exposure of women and fetuses to ionizing radiation.”
But testing moved somewhat to MRI’s with slight decreases in CT’s, probably indicating overcasting
but with slightly less radiation.
Riaa et al in Physica Medica 43 (2017) 57–62 simply fantasize that you can educate the patients,
while another article focussed on teaching med students.
So the update is that radiation exposure may be leveling off, but over-testing is not and that
radiation is more dangerous than thought. Only cancer is looked at, when there are many other risks
from radiation; and no one has implemented our ideas or proposed better ones.