Medical Imaging in the XXI Century: Too much of a good thing?

Editor's Corner

Submitted on Fri, 09/18/2009 - 09:14

Frank J. Criado
Vascular Surgery and
Endovascular Intervention;
Union Memorial Hospital/
MedStar Health,
Baltimore, Maryland

Many of us have come to depend on (even demand) the kind of exquisite imaging depicted in Figure 1. Contemporary management of aortic diseases is changing dramatically as it goes through a revolution of sorts, propelled — in a large measure — by the ability to visualize the vascular anatomy with a degree of definition and refinement we would not have thought possible a decade ago. Add to this the remarkable developments in the endovascular technology field and one can explain easily the near-incredible transformation in all the cardiovascular specialties. We now use this imaging capability for diagnosis, pre-operative assessment and procedure planning, stent-graft device sizing, as well as patient follow-up and surveillance — lifelong. Furthermore, it is clear that the impact of modern medical imaging is being felt much beyond aortic intervention, inducing transformational influence in — essentially — every anatomy-centered area of medicine. Today, a great number of patients enjoy the advantages of precise diagnosis and treatment with less-invasive technologies in a manner that is increasingly safe and successful. Importantly though and on the downside, these patients are also being exposed to significant doses of radiation over time... So, what’s the problem? Fazel et al focused on this very issue in a recent study.1 They found that, indeed, “imaging procedures are an important source of exposure to ionizing radiation in the United States and can result in high cumulative effective doses of radiation”. Computed tomography scans and nuclear imaging accounted for 75.4% of the cumulative effective dose, and more than 80% of the procedures were done in an outpatient setting. In addition to radiation, economic costs are another source of concern related to the widespread and ever-increasing use of medical imaging in this country. It was almost too good to be true, wasn’t it? Just when we were finally feeling at the very top of our game in some of the fields where modern imaging has made a world of difference… we are now beginning to hear that perhaps this should be slowed down and that we ought to re-think some of the diagnostic and surveillance strategies…. I for one would not be surprised to see attempts (from various corners) to restrict and/or micro-manage physicians’ ability to order and perform imaging procedures in the near future. From that perspective, it would be in our best interest to become proactive in proposing and implementing reasonable guidelines that experts and professional societies can hopefully agree on — as opposed to impositions coming from outside entities. It may well be our best chance to retain the ability to use advanced imaging modalities in a manner that contributes to the ultimate goal of best patient care but, at the same time, minimizes costs in terms of economic expense and excessive exposure to radiation.