Volume 187 - Issue 8
Towards the appropriate use of diagnostic imaging
Authors: Lizbeth M Kenny, Stacy K Goergen and Catherine J Mandel
Med J Aust 2007; 187 (8): 473-474. || doi: 10.5694/j.1326-5377.2007.tb01364.x
Published online: 15 October 2007
Published online: 15 October 2007
To the Editor: The views of Mendelson and Murray1 regarding inappropriate use of diagnostic imaging and how it might be reduced are timely and important. Unless governments, doctors, the medical imaging industry and consumers acknowledge the significant barriers to Mendelson and Murray’s proposed changes, the number of inappropriate tests will grow.
The authors argue that radiologists need to be more active in vetting requests. This is often hindered by the lack of relevant clinical information from referrers about the indications for tests. Broadhurst et al2 found that 34% of unselected Australian requests for shoulder ultrasound contained “no tangible information to assist the radiological examination”.
Surveys of doctors in the United Kingdom found that their knowledge of the radiation delivered by various imaging tests, relative to that of a chest x-ray, was poor.3 This lack of knowledge makes it difficult, if not impossible, for doctors to inform patients about the risks and benefits of an imaging test.
The Quality Use of Diagnostic Imaging (QUDI) Program of the Royal Australian and New Zealand College of Radiologists was set up in 2004 to develop a knowledge base of evidence-based best practice in radiology. To date, it has commissioned over 25 quality-related projects in areas such as development of information for consumers, best practice standards for radiology requests, and audit–feedback analysis of radiation dosage in paediatric computed tomography. The QUDI Program and the National Institute of Clinical Studies have sponsored fellowships in evidence implementation, training radiologists in the art and science of supporting clinicians’ use of evidence-based, appropriate diagnostic imaging. The results of QUDI projects are used in strategies to improve the use of radiology.
The Australian Medical Association is advocating that general practitioners have access to magnetic resonance imaging, arguing that it would reduce costs and radiation exposure.4 However, this does not address the issue of appropriate consultative referral, and has the potential to simply add to the burgeoning diagnostic imaging budget rather than directly benefiting patients.
A multifaceted approach to change is required, involving the referrer, the consumer and the entire radiology industry. This must be based on best-practice, patient-focused use of radiology. Radi-ologists are central to providing advice on the most appropriate imaging procedures and reducing the burden of inappropriate imaging. This is likely to require changes to practice and to legislation.
References
- Mendelson RM, Murray CPJ. Towards the appropriate use of diagnostic imaging [editorial]. Med J Aust 2007; 187: 5-6.
- Broadhurst N, Baghurst T, MacLaren S. Ultrasound imaging for shoulder pain in general practice. Aust Fam Physician 2004; 33: 668-669. 0_CBBBGDJJ
- Shiralkar S, Rennie A, Snow M, et al. Doctors’ knowledge of radiation exposure: questionnaire study. BMJ 2003; 327: 371-372. 0_pgfId-1425692
- Australian Medical Association. Big savings for government if GPs directly refer MRIs [press release]. Canberra: AMA, 2006; 24 Nov. http://www.ama.com.au/web.nsf/doc/WEEN-6VTUQ2 (accessed Aug 2007).