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Statewide campaign promotes optimal use of medical imaging

Andrea Etterman, an imaging technologist, left, acts as a patient for fellow technologist Paula Peterson as they demonstrate the CT scanner at the Affiliated Community Medical Centers clinic in Willmar. A statewide initiative aims to provide education on wise use of medical imaging to reduce radiation exposure. (Tribune photo by Ron Adams)

WILLMAR — Dr. Drew Hoffman analyzes the risk vs. the benefit of medical imaging almost every day: Should he order an X-ray or CT scan for the patient with abdominal pain? Should the child with a seemingly mild concussion receive a CT scan of the head?

The right answer isn’t always obvious, says Hoffman, a family practice doctor and medical director at Family Practice Medical Center of Willmar.

“It’s never as clear-cut as you would like. That is what we call the art of medicine,” he said.

Increasingly, however, doctors are taking a more restrained approach to medical imaging tests that involve radiation.

The Minnesota Department of Health recently became the first state health department in the U.S. to endorse a pair of national education campaigns promoting the optimal use of medical imaging technology.

In upcoming months, the department will be working with providers across the state to spread the word about ImageWisely, which addresses medical imaging for adults, and ImageGently, for children.

State health officials hope it will lead to more widespread and consistent use of best practices that ultimately are safer for patients.

“We wanted to use the avenues of communication we have to bring these to the local level,” said Heather Kehn, of the indoor environments and radiation division of the Minnesota Department of Health. “It’s supporting the national effort in getting the word out.”

Imaging is one of medicine’s workhorses. Pictures obtained by X-rays and CT scans can help doctors find tumors, visualize bone fractures or get an up-close view of the innards. Technology refinements have enabled images that are ever-sharper and more detailed.

But experts warn that when medical imaging is overused, it not only raises health care costs, it also unnecessarily exposes patients to ionizing radiation that could up their risk of cancer years later — and they are pushing harder to use the technology appropriately.

Research on medical imaging adds each year to a growing body of knowledge on what is safe and effective and what may not be.

 “What we don’t want is abuse or overuse,” said Kari Westby, imaging quality assurance manager for Willmar Imaging Services. “Our hope is that by increasing knowledge, both within the clinic setting and within the public setting, people will start to understand that it’s a collaborative effort to decrease cost and radiation exposure both.”

Humans are exposed every day to small amounts of environmental background radiation, and the radiation associated with an occasional CT scan, X-ray or mammogram is relatively low-risk, Westby said.

Larger amounts within a short period of time can be harmful, however, especially in children, she said. “Cumulative exposure is what we should be concerned about. … We do know that the younger we are, the more vulnerable we are to radiation exposure.”

Most providers are aware of the need to avoid overuse, said Kehn.

In the past, however, much of the emphasis was on cost. Now the focus includes quality as well, she said. “What’s best for the patient’s care includes risk and benefit in addition to cost. You meet in the middle with that.”

For doctors, it means weighing the risk vs. the benefit each time a medical imaging procedure is under consideration.

Oftentimes the benefit is clear. When it is not, doctors can turn to guidelines based on current evidence. “There are criteria that patients need to meet in order to justify these images, whether it be CT scans or X-rays,” Hoffman said.

Affiliated Community Medical Centers, for example, now requires a review by a radiologist whenever a physician requests an imaging scan.

“It has to start at the ordering level. If it hasn’t met medical necessity, they can’t order it,” Westby said. “We are always balancing the risk vs. the need. That is something every provider does before ordering.”

Checks and balances exist at each step in the process, down to the technologists who do a final check to ensure the patient is receiving the right scan and the right dose, she said

The goal is to prevent excess or unnecessary exposure to radiation, Westby said. “All of our protocols and measures are about minimizing the dose to patients.”

Local providers say they are seeing increased awareness of this.

Clinicians don’t hesitate to call a radiologist and ask if it’s OK for a child who has already had two recent CT scans to have a third, Westby said. “We’re seeing providers reaching out more to technical staff. The changes are certainly evident in everyday practice now.”

Doctors may sometimes wait before ordering an imaging test. And they are turning more often to other imaging modes, such as MRI or ultrasound, that do not involve radiation.

The issues surrounding medical imaging are filtering into exam rooms and hospital rooms in the form of more discussion between doctors and patients about risks and benefits.

Educating patients is a critical element in reducing overuse of the technology, Hoffman said. “Public awareness is huge. If we can help the public understand there is risk in radiology tests, they can start realizing it’s OK not to have those things every time.”

It’s a balancing act, experts acknowledge. One of their worries is that patients might overestimate the risk and turn down an imaging procedure that is medically necessary.

But when used the right way, imaging remains a valuable health care tool, Hoffman said.

 “I think what people need to know is that when necessary, it’s safe to use these modalities,” he said. “Where appropriate, people should not be afraid to have the test recommended by their doctor.”

Anne Polta

Anne Polta covers health care, business/economic development and general assignment. Her HealthBeat blog can be found at Follow her on Twitter at @AnnePolta.

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