May 31, 2023

To Test or Not to Test: Thinking Twice Before Asking Your Doctor for a Full-body Scan

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By Bennet Chun, MS3, Creighton University School of Medicine and Joan Hwang, MS3, A.T. Still University School of Osteopathic Medicine
Bennet Chun 
Bennet Chun, BS
 Joan Hwang
Joan Hwang, BS

Medical imaging has revolutionized the way physicians diagnose and treat various health conditions. Plain film radiography, CT, MRI and other tests are often perceived as vital pieces of information necessary for the diagnosis of a patient’s chief complaint. If a symptom or disease cannot be easily explained through the initial history and physical, imaging is often done. While imaging has revolutionized medical practice, the potential risks associated with cumulative radiation exposure over a lifetime cannot be overlooked.

Medical information has become readily accessible with the internet, allowing patients to be privy to a wealth of data. Empowered by this information, patients in Emergency Departments and private offices have started to request specific types of imaging and lab work, wanting to allay their fears. The images requested may often not be clinically recommended or necessary. For example, some patients with vague symptoms may request full-body CT scans, wanting to detect a potential cancer. Such imaging is not indicated and, if done, can cause future health problems due to radiation exposure.

A full-body CT scan exposes an individual to approximately 10 millisieverts of radiation, which is equivalent to the amount received from 250 chest X-rays.1 Children are particularly sensitive to the effects of radiation, and physicians must seriously consider the risks and benefits before routinely ordering imaging. According to the Image Gently Alliance (IGA), children’s tissues and organs receive higher effective doses of radiation.2 Their increased susceptibility to radiation correlates to an increased likelihood of cancer.2 As physicians, we need to raise awareness about the benefits and risks of advanced imaging to ensure that patients and families make well-informed decisions.

When receiving requests for imaging, physicians should have conversations with families, discussing their fears and concerns. Once their worries have been addressed, it is important to share why specific imaging is not indicated and inform families of the potential health risks of performing unnecessary testing. Various hospitals are already promoting awareness on this issue. At Cedars-Sinai Medical Center, the Choosing Wisely campaign was integrated into the electronic health record, providing physicians with information about why a specific medical test may be unnecessary when they attempt to order it.3 Having real-time feedback allows physicians to engage their patients and discuss why certain requested tests may not be appropriate. The Choosing Wisely campaign has been shown to reduce overuse of diagnostic imaging while also engaging patients in discussions through shared decision making and education.4 IGA emphasizes the importance of providing families with proper education to protect children from unnecessary radiation exposure. Research has shown that parents who are properly informed are often accepting of these tests.2 Through a concerted effort, physicians, patients and families can work together to promote patient safety and optimal use of health resources.

Although imaging has become vital in patient care, it is important to consider the risks and benefits of any intervention. Unnecessary tests can lead to false positive findings, which can potentially present a new diagnosis to a patient, placing undue burden on them. False positives may warrant further confirmatory tests, which may culminate in further work-up, procedures and financial burden. Avoiding imaging overuse is not a new concept, but it is an important practice for providers to consider when providing care for our patients.

References:

  1. Jones, J. G., Mills, C. N., Mogensen, M. A., Lee, C. I. (2012). Radiation dose from medical imaging: a primer for emergency physicians. The western journal of emergency medicine, 13(2), 202–210. https://doi.org/10.5811/westjem.2011.11.6804
  2. Image Gently. (n.d.). Retrieved April 17, 2023, from https://imagegently.org/
  3. Griffith, J., Monkman, H., Borycki, E., Kushniruk, A. (2015). Physician Experiences with Perceived Pressure to Order Diagnostic Imaging Services. Studies in health technology and informatics, 218, 20–25.
  4. American Family Physician (n.d.). Choosing Wisely: Five Years of Achievements in Reducing Unnecessary Medical Tests and Procedures. https://www.Choosingwisely.org. https://www.choosingwisely.org/wp-content/uploads/2017/10/Choosing-Wisely-at-Five.pdf

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