Study: Medical imaging on the rise, even among HMOs

Medical imaging is increasing, even in health maintenance organization systems, which do not have a financial incentive to conduct them, according to a recent study.

"You would have imagined that the rate of increase would be lower," said first author Rebecca Smith-Bindman, MD, of the University of California, San Francisco. "Our results showed very similar growth in imaging within these integrated settings as has been shown outside of these settings."

In the study, which was published in JAMA (2012; 307:2400-9), Dr. Smith-Bindman and colleagues examined the health records of millions of patients in several Western and Midwestern states who participate in six large integrated health care systems.

The findings revealed a dramatic increase in imaging rates and a doubling in the proportion of patients who incurred high and very high radiation exposures from 1996 to 2010, paralleling the rise in the fee-for-service world. The number of ultrasound examinations doubled, the number of computed tomography scans tripled, and the number of magnetic resonance imaging scans quadrupled.

To the authors’ surprise, for patients in these systems, the average amount of radiation has increased over the last 2 decades. The study showed a doubling in imaging rates, and by 2010, for every 100 adult patients, approximately 20 CTs were performed. Older patients underwent even more CT scans. For every 100 patients age 65 to 75 years, approximately 35 CTs were obtained.

In addition, a significant number of individuals in these systems undergo repeated testing, so they are accumulating doses that are in the range where cancer is a real concern, Dr. Smith-Bindman said.

"It is only by measuring the doses that they deliver to their patients that clinicians can begin to do everything in their power to keep those doses as low as possible," she said.

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