Overdiagnosis and overimaging: an ethical issue for radiological protection
- 223 Downloads
- 4 Citations
Abstract
Aims and objectives
This study aimed to analyse the key factors that influence the overimaging using X-ray such as self-referral, defensive medicine and duplicate imaging studies and to emphasize the ethical problem that derives from it.
Materials and methods
In this study, we focused on the more frequent sources of overdiagnosis such as the total-body CT, proposed in the form of screening in both public and private sector, the choice of the most sensitive test for each pathology such as pulmonary embolism, ultrasound investigations mostly of the thyroid and of the prostate and MR examinations, especially of the musculoskeletal system.
Results
The direct follow of overdiagnosis and overimaging is the increase in the risk of contrast media infusion, radiant damage, and costs in the worldwide healthcare system. The theme of the costs of overdiagnosis is strongly related to inappropriate or poorly appropriate imaging examination.
Conclusions
We underline the ethical imperatives of trust and right conduct, because the major ethical problems in radiology emerge in the justification of medical exposures of patients in the practice. A close cooperation and collaboration across all the physicians responsible for patient care in requiring imaging examination is also important, balancing possible ionizing radiation disadvantages and patient benefits in terms of care.
Keywords
Overimaging Overdiagnosis Ethics Radiation protectionNotes
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This article does not contain any studies with human participants performed by any of the authors but is a review of current clinical cases.
Ethical standards
This article does not contain any studies with animals performed by any of the authors.
References
- 1.ESR Executive Council 2009; European Society of Radiology (2010) The professional and organizational future of imaging. Insights Imaging 1:12–20CrossRefGoogle Scholar
- 2.Hendee WR, Becker GJ, Borgstede JP et al (2010) Addressing overutilization in medical imaging. Radiology 257:240–245CrossRefPubMedGoogle Scholar
- 3.Kouri BE, Parsons RG, Alpert HR (2002) Physician self-referral for diagnostic imaging: review of the empiric literature. AJR 179:843–850CrossRefPubMedGoogle Scholar
- 4.Kainberger F (2017) Defensive medicine and overutilization of imaging-an issue of radiation protection. Wien Klin Wochenschr 129:157–158CrossRefPubMedGoogle Scholar
- 5.Lee TH, Brennan TA (2002) Direct-to-consumer marketing of high-technology screening tests. N Engl J Med 346:529–531CrossRefPubMedGoogle Scholar
- 6.Sistrom CL, Dreyer KJ, Dang PP et al (2009) Recommendations for additional imaging in radiology reports: multifactorial analysis of 5.9 million examinations. Radiology 253:453–461CrossRefPubMedGoogle Scholar
- 7.Fisher ES, Wennberg DE, Stukel T et al (2003) The implications of regional variations in medicare spending. Part 1. The content, quality and accessibility of care. Ann Intern Med 138:273–287CrossRefPubMedGoogle Scholar
- 8.Dunnick NR, Applegate KE, Arenson RL (2005) The inappropriate use of imaging studies: a report of the 2004 Intersociety Conference. J Am Coll Radiol 2:401–406CrossRefPubMedGoogle Scholar
- 9.Blackmore CC, Castro A (2015) Improving the quality of imaging in the Emergency Department. Acad Emerg Med 22:1385–1392CrossRefPubMedGoogle Scholar
- 10.Armao D, Semelka RC, Elias J Jr (2012) Radiology’s ethical responsibility for healthcare reform: tempering the overutilization of medical imaging and trimming down a heavyweight. J Magn Reson Imaging 35:512–517CrossRefPubMedGoogle Scholar
- 11.Fenton JJ, Deyo RA (2003) Patient self-referral for radiologic screening tests: clinical and ethical concerns. J Am Board Fam Pract 16:494–501CrossRefPubMedGoogle Scholar
- 12.Malone J (2013) Ethical issues in clinical radiology. In: Oughton D, Hansson SO (eds) Social and ethical aspects of radiation risk management. Elsevier Science, Amsterdam, pp 105–130Google Scholar
- 13.ICRP (2007) Recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann ICRP 37:2–4Google Scholar
- 14.Del Rosario PM (2015) Referral criteria and clinical decision support: radiological protection aspects for justification. ICRP 2015. Proceedings of the second international symposium on the system of radiological protection. Ann ICRP 44(1S):276–287Google Scholar
- 15.ICRP (2018) Ethical foundations of the system of radiological protection. ICRP Publication 138. Ann ICRP 47:(1)Google Scholar
- 16.Cho KW (2016) Ethical foundations of the radiological protection system. ICRP, 2016. Proceeding of the third international symposium on the system of radiological protection. Ann ICRP 45(1S):297–308CrossRefPubMedGoogle Scholar
- 17.Brownlee S, Chalkidou K, Doust J, Elshaug AG, Glasziou P, Halth I, Nagpal S, Saini V, Srivastava D, Chalmers K, Korenstein D (2017) Evidence for overuse of medical services around the world. The Lancet 390(10090):156–168CrossRefGoogle Scholar
- 18.Silini G (1992) Sievert lecture. Ethical issues in radiation protection. Health Phys 63:139–148CrossRefPubMedGoogle Scholar
- 19.Beauchamp TL, Childress JF (1979) Principles of biomedical ethics, 1st edn. Oxford University Press, OxfordGoogle Scholar
- 20.Beauchamp TL, Childress JF (2012) Principles of biomedical ethics, 7th edn. Oxford University Press, OxfordGoogle Scholar
- 21.Dauer LT, Thornton HR, Hay JL, Balter R, Williamson MJ, St Germain J (2011) Fears, feelings, and facts: interactively communicating benefits and risks of medical radiation with patients. AJR 196:756–761CrossRefPubMedGoogle Scholar
- 22.Busardò FP, Frati P, Santurro A, Zaami S, Fineschi V (2015) Errors and malpractice lawsuits in radiology: what the radiologist needs to know. Radiol Med 120(9):779–784CrossRefPubMedGoogle Scholar
- 23.Olivetti L, Fileni A, De Stefano F, Cazzulani A, Battaglia G, Pescarini L (2008) The legal implications of error in radiology. Radiol Med 113(4):599–608CrossRefPubMedGoogle Scholar
- 24.Ramella S, Mandoliti G, Trodella L, D’Angelillo RM (2015) The first survey on defensive medicine in radiation oncology. Radiol Med 120(5):421–429CrossRefPubMedGoogle Scholar
- 25.Lysfahl KB (2012) Utilization and utility of diagnostic imaging. Quantitative studies and normative considerations. University of Oslo. ISBN 978-82-8264-065-7Google Scholar
- 26.Sokol DK (2013) ‘First do no harm’ revisited. BMJ 25(347):f6426. https://doi.org/10.1136/bmj.f6426 CrossRefGoogle Scholar
- 27.Malone J, Zölzer F (2016) Pragmatic ethical basis for radiation protection in diagnostic radiology. Br J Radiol. https://doi.org/10.1259/bjr.20150713 CrossRefPubMedPubMedCentralGoogle Scholar
- 28.Salerno S, Nardi C, Tudisca C, Matranga D et al (2018) Complete written/oral information about dose exposure in CT: is it really useful to guarantee the patients’ awareness about radiation risks? Radiol Med 123(10):788–798. https://doi.org/10.1007/s11547-018-0909-0 CrossRefPubMedGoogle Scholar
- 29.ICRP (2013) Radiological protection in paediatric diagnostic and interventional radiology. ICRP Publication 121. Ann ICRP 42(2):12Google Scholar
- 30.Medicare data. https://data.medicare.gov
- 31.Brenner DJ, Hall EJ (2007) Computed tomography - an increasing source of radiation exposure. NEngl J Med 357:2277–2284CrossRefGoogle Scholar
- 32.Behbahani S et al (2017) “Incidentalomas” on abdominal and pelvic CT in emergency radiology: literature review and current management recommendations. Abdom Radiol 42:1046–1061CrossRefGoogle Scholar
- 33.Furtado CD, Aguirre DA, Sirlin CB et al (2005) Whole body CT screening spectrum of findings and recommendations in 1192 patients. Radiology 237:385–394CrossRefPubMedGoogle Scholar
- 34.Hasan N, Kumar R, Kavuru MS (2014) Lung cancer screening beyond low-dose computed tomography: the role of novel biomarkers. Lung 192:639–648CrossRefPubMedGoogle Scholar
- 35.Myers RP, Fong A, Shaheen AA (2008) Utilization rates, communications and costs of percutaneous liver biopsy: a population-based study including 4275 biopsies. Liver Int 28:705–712CrossRefPubMedGoogle Scholar
- 36.Moser KM, Fedullo PF, LitteJhon JK et al (1994) Frequent asymptomatic pulmonary embolism in patient with deep venous thrombosis. JAMA 271:223–225CrossRefPubMedGoogle Scholar
- 37.Anderson DR, Khan SR, Rodger MA et al (2007) Computer tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients Wind suspected pulmonary embolism: a randomized controller trial. JAMA 298:2743–2753CrossRefPubMedGoogle Scholar
- 38.De Monaco NA, D’angelo Q, Kapoor WN et al (2008) Pulmonary embolism incidence in increasing with the use of spiral computer tomography. AJ Med 12:611–617CrossRefGoogle Scholar
- 39.Colagrande S, Origgi D, Zatelli G, Giovagnoni A, Salerno S (2014) CT exposure in adult and paediatric patients: a review of the mechanisms of damage, relative dose and consequent possible risks. Radiol Med 119:803–810. https://doi.org/10.1007/s11547-014-0393-0 CrossRefPubMedGoogle Scholar
- 40.Hopper KD, Landis JR, Meilstrup JW et al (1991) The prevalence of asymptomatic gallstones in the general population. Invest Radiol 26:939–945CrossRefPubMedGoogle Scholar
- 41.Ezzat S, Sarti DA, Cain DR, Braunstein GD (1994) Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Int Med 154:1838–1840CrossRefGoogle Scholar
- 42.Fleshner N, Koltz L (2002) Role of “saturation biopsy” in the detection of prostate cancer among difficult diagnostic cases. Urology 60:93–97CrossRefPubMedGoogle Scholar
- 43.Andriole GL, Crawford ED, Grubb RL et al (2009) Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 360:1320–1328CrossRefGoogle Scholar
- 44.Albin RJ (2010) The great prostate mistake. New York Times 10. https://www.nytimes.com/2010/03/10/opinion/10Ablin.html
- 45.Englund M, Guermazi A, Gale D et al (2008) Incidental Meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med 359:1108–1115CrossRefPubMedPubMedCentralGoogle Scholar
- 46.Kormick J, Trefelner E, McCarthy S et al (1990) Meniscal abnormalities in the asymptomatic population at MR imaging. Radiology 177:463–465CrossRefGoogle Scholar
- 47.Jensen MC, Brant-Zawadski MN, Obuchowski N et al (1994) Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994(331):69–73CrossRefGoogle Scholar
- 48.Cristofaro M, Busi Rizzi E, Schininà V et al (2011) Appropriateness: analysis of outpatient radiology request. Radiol Med. https://doi.org/10.1007/s11547-011-0725-2 CrossRefPubMedGoogle Scholar
- 49.Faletti C (2013) L’allarme dei Radiologi. Quotidiano sanità, October 4, 2013Google Scholar
- 50.Linet MS et al (2012) Cancer risks associated with external radiation from diagnostic imaging procedures. CA Cancer J Clin 62:75–100CrossRefPubMedPubMedCentralGoogle Scholar
- 51.Vaiserman A et al (2018) Health impacts of low-dose ionizing radiation: current scientific debates and regulatory issues. Dose Response 16:112CrossRefGoogle Scholar
- 52.Ten Haaf K, de Koning HJ (2015) Overdiagnosis in lung cancer screening: why modelling is essential. J Epidemiol Community Health 69:1035–1039CrossRefPubMedPubMedCentralGoogle Scholar
- 53.Newton EH (2017) Addressing overuse in emergency medicine: evidence of a role for greater patient engagement. Clin Exp Emerg Med 4:189–200CrossRefPubMedPubMedCentralGoogle Scholar
- 54.Morris E et al (2015) Implications of overdiagnosis: impact on screening mammography practices. Popul Health Manag 18(Suppl 1):S3–S11CrossRefPubMedGoogle Scholar
- 55.Carrier M et al (2010) Subsegmental pulmonary embolism diagnosed by computed tomography: incidence and clinical implications. A systematic review and meta-analysis of the management outcome studies. J Thromb Haemost 8:1716–1722CrossRefPubMedGoogle Scholar
- 56.Puliti D et al (2012) Overdiagnosis in mammographic screening for breast cancer in Europe: a literature review. J Med Screen 19(Suppl 1):42–56CrossRefPubMedGoogle Scholar
- 57.Warren LM, Dance DR, Young KC (2016) Radiation risk of breast screening in England with digital mammography. Br J Radiol 89(1067):20150897CrossRefPubMedPubMedCentralGoogle Scholar
- 58.Hendrick RE, Helvie MA (2011) United States preventive services task force screening mammography recommendations: science ignored. AJR 196(2):W112-6CrossRefPubMedGoogle Scholar
- 59.Miglioretti DL et al (2016) Radiation-induced breast cancer incidence and mortality from digital mammography screening: a modelling study. Ann Intern Med 164:5–14CrossRefGoogle Scholar
- 60.Patz EF Jr et al (2014) Overdiagnosis in low-dose computed tomography screening for lung cancer. JAMA Intern Med 174:269–274CrossRefPubMedPubMedCentralGoogle Scholar
- 61.De Koning HJ et al (2014) Benefits and harms of computed tomography lung cancer screening strategies: a comparative modelling study for the U.S. Preventive Services Task Force. Ann Intern Med 160:311–320CrossRefPubMedPubMedCentralGoogle Scholar
- 62.Usman Ali M et al (2016) Screening for lung cancer: a systematic review and meta-analysis. Prev Med 89:301–314CrossRefPubMedGoogle Scholar
- 63.Moyer VA (2014) USPST force, screening for lung cancer US preventive services task force recommendation statement. Ann Intern Med 160:330–338PubMedGoogle Scholar
- 64.Salerno S, Marrale M, Geraci C, Caruso G, Re GL, Casto AL, Midiri M (2016) Cumulative doses analysis in young trauma patients: a single-centre experience. La Radiol Med 121:144–152CrossRefGoogle Scholar
- 65.Humphrey LL et al (2013) Screening for lung cancer with low-dose computed tomography: a systematic review to update the US Preventive services task force recommendation. Ann Intern Med 159:411–420CrossRefPubMedGoogle Scholar
- 66.Rampinelli C et al (2017) Exposure to low dose computed tomography for lung cancer screening and risk of cancer: secondary analysis of trial data and risk-benefit analysis. BMJ 356:j347CrossRefPubMedPubMedCentralGoogle Scholar
- 67.Crowley KD et al (2015) Comments on estimating risks of low radiation doses-a critical review of the BEIR VII report and its use of the linear no-threshold (LNT) hypothesis by Edward J. Calabrese and Michael K. O’Connor. Radiat Res 183(4):476–481CrossRefPubMedGoogle Scholar
- 68.Drescher FS, Sirovich BE (2016) Use of computed tomography in emergency departments in the united states: a decade of coughs and colds. JAMA Intern Med 176:273–275CrossRefPubMedGoogle Scholar