Overuse of Imaging, Capstone Project Example

The issue regarding overutilization of imaging equipment in patient diagnosis is emerging as a key concern of patients and doctors alike.  Indeed, although the use of imaging equipment facilitates the accurate diagnosis of illness; at the same time, it can expose patients to excessively high radiation levels, putting individuals at an increased risk for cancer.  The problem has received increasing coverage in medical journals.  David Brenner and Eric Hall identified over use of computed tomography (CT) as a potential public health threat: Basing their analysis on the current number of CT scans in the US, the authors conclude there is a strong case too many CT scans are being performed (Brenner & Hill, 2007).

Looking at more specific studies on where the primary overutilization is occurring, the use of CT scans on children, particularly in emergency rooms, is particularly disconcerting.  Larson et al. analyzed hospital data from 1985-2008 regarding use of CT scans in pediatric emergency room visit. The researchers found the number of pediatric ED visits that included CT examination increased from .33 to 1.65 million over the time period, a 500% increase  (CAGR of 13.2 %) (Larson, Johnson, Schnell, Goske, Salisbury, Forman, 2011).  These findings are particularly worrisome because children are more vulnerable to radiation exposure.

With the literature pointing out potential excessive use of CT imaging technology, what does this mean at the patient level?  Smith-Bindman examines the issue and concludes that too many CT scans are being used for diagnosis in conditions that likely do not require the technology (Smith-Bindman, 2010).  She recommends new guidelines for the use of CT scans, as well as educating doctors about alternatives that can result in equally effective (Smith-Bindman, 2010).

The literature supports the problem statement that there is currently a problem with the overuse of imaging technology, particularly CT scans, in patient care. I hope that through examining the underlying reasons for the increased use of imaging equipment that clinicians can be educated about this problem, more alternatives can be introduced to using CT scans, and the problem can ultimately be addressed at the patient and aggregate level.  In particular,  using PICO methodology of patient, intervention, comparison, observation- the question I want to ask is: For an individual patient) seeking a controlled tomography (CT) scan (intervention), are there other imaging alternatives (comparison) that will provide similar diagnostic benefits (outcome)  without the same level of radiation?

References

Brenner, D &  Hall, E (2007).  Computed Tomography- An Increasing Source of Radiation Exposure. New England Journal of Medicine.  357 2277-2284. 

Larson, D.B., Johnson, L.W., Schnell, B.M., Goske, M.J., Salisbury, S.R., Forman, H.P. (2011).  Rising use of CT in Child Visits to the Emergency Department in the United States 1995-2008. Radiology.  259(3), 793-801.

Smith-Bindman, R. (2010).  Is Computed Tomography Safe.  New England Journal of Medicine. 363(1), 1-4.