Imaging overutilisation: Is enough being done globally?

The discovery of X rays by Roentgen in 1895 was one of the greatest discoveries with historical impact on on each and every one of us. The ability to view anatomy and infer function of inner organs and tissues of human body has provided immense potential that have led imaging to therapeutic arena through interventions and follow-up. How much imaging is appropriate is a legitimate question to ask. This stems from recent emphasis on overutilisation of medical imaging [1–2]. Overutilisation of imaging has been defined as any application where imaging is unlikely to improve patient outcome. Being a probabilistic situation the uncertainties of the outcome provide ground for appropriateness. Therefore, a number of prominent organisations such as the American College of Radiology (ACR), Royal College of Radiology (RCR) and World Health Organization (WHO) have provided appropriateness criteria [3–5]. Despite the existence of these criteria, a significant fraction (perhaps 20 to 50 percent in some areas) of radiological examinations may be inappropriate [6]. Large part of the growth in imaging is beneficial and it cannot be considered overutilisation. In a recent summit organised by the American Board of Radiology Foundation (ABRF) in collaboration with the American Board of Radiology and the National Institute of Biomedical Imaging and Bioengineering, it became clear that detailed considerations support the conclusion that overutilisation exists and numerous factors drive it [1]. Some of the factors are: defensive medicine, self-referral, patient wishes, inappropriate financially motivated factors, health system factors, industry, media and lack of awareness. Some publications have discussed these factors [7–8]. What has not been commented on is the difference between developed and developing countries. While overutilisation is becoming a problem for developed countries, lack of access remains an issue in a large part of the third world, despite the fact that there has been an increase in the rate of growth and unnecessary radiation dose to patients, in a number of developing countries, undergoing computed tomography (CT) and interventional procedures [9–10]. Even though access is limited in developing countries, inappropriate utilisation of imaging modalities still exists. While defensive medicine and self-referral are relatively minor or insignificant issues in developing countries, lack of awareness, patient wishes and inappropriate financially motivated factors are dominant causes. In a study from Canada, it was concluded that although patients do not wish to be involved in problem-solving tasks, few wish to hand over decision-making control to their physician [11]. The …