Reality is never quite as simple as it seems. For all the good that imaging has done, it has come with significant costs: exorbitant financial costs to individual patients and society, and personal health costs to patients through over-diagnosis, over-radiation, and over-treatment.
At issue in any review of the appropriateness of imaging utilization are the various interests of the stakeholders. The primary stakeholders are the patient and the physician. Their motivation to acquire as much information as possible through imaging is laudable but is, in fact, misguided. The core of the dilemma is that our ability to diagnose subtle findings far exceeds our knowledge of what to do with the information: advanced diagnostic studies have led to an epidemic of indeterminate incidental findings that physicians and patients often find at least as troubling as the events that triggered the initial imaging study. In a sense, imaging has become too powerful: it frequently identifies subtle, questionable, unrelated, indeterminate pathology that it cannot characterize any further, leaving both stakeholders up in the air regarding what to do next. This often leads to a vicious cycle of more and more imaging and testing.
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— Robert G. Stern, MD
This article originally appeared in February 2012 issue of The American Journal of Medicine.
