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Helene Pavlov, M.D. Headshot

Are Radiation-Producing Medical Tests Necessary?

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There are pills if you are depressed, if you are overweight, if you go to the bathroom too much, don't go enough, don't go fast enough, can't sleep, can't stay awake, etc. etc. etc. We are told through television, newspapers, friends and family to worry about everything.

Everything is presented as a crisis for which our control is limited. The most recent "hot topic" to worry about, in addition to airport scanners, power lines, cell phones and microwaves, is radiation exposure from medical tests. You do, however, have some control over this. First, not every ache and pain requires an instant "fix" or even a diagnosis. A reasonable period of "wait and see" is not to be undervalued. There should be a medical reason for having a medical test. Ideally, the facility that is to do the imaging should not be under the control of the individual ordering the test -- i.e., not self-referred. Your ordering physician should not be in a position to "benefit" by reimbursement for your having the imaging examination.

Where you go to have your imaging study is under your control. Your facility of choice should be accredited or in a Hospital that is accredited by The Joint Commission. There should be a radiologist overseeing the imaging test and the examination should be performed by a licensed technologist. You should ask if the dose to be used is being adjusted for your specific body habitus (will it be as low as possible?). Is the suspected condition, the clinical concern and reason for the examination identified on the order so proper positioning can be used to optimally demonstrate if an abnormality is present? Is the equipment state of the art, etc? All of these questions should help assure that the initial examination will not need to be repeated. Furthermore, once the image examination is acquired, it should be interpreted "unbiasedly." That means, the interpreting physician should not "benefit" from an interpretation that recommends surgery or intervention. Radiologists are trained both in image acquisition and interpretation and provide accuracy to the interpretive report. If possible, the examination should ideally be interpreted with subs-pecialty imaging expertise for your suspected condition.

It is important to remember that while you are hearing that ionizing radiation causes cancer, you also need to know or remember that ionizing radiation examinations (X-ray, CT, and Nuclear Medicine examinations) also help diagnose cancer. When properly imaged and interpreted, a cancer may be detected while it is still early and treatable. Ultrasound and MRI are imaging examinations that do not use ionizing radiation and in some conditions are appropriate alternative imaging examinations that may provide similar or even enhanced accuracy to an ionizing imaging examination, but not for all conditions. Dedicated expertise in MRI and ultrasound specific for condition and also using state-of-the-art equipment are necessary, similar to that suggested for an ionizing radiation examination. We need to remember that there is value in medical testing and the different imaging examinations each have certain strengths and weaknesses. Appropriate utilization of imaging, in the right sequence for the suspected condition, requires a fundamental understanding of each imaging examination and the expectation.

It is wrong to be made to be scared of something that can help you and that you can "control." Your control is in doing due diligence of where you go to have the referred imaging examination and also, in asking valid questions. The first question should be: "Is this test necessary?" The next question is: "How will the result of this test influence how I am to be treated?"

HSS

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