New York reiterates ban on CT screening without referral
Absent any fanfare, a memorandum prohibiting CT screening without a physician's referral was issued from the New York Department of Health on Oct. 10. Many physicians were caught off-guard by the declaration, saying they weren't aware of any public discussion on the matter.
The memorandum may not actually change practice in New York. Apparently, radiologists can still decide their walk-in patients are eligible for a screening exam. But it does indicate a heightened degree of concern by state health officials as consumer-driven screening centers proliferate.
The ban against the practice of self-referred CT screening examinations is nothing new. It has essentially been in effect for about a dozen years, said Maryanne Harvey, chief of the radiation equipment section of the Bureau of Environmental Radiation Protection in the New York Department of Health.
"The prohibition was originally written for mammography, when we had concerns that there'd be corner-store facilities. Then mammography became universally approved and government regulated," Harvey said.
The memorandum issued Oct. 10 was meant to be a reminder of this rule already in effect, Harvey said. The timing coincides with intense debate over screening asymptomatic individuals, including issues of x-ray exposure, overdiagnosis, and possible complications from downstream medical procedures related to CT findings.
In keeping the prohibition intact, the Department of Health relied on studies to date, which have not proved conclusively the benefits of CT screening for lung masses, colon polyps, and coronary artery calcification. In addition, these screening procedures have not received endorsement from any national professional organization or the federal government.
"If these screening studies were useful, the American College of Radiology would be endorsing them," Harvey said. "As soon as it does, we'd be happy to approve it."
Anybody can do a study as long as they have an order. In New York state, an order can be written by physician's assistants and nurse practitioners working in collaborative agreements with physicians or in a hospital setting, as well as by physicians. This, of course, includes radiologists.
"It's perfectly within the law for me -- as a radiologist and a physician -- to say, based on your demographics, that you need a virtual colonoscopy or some other screening test," said Dr. Lawrence N. Tanenbaum, section chief for CT, MRI, and Neuroradiology at the New Jersey Neuroscience Institute in Edison, and a medical advisor to CT Screening International, which has sites in New York.
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