Call goes out for self-referred imaging center guidelines

It's time for the professional community, including the RSNA and the American College of Radiology, to develop guidelines for self-referred whole-body CT screening, according to researchers at Stanford University.

Using results of a study of U.S.-based imaging centers, they call for standard reporting procedures and guidelines for disseminating information on the risks and limitations of whole-body imaging. They would also like to see additional input from the National Cancer Institute and the National Institute on Aging, along with representatives from vendors and the public, said Judy Illes, Ph.D., senior research scholar at Stanford.

Led by Illes, the team at the Stanford Center for Biomedical Ethics took to the Internet to document the demographics of the boom in self-referred imaging centers. They found that these centers were located in areas with significantly higher percentages of whites compared with African Americans and other minorities, except for Asian Americans. These areas were home to a much higher percentage of people with advanced degrees than the national average. Per capita median income and average household income were also greater.

"Sometimes findings are intuitive, but intuition isn't enough. This is the first time we've documented where these imaging centers are located, what the sociodemographics involved are, what services are being offered, what the costs are, and what the reporting methods are," Illes said.

Out of the 88 imaging centers in the US with information available over the Internet, 30 call California home, especially in the southern part of the state, and 13 are established in New York.

Costs for services rendered at the facilities ranged from $795 for a whole-body examination to $1215 for a whole-body exam that included a bone density test. The study was published in the August issue of Radiology.

One of the major concerns unearthed by the study was the high variability in reporting methods at the different imaging centers.

"The variability in reporting speaks to the variability in the ways these services are provided at large," Illes said.

Fifty-seven of the centers outlined their procedures, with 25 of them relying on direct hard-copy mailing as a sole method for reporting results. The reporting methods ranged from providing results during a consultation between radiologist and patient, with report mailed afterwards, to sending a report directly to a physician of the patient's choice, to a postexamination phone consultation followed by a mailed report.

"These scans are performed without any physician of the patient in the loop," said coauthor, Dr. Scott W. Atlas, a professor of radiology at Stanford.

The conventional method of reporting radiology results is always doctor to doctor. This method is appropriate because of the wide information gap between healthcare provider and consumer. Moreover, radiologists are virtually never knowledgeable about the patient's capacity to digest abnormal results, Atlas said.

"We are not against these services," Illes said. "We very much believe in self-empowerment and intelligent decision-making in healthcare. By pointing out some of the missing pieces and some of the risks, by imploring consumers to educate themselves so they can make informed decisions, and by calling for guidelines, we may be able to help bring this service to another level."

For more information from the Diagnostic Imaging archives:

Global attention focuses on pros and cons of CT screening
http://www.dimag.com/db_area/archives/europe/2003/0302.editorial.die.shtml

CT screening: Is technology running ahead of the science?
http://www.dimag.com/db_area/archives/2002/0211.consumerimag.di.shtml?ref=log

Imaging on demand is where healthcare meets consumerism
http://www.dimag.com/db_area/archives/2001/0108.frontline.di.shtml

CT screening programs become popular and controversial
http://www.dimag.com/db_area/onlinenews/2000/2000032401.shtml