A Gomer moment: Medical imaging saves lives

"Surprise, surprise, surprise!" drawled an awestruck Gomer Pyle, taken off guard by the obvious way more than he should have been. Maybe that's why this hound-dog–looking actor came to mind as I read a study indicating that hospital deaths drop when more imaging exams are done.

The conclusion, published in the November issue of the Journal of the American College of Radiology, came from a peer-reviewed study of more than a million patient outcomes gathered from more than 100 hospitals nationwide. Making the study even more relevant to today's healthcare debates is the conclusion that this improvement in patient mortality was achieved with no impact on cost.

In the study, a research team led by David W. Lee, Ph.D., senior director of health economics and outcome research at GE Healthcare, examined data from the Thomson Reuters Drug Database (HDD). The researchers explored the association between utilization of diagnostic imaging services and two key hospital outcome measures: mortality and costs. Their analysis included data from inpatient admissions during 2007 to the 102 hospitals in the HDD that provided sufficiently detailed information to support assessment of the utilization of inpatient diagnostic services. Their study addressed all clinical conditions treated in the hospital, assessing the experience of patients with private, commercial, and government-sponsored insurance.

Lee and colleagues found an association between greater use of imaging and better patient outcomes in terms of fewer in-hospital deaths-and found that had no significant impact on overall cost. Although the study looked only at inpatient imaging, it bolsters the long-held belief that medical imaging exams save lives.

The intuitive reasoning that drives doctors to order imaging studies is based on the fundamental belief, made famous 400 years ago by Sir Francis Bacon, that knowledge is power. It goes without saying that medical imaging visualizes what otherwise cannot be seen, providing knowledge that otherwise could not be obtained.

While few doctors would want to give up the ability to look noninvasively into their patients, payers and policy makers in the U.S. have questioned whether the increased use of diagnostic imaging results in better health outcomes. The JACR study provides at least a partial answer. It will not be enough.

In the JACR paper, Lee and colleagues write that their study "lays the foundation for further exploration of the relationship between resource use and the clinical and economic outcomes associated with imaging utilization." This work will probably have to be done by vendors. Whether and how imaging affects patient outcomes is too broad to attract much interest from the mainstream research community. When this community veers into questions addressed by medical technology, it tends to focus on data to support one or another hypothesis about a tightly focused use. Broad questions, such as the one examined by Lee and his colleagues, are exactly the kind that matter to companies that make imaging equipment.

As we move from an intuitive-based practice of medicine to one based on evidence, we must not neglect the big questions, ones about whether and which medical products make a difference under what circumstances. That medical imaging exams save lives is obvious to people in the imaging community. That it comes as a surprise to payers and policy makers is all the more reason to do the work necessary to prove it.