It’s time to fight back

September 10, 2009

The argument that diagnostic technologies make a difference in clinical outcomes is like the one that eyesight is helpful when crossing the street. If you don’t see danger coming, whether it is a disease or car, it’s hard to avoid it. Most in radiology would agree that this certainly makes sense for preventive medicine. Another obvious argument applies to the diagnostic/therapeutic process. How can patients be treated if physicians don’t know what ails them?

The argument that diagnostic technologies make a difference in clinical outcomes is like the one that eyesight is helpful when crossing the street. If you don't see danger coming, whether it is a disease or car, it's hard to avoid it. Most in radiology would agree that this certainly makes sense for preventive medicine. Another obvious argument applies to the diagnostic/therapeutic process. How can patients be treated if physicians don't know what ails them?

While these arguments make sense to us, they apparently have not occurred to many outside of radiology. The increasingly shrill attacks from the nonradiological quarter, notably the one published in the New England Journal of Medicine a few days ago, bear that conclusion out.

The sad fact is that we, as a community, have been sitting around for years- decades, actually-satisfied that the public and referring physicians recognize the value of medical imaging when, in fact, they do not. The first signs that this was not the case appeared years ago. In response, I suggested a "Got Imaging" publicity promotion similar to the "Got Milk" campaign.

A campaign designed to raise public awareness of the benefits that come from imaging, as was done for milk, was necessary. The radiology community and its services, I argued, were being taken for granted. Consequently, growing budget deficits and rising healthcare costs, particularly for Medicare, would make imaging vulnerable to cuts. This vulnerability became apparent in the wake of the Deficit Reduction Act, which gutted outpatient imaging payments, and other reimbursement cuts that have chipped away at hospital imaging as well. And this will likely be only the beginning.

A new front has opened up recently in what is shaping up to be a war against radiology. No longer are we just unappreciated. No longer is imaging seen simply as wasteful. Now radiology is being attacked for being dangerous. CT and x-ray exams, the critics say, are exposing patients to harmful radiation with no redeeming clinical value.

When will it stop? Never, unless we make it stop.

Radiology cannot afford to fire off the occasional PR volley describing some narrow slice of imaging data that demonstrate improved detection of this or that disease. The field is under heavy bombardment. Shooting off bottle rockets that whistle into the air, bang, and then fall invisibly to the ground isn't going to do the trick.

We need to respond with meaningful, thought-provoking, fact-based arguments that support what we know to be true. These have to be part of a coordinated and long-term effort aimed at referring physicians and the public.

The ammunition to wage this battle will come from multiple sources. To name a few, consider:

 

  • Meta-research that draws together findings from multiple studies to document the value of medical imaging;

  • Comparisons of disease incidence and prognoses before and after the advent of modalities that now find diseases in their earliest stages;

  • Personal stories of patients whose lives have been made better-or saved-by the ability to look noninvasively into the body; and

  • Documentation of how the treatments for these diseases came about through a better understanding of the underlying processes and progression of the disease, made possible, at least in part, by imaging.

In response to the legitimate risks of using ionizing radiation, we have to not only document how radiology has reduced that risk but effectively convey this to referring physicians and patients. New algorithms and improved hardware for installed and newly made equipment are already in place and more are on the way. Why do we keep this to ourselves?

Enough already. We cannot afford to allow fear-mongering, especially in peer-reviewed journals, to make referring docs and patients afraid of radiology. Our rope-a-dope in response to attacks on the value of medical imaging has to end and it has to end quickly.

If it doesn't, the DRA and other reimbursement cuts we've seen so far will look like a walk in the park. And the ultimate loser in this battle will be the patient, who will be deprived of needed and often life-saving imaging services.