Is radiology too expensive?

In discussions about the high cost of medicine in the U.S., expensive imaging systems can be an easy target. After all, it seems there are multimillion-dollar MRI units on every block and new CT and PET equipment around every corner. But is radiology a prime mover in escalating healthcare costs, or is it just a convenient lightning rod?

According to the Centers for Medicare and Medicaid Services, we spent about $1.65 trillion on traditional medicine in 2003, or about 15.3% of our annual GDP. This is a substantially higher percentage than other developed countries spend and may portend danger if it is allowed to increase much further. But what fraction of that figure did radiology equipment and services consume? Best estimates based on radiology utilization statistics place the 2003 total for radiology equipment, staff, materials, space, and administration at about $85 billion. This is just 5% of all medical costs last year.

Other parts of healthcare are far more likely candidates for drivers of the spiraling costs. According to health economists, pushing paper around the system gobbles 15% to 25% of total costs. Low hospital occupancy rates contribute to inefficiency by spreading large fixed costs over a few patients. Prescription drugs are the fastest growing portion of healthcare spending, up from 5.8% in 1992 to 10.5% in 2002 and estimated at $230 billion in the U.S. and Canada in 2003.

There is evidence to support spending increases due to high technology, but those associated with radiology are modest at best. A review of radiology costs by Sunshine et al, published in the September 1991 issue of the American Journal of Roentgenology, found they totaled about 3.5% of U.S. healthcare spending. The increase of less than 2% of total costs in the intervening 13 years is a bargain, considering the benefits of noninvasive imaging.

What surgeon would operate without MR, CT, or even just a plain film to guide him or her? Would most physicians even consider assessing a stroke patient without CT or MRI? What would emergency room services be like without CT or x-ray? Modern ultrasound has saved the lives of countless infants by detecting problems early enough to allow in utero surgery or treatment shortly after delivery. Indeed, can one even imagine what medical care would be like without its chief diagnostic arm?

What can be done when radiology is attacked? Knowing the facts is the best defense. If "investigative" reporters show up with the news crew, be ready to educate them! Advanced imaging does not come cheaply. But it is foolhardy to blame this, one of the most efficient parts of medicine, for all of medicine's ills.

This is the third in a three-part series of commentaries regarding the cost of medical imaging and the need for increased public awareness of its offsetting benefits. Dr. Bell is a private consultant.