These Imaging Tests Aren’t Always Necessary

Think twice before using PET/CT for cancer screening on healthy individuals or PET imaging to evaluate certain patients with dementia.

Those are a couple of the five commonly ordered, but not always necessary, imaging tests in nuclear medicine and molecular imaging. The Society of Nuclear Medicine and Molecular Imaging released the list as part of the Choosing Wisely campaign.

“All of us on the front lines of medical care know we have the opportunity to improve the care we deliver by engaging our patients in conversations about what tests are truly necessary and beneficial to their health,” said Gary Dillehay, MD, SNMMI president-elect and chair of the SNMMI Choosing Wisely Taskforce. “The recommendations released today for nuclear medicine and molecular imaging provide valuable information to help patients and physicians start important conversations about treatment options and make wise choices about their care,”

The SNMMI recommendations are:

1. Don’t use PET/CT for cancer screening in healthy individuals. The likelihood of finding cancer in health adults is extremely low using PET/CT for screening, and imaging without clear clinical indication could lead to harmless findings that lead to more tests.

2. Don't perform routine annual stress testing after coronary artery revascularization. These tests usually don’t change management, and it may lead to unnecessary testing.

3. Don’t use nuclear medicine thyroid scans to evaluate thyroid nodules in patients with normal thyroid gland function. Nuclear medicine thyroid scans don’t conclusively determine whether nodules are benign or malignant, and these scans are useful to evaluate the functional status of thyroid nodules in patients who are hyperthyroid.

4. Avoid using a CT angiogram to diagnose pulmonary embolism in young women with a normal chest radiograph; consider a radionuclide lung study (“V/Q study”) instead. A V/Q study can determine whether or not pulmonary emboli are present, with lower overall radiation dose.

5. Don't use PET imaging in the evaluation of patients with dementia unless the patient has been assessed by a specialist in this field. Clinical evaluation and imaging should be assessed together to make a reliable diagnosis.

In creating this list, SNMMI convened a work group of leadership, at-large members, and presidents of the brain imaging, cardiovascular, general clinical nuclear medicine, nuclear oncology, and pediatric councils. Members were encouraged to submit suggestions.

SNMMI’s is the latest list from participating physician organizations. The Choosing Wisely initiative was created by the American Board of Internal Medicine (ABIM) Foundation to provide evidence-based recommendations for physicians with the goal of reducing healthcare costs and improving patient care.